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Over the last ten years there has been a steady increase in the volume of private dental treatment and numerous finance schemes have been developed to help both patients and dentists. Private orthodontic treatment is increasing and the purpose of this article is to summarise the main features of the schemes currently available to fund private orthodontic treatment and to provide a source of reference.
This study examined the extent to which private practice physical therapy firms focused on specific environmental sectors in the process of making business decisions. Furthermore, the relationship between scanning behavior and both entrepreneurship level (high, middle, low) and direct-access status (complete, partial, none) were analyzed. The sample consisted of 450 randomly selected private practice decision makers (eg, owners, chief executive officers) from throughout the United States. Data were gathered using a mailed, structured questionnaire. Physical therapy private practices were found to differentially attend to environmental sectors with the customer sector ranked the highest followed, in descending order, by the technological, regulatory, socio-cultural-political, competitive, and economic sectors. In addition, firms in the high-level entrepreneurship group scanned the technological and marketing (customer, competitive) environments to a significantly greater degree than did the middle- and low-level groups. Direct-access status had no effect on scanning behavior.
This article presents the results of a study that assessed the effect of privatized management on social service availability, utilization, and resident satisfaction in public housing communities. The respondents were heads of household who lived in public housing "projects" in Miami, Florida-more than 90 percent of whom were African American women. A quasi-experimental design with nonequivalent control groups compared respondent data from privately and publicly managed sites. Publicly managed sites reported more availability of social services, but privately managed sites reported higher levels of use. Implications for welfare reform, public housing demolition or renewal policies, the importance of social services with self-sufficiency efforts, and the need for culturally sensitive social work practices in ethnic minority public housing communities are discussed.
The attitudes of private patients toward resident participation in their ambulatory care were evaluated. Of 195 patients (29 percent) responding to 667 mailed prospective questionnaires, 143 (73 percent) stated that they would allow resident participation in their care. Satisfactory prior experiences with trainees was the most important factor predicting acceptance (p less than .0001) of resident participation. A majority of "accepting" respondents would allow the following limited delegation of responsibility to residents: history-taking, physical examination, and visit scheduling. The majority (71 percent) desired faculty consultation at every visit. A small, retrospective survey of resident-treated private patients revealed that 70 percent were fully satisfied, 20 percent partially satisfied, and 10 percent dissatisfied. Dissatisfaction by the patients was associated with not knowing beforehand that a trainee would participate in the health care delivery. The private patients usually accepted trainees for outpatient care if: (a) they had been informed in advance, (b) they had not had a prior unsatisfactory resident experience, and (c) the responsibility of the residents had been carefully delegated and the residents closely supervised.
Starting in the last decade of the 20th century, private colleges of osteopathic medicine (COMs) began to restructure themselves in ways that represent a distinct departure from the past. Their new organizational model de-emphasizes many of the characteristics that distinguish allopathic medical schools today. The new emphasis centers on high enrollment, diversity of health-related programs, formation of universities of health science, expansion, and a retreat from involvement in clinical and postdoctoral education. Such changes reflect an admixture of entrepreneurship, an ability to respond quickly to changing environments, and an insularity that draws them away from traditional forms of clinical and postdoctoral medical education. The private COMs carved out their own niche in medical education and created a new model compatible with their institutional strengths and weaknesses and related to their economic, educational, and human resources. As an evolving educational model, the private COMs have undergone a remarkable transformation in a brief period; they bear watching for future developments and to assess their long-term viability.
Factors to be considered by the CNS before implementing the role in private practice with a physician are discussed. Four CNSs were interviewed regarding their experiences in such a practice. The CNS subroles of expert practitioner, educator, consultant, and researcher are described as they apply in private practice with a physician. A four-step process is proposed to guide the CNS considering entry into private practice. The steps discussed are: self-assessment, evaluation of the legal and financial aspects, development of marketing and cost-justification strategies, and negotiating for a position. A method for cost justification is proposed, and some elements of marketing and negotiating are reviewed.
