Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Privatization”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 847 records · Page 47Linked to original sources
PubMed2003

Methods for estimating and comparing VA outpatient drug benefits with the private sector.

OBJECTIVES: To estimate and compare Veterans Health Administration (VA) expenditures for outpatient pharmaceuticals for veterans at six VA facilities with hypothetical private sector costs. METHODS: Using the VA Pharmacy Benefits Management Strategic Health Care Group (PBM) database, we extracted data for all dispensed outpatient prescriptions from the six study sites over federal fiscal year 1999. After extensive data validation, we converted prescriptions to the same units and merged relevant VA pricing information by National Drug Code to Redbook listed average wholesale price and the Medicaid maximal allowable charge, where available. We added total VA drug expenditures to personnel cost from the pharmacy portion of that medical center's cost distribution report. RESULTS: Hypothetical private sector payments were $200.8 million compared with an aggregate VA budget of $118.8 million. Using National Drug Code numbers, 97% of all items dispensed from the six facilities were matched to private sector price data. Nonmatched pharmaceuticals were largely generic over-the-counter pain relievers and commodities like alcohol swabs. The most commonly prescribed medications reflect the diseases and complaints of an older male population: pain, cardiovascular problems, diabetes, and depression or other psychiatric disorders. CONCLUSIONS: Use of the VA PBM database permits researchers to merge expenditure and prescription data to patient diagnoses and sentinel events. A critical element in its use is creating similar units among the systems. Such data sets permit a deeper view of the variability in drug expenditures, an important sector of health care whose inflation has been disproportionate to that of the economy and even health care.

Aged↗
PubMed2006

Access to care and utilization among children: estimating the effects of public and private coverage.

OBJECTIVES: We examine the relationship between health insurance coverage and children's access to and utilization of medical care. Access measures we study are having a usual source of care (USC) and lacking a USC for financial or insurance reasons. We also examine indicators for ambulatory visits, well-child visits, dental visits, emergency room use, and inpatient hospital stays. METHODS: We pool data from the first 7 years of the Medical Expenditure Panel Survey (MEPS), 1996 to 2002. Pooling yields a large sample of children, enabling us to analyze access and utilization using simple descriptive statistics, multivariate analysis, and instrumental variables estimation (IV). IV estimation is of particular interest given the possibility of bias caused by confounding factors (such as child health or parent attitudes) and measurement error in insurance coverage. We also compare estimates from IV linear probability models to estimates from IV probit with residual inclusion. RESULTS: As previous studies have found, public and private coverage are both associated with large increases in access and utilization. Simple mean comparisons suggest that private coverage has a larger effect than does public coverage. Differences between public and private coverage are reduced (and often reversed) when we control for other characteristics of children and their families. IV coverage effect estimates from both linear probability and residual inclusion probit models are substantially greater than conventional estimates across a wide range of access and utilization measures. CONCLUSIONS: Despite concerns that conventional estimates overstate the impact of coverage on access and use, our results suggest that the reverse may be true. One explanation may be that conventional estimates are biased toward zero due to error in the reporting of insurance coverage. The magnitude of the coverage effects we find highlights the importance of reducing uninsurance among children.

Aid to Families with Dependent Children↗
PubMed2004

Sexually transmitted disease management in Uganda's private-for-profit formal and informal sector and compliance with treatment.

OBJECTIVE: The objective of this study was to investigate the management of sexually transmitted diseases (STDs) in the Ugandan private sector clinics and drug shops. STUDY: Men with urethral discharge who had consulted clinics (264) or drug shops (141) for treatment in 5 districts were interviewed using a precoded questionnaire 1 to 3 weeks after initiation of treatment. RESULTS: Seventy-seven percent of patients sought treatment within 1 week of onset of symptoms but only 7% were properly managed (treated according to National Guidelines, told to use a condom or abstain, and to refer their partner). The reported cure rate was 47% and only 9% were treated according to National Guidelines. Eighteen percent of patients used condoms during treatment, 36% persuaded their partner to go for treatment, and 87% completed the recommended treatment course. Of patients not reporting cure, 56% would still recommend the treatment to a friend. CONCLUSION: Quality of STD management by private providers is poor. Improvement should occur concurrently at public and private facilities. Possible strategies include training and social marketing of prepackaged treatment for STDs.

Adolescent↗
PubMed1996

A comparative study of adverse drug reactions reported through hospital and private medicine.

Adverse drug reactions spontaneously reported by physicians in the hospital and the private practice were compared. All reports were sent to a French Regional Pharmacovigilance Centre over the period of 1 year (1992). Hospital-based physicians reported more adverse reactions and more serious reactions than physicians in private medicine. For both groups of reporters, the skin, central nervous system and digestive tract were the body systems most commonly involved. There were significant differences between the hospital and private practice reports as regards the drugs most frequently involved in adverse drug reactions.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Patient satisfaction with NHS elective tonsillectomy outsourced to the private sector under the Patient Choice Programme.

