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PubMed1991

A change from public to private sale of wine: results from natural experiments in Iowa and West Virginia.

Several proposals to change the existing structure of state alcoholic beverage control authorities have been advanced over the past 10 years in the United States. Most call for eliminating or substantially reducing the state's role in retail sales of alcohol, particularly distilled spirits and wines. In recent years the states of Iowa and West Virginia eliminated state monopolies for retail sales of wine, and now allow such sales by privately-owned licensed establishments. Using time-series methods, we assessed the effects of these policy changes on the alcoholic beverage market in each state. Privatization was associated with statistically significant increases in wine sales in Iowa and West Virginia, after controlling for an initial stocking effect and broader nationwide trends in alcohol sales in the 1980s. In addition, there was a net increase in absolute alcohol consumed in both states across all beverages (beer, wine and distilled spirits) associated with privatization.

Alcohol Drinking↗
PubMed1993

Privatization, price and cross-border liquor purchases.

Self-report survey data were used to investigate the effects of liquor sales privatization on cross-border liquor purchases. A state survey sample representing the Iowa age 18+ noninstitutionalized population was interviewed in April 1989, some 25 months after retail spirits sales were privatized. Despite a privatization induced 6.1% increase in retail liquor prices, there was little, if any, change in the self-reported amount of liquor purchased outside the state of Iowa.

Adolescent↗
PubMed1996

Alcoholism and typology: findings in an Irish private hospital population.

OBJECTIVE: To assess the validity of alcoholic typology in an Irish private hospital population. METHOD: We interviewed a randomly selected group of inpatient and outpatient alcoholics (N = 48, 42 male) in a private hospital in Ireland. Subjects had a structured psychiatric interview, including completion of a severity of alcohol dependence questionnaire, a Hamilton depression rating scale and a typology questionnaire. RESULTS: We found that there were differences between groups of alcoholics when divided according to Cloninger's typology hypothesis and by Von Knorring's age of onset criteria. The Type 2 early age of onset alcoholics (n = 23) had a significantly higher percentage of positive family histories of alcoholism, (p < .01), a higher percentage of sociopathic traits (p < .01) and increased severity of alcoholism (p < .05), relative to the Type 1 late age of onset alcoholics (n = 25). The Type 2 alcoholics also had increased daily consumption of alcohol in the month prior to admission, poor behavioral tolerance to the effects of alcohol and more fights that the Type 1 alcoholics. CONCLUSIONS: We concluded that there is validity to alcohol typology theory in relation to this Irish private hospital population and that age of onset is a useful defining criterion.

Adult↗
PubMed1998

A population-based study of access to immunization among urban Virginia children served by public, private, and military health care systems.