This study examines the influence of Local Health Department (LHD) directors' managerial beliefs on the decision to privatize or discontinue personal health services. A stratified representative national sample of LHD directors was interviewed by telephone. Directors who believed temporary workers should be used wherever possible had about three times the odds of privatizing one or more personal health services. Directors who believed their department should focus exclusively on the core functions had more than ten times the odds of discontinuing at least one service. Declining revenue was not predictive of either privatization or discontinuation of personal health services.
OBJECTIVES: This study examined the effect of private health insurance on the use of medical, surgical, psychiatric, and addiction services for patients eligible for publicly supported care. METHODS: The authors assembled administrative databases describing 350,000 noninstitutionalized veterans who had been discharged from a Veterans Affairs (VA) inpatient medicine or surgery bed section during a 1-year period. Patient use of care was followed for 1 year after the index discharge. Patient insurance information came from Medical Care Cost Recovery Billing and Collection files obtained separately from each of 162 VA Medical Centers. Distances between VA and non-VA sources of care were estimated from the Health Care Financing Administration's Hospital Distance File. RESULTS: Insured patients were less likely to seek surgical care but were 12 times (65 years of age and older) and 73 times (63 years of age and younger) more likely to initiate outpatient medical visits than were their counterparts, adjusted for patient demographic, diagnostic, and index facility characteristics. Patients who had private health insurance also were 3.4 (> or = 65) and 2.6 (< or = 64) times less likely to use VA surgical care in response to changes in available surgical staff-to-patient ratios than were their uninsured counterparts. CONCLUSIONS: Private health insurance may substitute (reduce) or complement (increase) the continued use of publicly supported health care services, depending on patient age, care setting, and service type.
BACKGROUND: Although the current immunization schedule for children requires as many as four or five injections at a single visit, both parents and health care providers hesitate to administer more than two or three simultaneous injections. Therefore new combination vaccines that include multiple unrelated antigens are needed. METHODS: Individuals from the Immunization Division of the Colorado State Department of Health and pediatricians in private practice in Denver, CO, were interviewed and asked about incorporating new combination vaccines into their practice. RESULTS: At a state health department level the transition to combination vaccines will likely require reprioritizing of public health resources. In addition state health officials are important information resources for public and private providers, as well as for the community. At the level of the private provider combination vaccines hold promise for simplifying the immunization schedule, but successful implementation will require education and guidance on how best to integrate the new combination into practice. CONCLUSIONS: Combination vaccines are the immediate solution to the addition of new childhood vaccines and will alleviate the concern of parents and physicians regarding the trauma related to multiple injections at a single visit.
The National Ambulatory Care Survey, conducted by the National Center for Health Statistics (Rockville, Md.), provides national estimates for conditions diagnosed by office-based private practitioners in the United States. The Venereal Disease Control Division of the Centers for Disease Control (Atlanta, Ga.) obtained data from the National Ambulatory Care Survey for the years 1973-1976 and analyzed the epidemiology of pelvic inflammatory disease in women who sought care from private physicians. More that 7.5 million office visits for pelvic inflammatory disease were made over the four-year period (average, 1.89 million visits pe year). All races other than white bear a disproportionate burden of pelvic inflammatory disease. Since the advent of the National Gonorrhea Screening Program in 1972, the number of visits to private physicians for pelvic inflammatory disease has apparently declined.
BACKGROUND AND OBJECTIVES: This study describes key features of the privatized model of sexually transmitted disease (STD) service provision in Tacoma, Washington. GOALS: To assess the operational characteristics and the quality of care provided in the privatized STD clinics. STUDY DESIGN: Key informant interviews and surveys were conducted. Medical records were reviewed and compared to a standardized STD clinic medical record. Client treatment was compared to the Centers for Disease Control and Prevention (CDC) 1993 STD Treatment Guidelines. RESULTS: In 1997, the contract clinics provided 3,275 publicly sponsored STD visits. The goals of multiple access sites, STD screening, appropriate therapy for laboratory-diagnosed, bacterial STD were achieved. However, medical records were frequently incomplete and Gram stains were not done. Significant deviations from CDC STD Treatment Guidelines were documented in the medical management of pelvic inflammatory disease (PID). CONCLUSIONS: Privatized STD services would be improved by use of a standardized medical record. Availability of a Gram stain and management of PID as recommended by the CDC would augment quality of care.