RATIONALE, AIMS AND OBJECTIVES: An interim goal of the NHS 'Extending choice for patients' initiative was that, by 2004, patients who had been on the NHS waiting list for elective surgery for 6 months were provided with a choice of staying on the waiting list or being treated faster by opting to have their operation with an alternative provider. The aim of this study was to examine patient satisfaction in a cohort of patients who travelled out-of-region to undergo routine tonsillectomy performed by an NHS consultant at a private hospital. METHOD: A questionnaire survey was conducted of adult patients undergoing elective tonsillectomy in 2002 and 2003 at The Hampshire Clinic, Basingstoke, UK. RESULTS: Our results showed that 95% (n = 123) of patients were happy to travel considerable distances from their local hospital to have their operation. Overall 71% (n = 92) of patients rated the overall experience of having the operation performed at the private hospital as excellent and 25% (n = 32) rated it as satisfactory. CONCLUSION: We conclude that tonsillectomy performed by a consultant in an out-of-region private hospital is associated with a high level of patient satisfaction and is an acceptable way to reduce waiting times for tonsillectomy provided clear guidelines and safeguards are in place.

Adult↗
PubMed2004

Intention to claim a Medicare rebate among women receiving private Victorian pregnancy termination services.

OBJECTIVES: To determine the proportion of women who have pregnancy terminations as private patients in Victoria who do not intend to claim a procedure fee rebate from Medicare, to compare characteristics of women who intend to submit a Medicare claim with those who do not and to compare the findings to the results from a similar study conducted in NSW in 1992. DESIGN, SETTING AND PARTICIPANTS: This was a cross-sectional observational study over a 12-week period. Women having a pregnancy termination service in eight large Victorian private clinics were invited to complete a brief written questionnaire. OUTCOME MEASURE: The proportion of women who did not have a Medicare card or who had a Medicare card but did not intend to use it to claim from Medicare. RESULTS: Of the 1,329 women who responded, 13.1% either did not have a Medicare card or did not intend to use their card to claim a Medicare rebate. A further 20.7% of respondents were not sure about whether they would submit a claim. Women who intended to claim a Medicare rebate were different from women who did not according to age, language spoken at home, residency, citizenship and distance travelled to the service. These results are very similar to the findings from the 1992 NSW study. CONCLUSION: Between 13.1% and 33.8% of private Victorian pregnancy terminations were estimated to not be recorded at the Health Insurance Commission. Health Insurance Commission records of Medicare rebate claims for pregnancy terminations are an incomplete and somewhat biased record of the services that are provided and are likely to have been so for some time.

Abortion, Induced↗
PubMed2004

The impact of a microfinance program on client perceptions of the quality of care provided by private sector midwives in Uganda.

OBJECTIVE: To assess the impact of a microfinance program that provided business skills training and revolving loans to private sector midwives on perceived quality of services and client loyalty. STUDY DESIGN: A quasi-experimental study with a pretest, posttest design was used to evaluate the impact of the intervention. Exit interviews were conducted at 15 clinics that received the intervention and 7 clinics that did not. Baseline exit interviews were conducted between November and December 2000. Five days of business skills training were provided to midwives, and loans (averaging $454) were given during January and February 2001. A follow-up clinic visit was made to assess whether midwives were implementing what was emphasized during the training. The loans were to be repaid with interest within 6 to 12 months, at an interest rate that is standard within the local commercial market. For those who repaid the first set of loans (11 clinics), a second set of loans (averaging $742) was provided after June 2001. Follow-up exit interviews were conducted at the same clinics between February and March 2002. We assessed the effect of the intervention at both clinic and client levels. T-tests, the analysis of variance, and multivariate logistic regression analysis were conducted. PRINCIPAL FINDINGS: These findings should be interpreted cautiously since secular trends were observed during the study period. The intervention was associated with improvement in clients' perceptions of the quality of care received at intervention clinics. The intervention was also associated with a higher level of client loyalty. CONCLUSIONS: The enthusiastic response of midwives and the high loan repayment rate indicate that midwives were very receptive to the microfinance program. Overall, these findings suggest that microfinance may have an important role in strengthening private sector health services by increasing private providers' business skills and clients' satisfaction with services.

Female↗
PubMed1993

Easing the burden on health departments: a cost-effective method for public health nurses to increase private sector participation in the early and periodic screening, diagnosis, and treatment program.