BACKGROUND: Pediatric immunization rates have increased in the United States since 1990. Nevertheless, national survey data indicate that up to one third of 2-year-old children in some states and urban areas lack at least one recommended dose of diphtheria-tetanus-pertussis (DTP)-, polio-, or measles-containing vaccines. Immunization has become a key measure of preventive pediatric health care in the United States. To achieve and maintain the national immunization goal that 90% of children receive all recommended immunizations by 2 years of age, the role of the health care system in immunization delivery must be examined. Urban eastern Virginia has a diverse population that obtains immunization services from public, private, and military providers and insurers. At the time of this survey, immunization services in Virginia were available free to all children through public health clinics and to military families when using a military facility. OBJECTIVE: To examine access to pediatric immunization services and health system factors associated with underimmunization in a representative sample of children at 12 and 24 months of age. METHODS: We conducted a household survey in urban eastern Virginia from April through September 1993. A total of 12 770 households in Norfolk and Newport News, VA, were selected for inclusion in the study using probability-proportionate-to-size cluster sampling. Use of probability-proportionate-to-size sampling ensured that children within each city had equal probability of being included in the survey. Selected households were visited by trained interviewers to determine their eligibility, defined as having at least one child 12 to 30 months of age residing in the household. In eligible households, parents were asked to participate in a standardized, 15-minute interview. Survey respondents were asked about household demographics, and for each eligible child, the immunization history, health insurance, the name and location of all immunization providers, the usual immunization provider, and any problems the parent had experienced accessing immunization services with that child. Up-to-date (UTD) immunization status was defined as having all recommended doses of DTP, polio, and measles-mumps-rubella at 12 months (three DTP and two polio immunizations) and 24 months (four DTP, three polio, and one measles-mumps-rubella immunizations). The child's immunization history was assessed from parent and provider records only. Data analysis accounted for the survey's cluster sampling design (ie, within-cluster correlation). Because the immunization rates of the two cities did not differ significantly, unweighted analyses were used for ease of computation. Significance was determined for contingency tables by Wald's chi2 test. RESULTS: A total of 749 children (91% of eligible households) participated in the survey. Study children were born between October, 1990, and July, 1992. Immunization records were obtained for 705 children (94%). Eighty-seven percent of respondents were mothers, 44% were African-American, 40% of children were military dependents, and 40% were enrolled in the Women, Infants and Children (WIC) program. Sixty-five percent of children were UTD at 12 months and 53% at 24 months. Parents reported that their children's usual immunization providers were private doctors (34%); public health, hospital clinics, or community health centers (32%); and military clinics or a military contract provider (34%). At least one problem accessing immunization services was reported by 35% of respondents, ranging from 29% among those who used a private doctor as their child's usual immunization provider to 46% among those using a military contract provider. Overall, the most commonly reported problem was clinic waiting time (12%), with reports of waiting time as a problem occurring most often among those using the military contract provider (22%) and public health clinics (17%). (ABSTRACT TRUNCATED)

Child, Preschool↗
PubMed2000

Immunization levels and risk factors for low immunization coverage among private practices.

OBJECTIVES: Previous studies have indicated that provider characteristics are an important determinant of immunization coverage. The objectives of this study were to: 1) assess immunization coverage levels among 2-year-old children receiving care in private practices in 3 California counties; and 2) evaluate practice and patient risk factors for low immunization coverage. STUDY DESIGN: Cross-sectional chart review of immunization histories and provider survey of immunization policies. SETTING: Forty-five randomly selected, private medical practices in 3 counties in California. PATIENTS: Children 12 to 35 months old, followed by the participating practices. METHODS: Providers underwent a detailed assessment of their immunization coverage and completed a questionnaire describing their immunization policies and procedures. Immunization data were abstracted from randomly selected medical charts of children 12 to 35 months old. Only patients who met the criteria for active status (>/=2 visits and >/=1 visit during the preceding 18 months) were included in analyses. Immunization coverage levels were calculated and logistic regression was used to estimate the risk of underimmunization associated with different practice and child characteristics. RESULTS: Of the 72 eligible practices that were contacted, 45 participated in the study, yielding a participation rate of 62%. The median immunization coverage of participating offices was 54% (range: 0%-91%). Multivariate analysis revealed 5 independent risk factors for underimmunization. The strongest predictors were having fewer than 50% active children in the practice and children having fewer than 8 visits to the provider. Other significant predictors were the percentage of patients in the practice on Medicaid, administering diphtheria-tetanus-pertussis 4 at a separate visit from the Haemophilus influenzae type b booster, and practice location. CONCLUSIONS: These data provide new insights into immunization practices in an important clinical setting that has been poorly characterized previously. Immunization coverage levels were found to be low and significant risk factors for underimmunization were identified. Recommendations are made for immunization policy changes and targeting of immunization improvement interventions at practices that may be at risk for low immunization coverage. immunization, vaccination, immunization programs, primary prevention, private practice, child, preschool, pediatrics, family practice.

California↗
PubMed2004

[Dental caries experience in children at public and private schools from a city with fluoridated water].