OBJECTIVES: To determine whether employees working for a transformational leader perceive their leader as more effective than do those working for a transactional leader. To assess whether employees in private hospitals are more likely to perceive their leaders as transformational than are employees in public hospitals. DESIGN: A questionnaire study of a random sample of employees working at 4 hospitals (private and public) in Kuwait; 266 respondents included. RESULTS: Analysis of varience and regression analysis showed that the transformational style of leadership was linked to high level of employee perception of leadership efficacy. Also, the employees in private hospitals were more likely to perceive their leaders as transformational than were employees in public hospitals. CONCLUSIONS: Hospitals in Kuwait may benefit by recruiting leaders with a transformational style, as it is directly related to quality, employee satisfaction, increased productivity, and employee perception of leadership efficacy.
Although sexually transmitted diseases (STDs) are particularly widespread in poor, largely minority, inner-city areas, little is known about the role private physicians play in these communities in STD control. A cross-sectional mail survey of private physicians potentially involved in STD management in two inner-city communities in Houston, Texas with STD prevalence rates well above city, state, and national averages was conducted to find the level and type of STD care provided. Twenty-seven of 65 physicians completed the survey. The survey found that the preventive orientation among private providers of medical care in these inner-city communities has to be increased to effectively control STDs.
OBJECTIVE: To describe trends in episiotomy use among residents, faculty, and private practitioners at an academic institution. METHODS: We reviewed data from the Magee Obstetric Medical and Infant database, containing details of every delivery at Magee-Womens Hospital since 1995. The study population was women who had spontaneous or operative vaginal delivery of a singleton, liveborn, vertex-presenting infant, at 37 weeks or more, from 1995 to 2000 (completed data set years). The first delivery recorded for a patient in the database was analyzed. Residents and faculty were described as "academic" practitioners. Data were analyzed with the Fisher exact test, chi2 test for linear trend, and logistic regression models. RESULTS: There were 27702 women with 15190 episiotomies, for an episiotomy rate of 54.8%. The rate of episiotomies decreased from 59.7% to 45.0% during the study period (P <.001). Independent risk factors for episiotomy included age 30 years or more, white race, higher educational status, married, nulliparity, and history of cesarean delivery. The strongest predictor of episiotomy use was practitioner type, with women attending private physicians having an adjusted 7-fold increased risk of episiotomy (odds ratio 7.1; 95% confidence interval 6.5, 7.7). Patient characteristics related to practitioner type included age, race, educational status, marital status, nulliparity, and mode of delivery (P <.001). CONCLUSION: High rates of episiotomy use were found among private practitioners, despite current evidence-based literature that supports restricted use of episiotomy.
The aim of this study is to present the clinical data from the use of implants that were placed and restored in four independent private dental offices. In part I, the survival rate was calculated and the failure causes were associated with some potential risk factors. In part II, the surgical and prosthetic complications were also recorded and associated both with failures and clinical factors. During 1990-2002 (mean observation 4.6 years), 1692 dental implants were placed and restored in 405 patients in 4 private clinics following the same treatment protocol. The prosthetic restorations included fixed partial dentures, single crowns, and overdentures. The results were statistically analyzed and survival rate probability curves were calculated according to Kaplan-Meier analysis. Part I: Seventy-four implants (4.4%) in a total of 1692 implants failed. The mean of time elapsed before removal of the failed implants was 40 months. The failure rate was higher in the maxilla in patients with metabolic diseases, in D4 bone quality, in smokers, and in patients with insufficient oral hygiene. Part II: Surgical complications happened to 65 implants (3.8%). Prosthetic complications appeared in 152 implants (9%). The overall survival rate (95.6%) in a period of 1 to 12 years is comparable to other studies. The early failures represented a high percentage of failures. Peri-implantitis was the main cause of late failures. The results of this study indicate that the use of implants in private clinics is a safe and predictable method for the treatment of partially or completely edentulous patients, if the proper clinical protocol is followed. The need of a severe recall program must also be emphasized.