Federal legislation requires states to increase use of the early and periodic screening, diagnosis, and treatment (EPSDT) program. The program provides comprehensive health services to children from low-income families on Medicaid and has been shown to improve health and reduce health care costs. Health departments and public health nurses (PHNs) bear a major burden conducting EPSDT screenings because many private physicians choose not to provide these services. Given scarce resources, health departments alone may be unable to meet the mandate for increased EPSDT services. Thus PHNs concerned about children's access to health care may have to encourage provision of EPSDT through the private sector. This project, phase I of the federally funded Healthy Kids Project to increase EPSDT use in rural areas of North Carolina, established the cost-effectiveness of a mailed intervention to recruit private physicians to do EPSDT screens that exceeded the capacity of health departments. The intervention, consisting of a personal letter, journal article, and pamphlet, was sent to all 73 primary care physicians in six rural counties. Before the mailing, 15 (21%) of the 73 physicians were willing to provide EPSDT screenings; after the mailing the number rose to 25 (34%). The one-time cost to recruit each provider was less than the estimated annual cost savings associated with each child in the EPSDT program.

Child Health Services↗
PubMedDate not supplied

First-trimester prenatal counseling in private practice.

The future of first-trimester prenatal counseling in private practice is as bright as office nurses choose to make it. Currently, counseling of this kind is being offered only at two places, the Sunnyside office and at the office of another obstetrician whose nurse was trained for counseling by the author. A huge network of private practice counseling is possible, however, if office nurses would learn these skills. Despite some reports of opposition, many physicians would welcome nurses in this counselor's role. A 1972 survey of obstetrician-gynecologists showed that 51% favored delegating more tasks to the office nurse, if only to free the physicians's time to see additional patients. According to the physicians surveyed, the "maternity nurse could perform many of the prevention and counseling routines" the physicians felt took up roughly 75% of their office time. First-trimester prenatal counseling in private practice is not only possible in a structured, group-oriented sense, but it is necessary and worthwhile as well. Patients have become increasingly aware of their rights as consumers of health care. Where they get their information-and how accurate and complete it is-is largely up to the nursing profession.

Counseling↗
PubMed1989

Public and private immunisation services: a comparison of costs.

Cost inputs to infant immunisation programs were identified for both the public and private health systems, based on data from the fourteen local government areas which made up the Western Metropolitan Health Region in Sydney, New South Wales. The public health approach is shown to be significantly less costly than private immunisation services. The costs of the latter, however, are largely hidden within the national health bill, while the costs of the former are spread across all three levels of government. Total public sector costs of immunisation could be decreased, but only with increased input at the local government level. Thus, under present distribution and funding arrangements in NSW, covert fostering of the less cost efficient private immunisation services is likely to continue.

Child↗
PubMed1978

Computed tomography in a private practice office.

Since 1975, the author examined over 6,000 outpatient and hospital inpatients with computed tomography in a private practice CT office. The patients were referred by 368 physicians and 26 hospitals. A CT center in a private radiology office available for immediate utilization by several hospitals and many physicians is an effective method of controlling costs and containing unnecessary capital equipment expenditures, and contributes to the preservation of the private practice of radiology and medicine.

Adolescent↗
PubMedDate not supplied

[Differences between public and private hospital care in Spain: the realities of health care or a numerical fallacy?].

OBJECTIVE: To give an example of the misleading interpretations of the concepts "public and private" when dealing with simple data from hospital resources and activities in Spain. MATERIAL AND METHODS: Data comes from the survey of hospitals (EESCRI) for the year 2002 in Catalonia. Using the figures corresponding to resources (number of centers and beds) and activities (discharges, stays, mean stay, occupancy, and rotation) comparisons are made among different variables (managing authority and funding source) reclassified, according to the concepts of public and private. RESULTS: The figures on resources and activities offer a very different portrait about the public or private nature of the care provided, according to the variables being used for classification. CONCLUSIONS: It is necessary to specify the concepts and variables to be used when analyzing the performance of health services and to improve the information sources in order to adapt them to the new management forms of the health services.

Delivery of Health Care↗
PubMedDate not supplied

Cytologic grading of fine needle aspirates of breast carcinoma by private practice pathologists.

OBJECTIVE: To determine the reproducibility of two clinically proven grading systems for breast carcinoma assessed by private practice pathologists. STUDY DESIGN: Twenty fine needle aspiration (FNA) slides of histologically proven breast carcinoma were submitted to 15 private practice pathologists practicing in 11 separate groups who interpret cytology as part of their daily practice. The pathologists received the same set of slides. They graded the FNAs using the modified Black (MB) (grades 1-3) and simplified Black (SB) (low grade, high grade) grading systems. Specified criteria and guidelines as well as case samples were provided. RESULTS: There was complete agreement among the 15 pathologists on only one case using the MB grading system as compared to five using the SB grading system. In MB, > or = 10 pathologists were in agreement on 14 cases as compared to 19 cases using SB. There were three cases in MB where the grades ranged from 1 to 3. Also noted in MB was the high number of cases graded 2 (intermediate grade). The predominant comment made by the pathologists was the easier, more objective and practical application of the SB. CONCLUSION: High reproducibility in the cytologic grading of FNA of breast carcinoma can be more readily attained among private practice pathologists using the two-tier SB grading system.