The aim of this study was to verify the relationship between type of school as a measure of socioeconomic conditions and caries prevalence among preschoolers and schoolchildren in Rio Claro, São Paulo State, Brazil, a city with fluoridated water supply. The data were secondary, from a sample of 888 children 5 to 12 years old enrolled in private and public schools. Caries was measured by the dmft and DMFT indices as well as the Care index. Qui-square and Mann-Whitney tests were utilized with 5% significance. In 5-year-old children, mean dmft was 2.50, and 42.20% were caries-free. At age 12, mean DMFT was 2.70 and 28.90% were caries-free. Caries prevalence rates in public schoolchildren as compared to private were 74.50% and 61.20%, respectively (p < 0.0001), and the dmft and DMFT scores were the highest in public schoolchildren (p < 0.05). The Care Index was higher in private schoolchildren (71.20%) as compared to public (52.80%). Highest caries rates were found among public schoolchildren, so the variable type of school proved sensitive for discriminating different oral health conditions; however limitations need to be recognized, suggesting that other variables should be assessed.

Age Distribution↗
PubMed2004

[Factors associated with perinatal morbidity and mortality in a sample of public and private maternity centers in the City of Rio de Janeiro, 1999-2001].

This study compares socio-demographic factors, mothers' biological characteristics, and quality of care at maternity hospitals in the City of Rio de Janeiro, Brazil. A sample of 10,072 post-partum women in 47 hospitals was selected. Data were collected by interviewing mothers in the immediate post-partum and from medical records. The chi2 test was used to analyze homogeneity of ratios. Significant differences were found between patients in public and private hospitals in relation to family support, healthy habits during pregnancy, reproductive history, access to and satisfaction with prenatal care and delivery, and particularly adverse effects in the newborns. Private maternity hospitals showed better results, although they displayed excessive cesarean and neonatal inter-hospital transfer rates. The stratum consisting of public Federal and State maternity hospitals received women with greater morbidity, had lower neonatal transfer rates, and received a more positive assessment by clients of the Unified National Health System (SUS). Private maternity centers contracted out by the SUS were the ones that most refused treatment to patients, leading to delays in patient care for delivery.

Adolescent↗
PubMed2004

[Hospital mortality and length of stay: comparison between public and private hospitals in Ribeirão Preto, São Paulo State, Brazil].

Performance assessment in health services is essential. The comparison of performance indicators requires the use of risk adjustment strategies. The objective of this paper was to assess variations in clinical performance, measured by hospital mortality and length of stay, between private and public hospitals, while taking into account the hospital case mix. This study is located in the Ribeirão Preto region in São Paulo State, Brazil. From 1996 to 1998, 32,906 patients admitted with cardiovascular and respiratory diagnoses were studied. Variables used for risk adjustment of performance indicators were: sex, age, principal diagnosis, and severity measures based on co-morbidity. Clinical performance in public hospitals as measured by adjusted hospital mortality (OR = 0.41) was better than in private hospitals. Public and private hospitals were not statistically different concerning patients' length of stay. Although some conceptual and methodological problems persist, hospital mortality and other adjusted performance indicators should be considered as useful tools to identify health services' performance problems.

Adolescent↗
PubMed2003

[Dental caries in 12- and 15-year-old schoolchildren from public and private schools in Salvador, Bahia, Brazil, in 2001].

The aim of this paper was to assess the caries experience of 12- and 15-year-old schoolchildren from public and private schools in Salvador, Bahia, Brazil, and to identify the access of children to dental services and the coverage of such services, which might be related to differences between the groups. Cross-sectional data were obtained from 3,313 clinical exams, which followed the WHO (1997) criteria for the diagnosis of dental caries. The analysis was carried out by means of the Student's t test, the chi-square test and analysis of covariance. There were no differences regarding DMFT and frequency of caries-free individuals between public and private schools. However, while F (filled teeth) was the most prevalent component of the index in subjects from private schools, M (missing teeth) was the most common in those from public schools. The access to dental services in the last year was the only variable associated to the differences between both groups. Thus, the importance of access to dental services and social benefits must be pointed out in order to guarantee equity in oral health.