PURPOSE: We determine if medications that have been proven effective for kidney stone prevention in prospective controlled trials can reduce kidney stone recurrence in a private practice of urology better than life-style advice, including hydration. MATERIALS AND METHODS: Between July 1, 1995 and December 31, 1996, 203 patients with stones received care from 1 private practice. Physicians chose to evaluate these patients metabolically based on clinical judgement. Thiazide, potassium citrate and allopurinol are recognized in this study as active treatments, and drug treatment intervals were calculated. Relapse and recurrent stones were counted as those stones manifesting after the initial index event. A stone was called a relapse stone if its date was included in the active treatment interval. RESULTS: The association between use of active therapy and ordering of metabolic evaluation was highly significant. Using survival tables, we separately considered all patients and only those who had formed more than 1 stone. For both populations active treatment reduced stone recurrence significantly more than diet advice and hydration. CONCLUSIONS: Medications validated in trials and guided by metabolic evaluation lower stone recurrence when used in a private practice setting as they do in trials.
OBJECTIVES: To describe methods used to estimate hospital institutional (facility) payments for providing Veterans Health Administration (VA) outpatient services. METHODS: A series of audits compared the accuracy of outpatient coding at six VA medical centers in federal fiscal year 1999 with private sector standards. Outpatient records were processed through industry standard software to determine validity and remove inappropriate services. Private sector payments were estimated by applying average payment data from Medicare cost reports and Medicare outpatient prospective payment schedules to counts of VA services. RESULTS: Coding audits found little difference in accuracy between VA and the community. Physician visits generated the most estimated payments and deviated most from Medicare payment experience. Radiology and laboratory services were the next highest expenditure categories for both the VA and Medicare. The proportion of radiology payments in VA data was notably lower and ambulatory surgery notably higher than Medicare's experience. Within major categories, the relative rankings of VA and Medicare services were consistent. DISCUSSION: Differences in payment criteria make exact cost comparisons of hospital-based and office-based settings difficult, particularly physician visits. Two VA clinical software applications, radiology and laboratory, provide information not readily convertible to a claims format; these applications need significant changes to be used for these purposes. They understate radiology services and overstate laboratory services compared with private sector standards. In addition, the laboratory application contains inappropriate or unspecified codes that cannot be accurately valued for many reasons.
OBJECTIVES: To describe methods for estimating what payments to private sector providers might be for specialized inpatient care in the absence of Veterans Health Administration (VA) facilities. METHODS: Psychiatric, rehabilitation, domiciliary, partial and day hospitalization, and psychiatric residential treatment programs at six study sites were audited for program content that would meet Medicare criteria for excluding providers from the prospective payment system. A 10% sample of patients in each program was also audited to see if they met VA program criteria. For programs similar to prospective payment system-exempt community-based providers, total days of care were valued at per diem rates calculated for those Medicare providers. RESULTS: Not all specialized programs at the study sites were similar to private sector programs. Day hospitalization programs did not involve physicians, and inpatient psychiatric care was judged to be payable under acute diagnosis-related groups. Blind rehabilitation was different from any private sector program identified. For programs qualifying under Medicare exclusion rules, a majority of patients would meet criteria with minor changes in VA documentation. DISCUSSION: Researchers need to separate specialized inpatient care from acute services in estimating payments. This caution applies especially to rehabilitation, psychiatric, and long-term care, often provided to patients in VA acute bedsections. As with Medicare, benefits extend to higher costs of care not correlated with current measures of acuity or diagnoses. Medicare bases payments on the costs of the specialized providers of this care.