Biopsy, Needle↗
PubMed1978

Private practice of psychiatry: future roles.

Psychiatrists in private practice have contributed more to treating the mentally ill in America than is generally known. The private practice sector may be viewed as a massive national outpatient and inpatient service for the mentally ill. The impact of national health insurance on the future character of the private practice of psychiatry and the thorny problems to be resolved are discussed and compared with the experiences of England, the Soviet Union, and China. Future trends will most likely include increased emphasis on adjuvant techniques, greater emphasis on resident training in general psychiatry, briefer forms of therapy, and psychiatry's return to the medical model.

Attitude of Health Personnel↗
PubMed1989

Private and public psychiatry: a comparison of two health care systems.

Psychiatrists in Australia and New Zealand are similarly trained, but the health care delivery systems in each country differ. Australia has unlimited insurance for fee-for-service private practice and has twice the psychiatrists and half the psychiatric beds per capita as New Zealand. Psychiatrists in the public sector in each country focus on hospital-based care of psychotic patients. Private-sector psychiatrists, in addition to caring for psychotic patients, also focus on psychotherapy for neuroses and personality disorders. The Australian combination of more psychiatrists in private office practice and fewer public hospital beds costs less than the New Zealand system, which supports only public-sector, hospital-based services.

Australia↗
PubMed2004

Comparing the quality of antidepressant pharmacotherapy in the Department of Veterans Affairs and the private sector.

OBJECTIVE: Comparing quality of care between large health care systems is important for health systems management. This study compared measures of the quality of pharmacotherapy for patients with major depression across a sample of patients from the Department of Veterans Affairs (VA) and the private sector. METHODS: In this observational study, all patients who were given a new prescription for an antidepressant and a diagnosis of major depression in the VA during fiscal year 2000 were identified by using administrative data (N=27,713). In the private sector, a similar sample of patients were identified by using Medstat's MarketScan database (N=4,852). For both groups, measures of the quality of antidepressant pharmacotherapy were constructed. These measures were compared across the two groups by using logistic regression models. Controls for age, gender, comorbid disorders, and initial antidepressant drug prescribed were included in some models. RESULTS: Although the populations had different demographic and clinical characteristics, differences in the quality measures between the two systems were few, with the VA slightly outperforming the private sector in the prescription of antidepressants during the acute phase of treatment, the first 84 days (84.7 compared with 81 percent) and during the maintenance phase of treatment, the first 181 days (53.9 compared with 50.9 percent). Patient characteristics that were associated with quality measures included being older, being female, and having a comorbid diagnosis of substance use disorder, bipolar disorder, or anxiety or adjustment disorder. CONCLUSIONS: Both systems had relatively high rates of adherence to pharmacotherapy guidelines. Even though the populations in the two systems were different, adjusting the analyses for clinical characteristics did little to change the measured differences between the two systems.

Adult↗
PubMed2004

Comparative prevalence of psychotropic medications among youths enrolled in the SCHIP and privately insured youths.

The one-year prevalence of use of psychotropic medications among youths enrolled in a Mid-Atlantic State Children's Insurance Program (SCHIP) in 1999 or 2000 was compared with the 1998-2000 prevalence findings for youths enrolled in four large multistate private medical insurance programs. Prevalence was significantly higher among youths enrolled in the SCHIP than among those with private insurance in all eight medication group comparisons. Unlike private insurance, the surveyed state SCHIP program did not require a copayment or have a restrictive formulary. These administrative differences may partly explain the comparatively higher rate of psychotropic use under the SCHIP.

Adolescent↗
PubMed2002

Intensive Short-term Dynamic Psychotherapy in a private psychiatric office: clinical and cost effectiveness.

OBJECTIVE: To assess the cost and clinical effectiveness of psychiatrist-provided Intensive Short-term Dynamic Psychotherapy (ISTDP) of patients referred to a private office. METHODS: ISTDP was provided to 89 patients referred to a private psychiatric office in Vancouver, Canada. Pretherapy self-report scores, (BDI, BAI, BSI, IIP [see full names in text]) medication costs, disability costs and healthcare costs were compared with posttherapy values and normative values. RESULTS: Patients' mean self-report scores went from the abnormal to normal range after an average of 14.9 hours of therapy. Returns to work, reduced healthcare utilization, and medication stopping accounted for a cost reduction of over Cdn$400,000 at one year after therapy. CONCLUSIONS: ISTDP appears to be an effective and cost-effective form of intervention when provided by a psychiatrist in a private office. Randomized controlled studies are warranted to further examine the cost benefits and efficacy of ISTDP.

Adult↗