Adolescent↗
PubMed2003

How to promote joint participation of the public and private sectors in the organisation of animal health programmes.

It is generally accepted that the first recorded outbreaks of foot and mouth disease (FMD) in South America occurred around 1870. The disease emerged almost simultaneously in the province of Buenos Aires (Argentina), in the central region of Chile, in Uruguay and in southern Brazil, due to the introduction of livestock from Europe. Argentina set up an agency for the control and eradication of FMD in 1961, Brazil began disease-control activities in Rio Grande do Sul in 1965, Paraguay and Uruguay initiated similar programmes in 1967, Chile in 1970 and Colombia in 1972. A common characteristic was observed in all early national FMD programmes, namely, they were developed, financed, operated and evaluated by the public sector, without major participation from the private sector, except when buying vaccines and abiding by the regulations. In 1987, the Hemispheric Foot and Mouth Disease Eradication Plan (PHEFA: Plan Hemisférico para la Erradicación de la Fiebre Aftosa) was launched and the private sector played a prominent role in achieving the eradication and control of FMD in several countries. However, this model of co-participation between the public and private sectors has suffered setbacks and a new approach is being developed to find ways in which local structures and activities can be self-sustaining.

Animal Welfare↗
PubMed2003

Determinants of mortality following a diagnosis of prostate cancer in Veterans Affairs and private sector health care systems.

OBJECTIVES: We compared patterns of mortality among men with prostate cancer at 2 Department of Veterans Affairs (VA) and 2 private-sector hospitals in the Chicago area. METHODS: Mortality rates for 864 cases diagnosed between 1986 and 1990 were estimated using Cox proportional hazards models that incorporated age; income; cancer stage, differentiation, and treatments; and baseline comorbidity. RESULTS: Race tended to associate with all-cause mortality irrespective of health care setting (Blacks vs Whites: hazard rate ratio [HRR] = 1.68 [95% confidence interval (CI) = 1.06, 2.67]; P <.001 in the private sector; HRR = 1.50 [95% CI = 0.94, 2.38]; P =.088 in the VA). However, comorbidity determined risk in the VA, whereas age and income predicted risk in the private sector. CONCLUSIONS: Determinants of all-cause mortality in men with prostate cancer vary according to health care setting.

Black or African American↗
PubMed1997

The welfare state, pensions, privatization: the case of Social Security in the United States.

In all high-income nations, the welfare state is under challenge, with particular concern voiced about the burden of retirement pensions on the public fisc and on younger workers. The strongest drive against social insurance is taking place in the United States, which has less of it than other nations and appears to be in the best position to meet future entitlement claims. In this article, the author examines the liabilities that the U.S. Social Security system is likely to incur over the next 35 years and finds that there is little danger that the system will fall into insolvency. Privatizing Social Security is not necessary to assure the integrity of future pension benefits. Furthermore, the cost-benefit ratio of privatization appears to be unfavorable, as borne out by the mandatory private pension plan in effect in Chile. Some wealthy nations will face greater demographic strains than the United States, but all need to retain the welfare state as a foundation for future changes in the world of work.

Aged↗
PubMed1987

Lessons from America? Commercialization and growth of private medicine in Britain.

This article examines the transition of the private medical sector in Britain from a mere appendage to the National Health Service to a significant business sector involving multinational enterprise. The author argues that private medicine continues to be in a state of flux because its degree of independence is limited by its links to the dominant public sector, particularly with regard to staffing, and is still vulnerable to attacks from the opposition parties. Private medicine, despite rapid growth in the late 1970s, is beset by mounting costs and intense competition.

Commerce↗
PubMed1994

Drug abuse prevention curricula in public and private schools in Indiana.

Recent research on drug education has focused on public schools. This study compares public school drug education programs with such efforts in private schools in one midwestern state. All schools in the state were asked to respond to a survey on curricula and training. This study reports on the types of prevention curricula used and at what grades, as well as the number of schools with trained staff. For almost every grade a higher percentage of public schools was found to be implementing drug education programs than private schools. This was manifested in public schools developing their own programs and/or purchasing commercially available drug curricula. Although an equal number of private and public schools have trained staff, less than half of all schools report a trained staff at each grade level. Directions for future research based on these results are suggested.

Adolescent↗
PubMed1996

Casemix and affective disorders: a comparison of private and public psychiatric systems.

OBJECTIVE: To determine whether there is a difference in length of stay for patients with affective disorders between private and public psychiatric hospitals. METHOD: The casemix Australian national diagnosis-related group (AN-DRG) diagnoses of all inpatient separations from private and public psychiatric hospitals in South Australia for 1 year were abstracted from records. The average length of stay for patients with affective disorders was calculated. RESULTS: There was no significant difference in the average length of stay for patients with affective disorders treated in private and public psychiatric hospitals. CONCLUSIONS: These results should allay fears that the treatment of patients with affective disorders in any particular treatment setting will be compromised by the introduction of casemix.

Affective Disorders, Psychotic↗
PubMed2002

Observations of private veterinary practices in Colorado, with an emphasis on anesthesia.

RATIONALE FOR THE STUDY: To give academic faculty in anesthesia a better understanding of the anesthetic techniques used by veterinarians in private practice, in order to enhance their teaching of anesthesiology to veterinary students. METHODOLOGY: Two anesthesia faculty members visited 20 different small-animal veterinary practices, interviewing veterinarians and technical staff about their use of anesthesia and their anesthesia-related problems. RESULTS: Compared to most university veterinary teaching hospitals, private practitioners tended to use fewer anesthetic drugs, provide fewer analgesics, do more out-patient procedures, and rarely monitor blood pressure in anesthetized animals. CONCLUSION: Techniques of anesthesia and monitoring used in private veterinary practice are often quite different from those used in large university teaching hospitals.

Anesthesia↗
PubMed2005

Determinants of private clinics' productivity: a comparison of city and county clinics in Korea.

This study was designed to assess determinants of private clinics' productivity, and to compare city and county clinics in South Korea. We analyzed the revenue and patient data from all 9,212 private clinics in South Korea. This data was obtained from the Korean National Health Insurance Corporation, during the period between 1996 and 1999. We used a mixed model for repeatedly measured data. The following listed variables were used in our analysis: sex and age of physician, number of beds of clinics, competitiveness of medical institution, inhabitants'incomes, the proportion of elderly in the administrative unit, and time effects. Age, sex, number of beds, and specialty were found to be the most relevant determinants for the productivity of private clinics in both urban and rural settings, and number of clinics and beds per 100,000 and income of the administrative unit were found to be significant determinants, but only in city environments.

Ambulatory Care Facilities↗
PubMed2004

[Height of pregnant women attended in the public and private health systems in Chile].

BACKGROUND: Adult height has increased around the world, especially in developed countries, probably due to the improvement in life conditions. AIM: To assess differences in women's height in two population samples of different socioeconomic status coming from the public and the private health system in Chile, and the influence of the year of birth on height. MATERIAL AND METHODS: Data from 5,416 pregnant women attended in the public health system and 1,658 women attended in the private system, were analyzed. Among women attended in the private system, the association of maternal height with anthropometric indices of the newborn were also studied. RESULTS: Mean height difference in the two systems reached 3.78 cm. The correlation coefficient of maternal height and year of birth was significant although weak in the two health systems, but mean height differences between decades of birth were significant only in the public sector: 0.7 and 1 cm in each of the two most recent decades. Association of maternal height was significant although weak, with both weight and height at birth, controlling for newborn's sex. CONCLUSIONS: Socioeconomic factors influence maternal height. Maternal height has an influence on fetal growth.

Adult↗