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PubMedDate not supplied

Evaluation of a Dutch public-private partnership to promote healthier diet.

PURPOSE: Public-private partnerships may help to promote healthy diets. We assessed customers' exposure to and the acceptability of a Dutch public-private healthy diet campaign in butcher's shops and investigated the effects on the purchase of lean meat and the use of liquid cooking margarine and potential behavioral determinants. METHODS: The pretest-posttest control group design included 486 customers (242 experimental and 244 control) of butcher shops representing 64% of the original sample. Campaign exposure, acceptability, and behavioral effects were measured by a questionnaire. RESULTS: Seventy-one percent of the customers noticed the campaign. Scores on the acceptability were positive to very positive. Regression analysis revealed that customers in the experimental condition evaluated the campaign better (B = .415; p < .05) and felt more encouraged to buy lean meat (B = .252; p < .05) than customers in the control condition. No effects on behavior were found. DISCUSSION: Study design limitations included possible campaign exposure of control group participants. The study shows the feasibility and acceptability of a joint health-promoting activity through a public-private partnership, but there were no effects on behavior.

Adult↗
PubMed1984

Reimbursement in private practice.

Occupational therapists in private practice must develop sound business policies and procedures to help ensure third party reimbursement for their services. Carefully delineated protocols and proper documentation in treatment are of utmost importance. Fee schedules are established within the framework of local government regulations, using one or a combination of the following methods: unit value system, modalities and procedures, cost-plus or overhead, and state relative value system or maximum allowable fees. Blue Cross/Blue Shield or other private third party payers, Medicare or Medicaid, and workers' compensation insurers are the usual parties billed for services rendered. Therapists must use good public relations methods to educate their present and future reimbursers and act as advocates for private practitioners in occupational therapy.

Documentation↗
PubMed2001

Private purchasing pools to harness individual tax credits for consumers.

While health insurance tax credits could help people who otherwise could not afford to purchase coverage, many might still find individual coverage too expensive and its marketplace dynamics bewildering. As an alternative, this paper outlines an approach using private purchasing pools for tax-credit recipients. The objective is to offer these individuals and families a choice among competing health plans, and provide many of the same advantages enjoyed by workers in large employer groups, such as relatively low administrative costs, no health rating, and an effective "sponsor." Some express optimism that private pools will emerge naturally and thrive as an option for individual tax-credit recipients. However, adverse selection and other individual health insurance market forces make this a dubious prospect. The approach presented here gives purchasing pools the same tool employer groups use to maintain stability and cohesion--a significant contribution that cannot be used elsewhere. The ability to offer health plans exclusive access to a sizable new, previously uninsured clientele--tax-credit recipients-would enable purchasing pools to attract health plan participation and thus overcome one major reason several state-directed pools for small employers have failed. To avoid other pitfalls, the paper also suggests private pool structures, as well as federal and state roles that seek to balance objectives for market innovation and choice with those for coverage-source stability and efficiency.

Economic Competition↗
PubMed2004

Government as reinsurer: potential impacts on public and private spending.

This paper analyzes the potential effects of alternative government reinsurance mechanisms on public and private expenditures in group and nongroup health insurance markets. High reinsurance thresholds, with the government taking responsibility for costs over dollars 50,000 per year, would absorb a small share of private costs. Lower thresholds would have greater effects, but would increase government costs significantly. We also find that reinsurance would reduce the variance in expenditures considerably and should reduce risk premiums charged by private insurers. We conclude that focusing on small employers and the nongroup market could target government spending where costs are highest and insurance markets most unstable.

Government Programs↗
PubMed1996

[Analysis of financial statements of Japanese private hospitals (1982-1991)].

In order to clarify the financial situation of Japanese private hospitals, the financial statements provided by the Social Welfare and Medical Service Corporation were analyzed for the period from 1982 to 1991. The results clarified the low growth rate and low profitability of the Japanese private hospitals, although their financial situation was relatively stable. However, the efficiency of cost has been stalled in recent years and profitability has been declining due to the low turnover rate of capital. According to the CVP analysis, the Profit volume ratio of the investigated hospitals has been increased to the level of 95%. This situation means that, in the current financial situation, more than half of the Japanese private hospitals will go into the red if revenue declines 5% due to some short term change in the managerial environment.

Cost-Benefit Analysis↗
PubMed1993

The public-private health partnership.

The comprehensive plan for a 21st Century American Health System that is embodied in the Jackson Hole Group initiatives will require both government and private sector actions. The new government roles will include implementing a public-private design for universal health-insurance coverage, insurance market reforms, tax-code revisions, and a national health-outcomes accountability system. These new government roles are necessary for the private health sector to perform its major role--to compete effectively on the basis of health-care costs, high quality, and value to the patient.

Comprehensive Health Care↗
PubMed1994

The Japanese health care system: planning the extinction of the private hospital?

The private hospital in Japan is like a patient with a very serious condition, but one that is reversible. Unless the treatment or appropriate support is given in a timely manner, the patient may have a cardiac arrest and either die or suffer permanent injury. In 1992 and 1993 there were record bankruptcies in private hospitals in Japan. These hospitals suffered permanent injuries, or ceased to exist because the proper support was not provided. More will suffer the same fate in the immediate future, because life saving measures continue to be withheld. This article attempts to provide some general and specific aspects of the Japanese health care system that have led private hospitals to the brink of extinction, and makes a plea for their survival.

Bankruptcy↗
PubMed1999

Hypertension management of medical aid patients attending private practices.

OBJECTIVES: The study aimed to describe the treatment status of hypertensive patients and the prescribing patterns of private medical practitioners treating medical aid scheme patients with hypertension. METHOD: Data on hypertensive patients belonging to medical aid schemes were provided to the drug utilisation review consultancy, Quality Health Services (QHS), by private medical practitioners. The data were computerised and included the age and gender of the patient, the diastolic and systolic blood pressure (BP), the medication prescribed for the condition and the qualifications of the reporting doctor. All the prescribed drugs were categorised into 12 drug classes and combination preparations had each constituent categorised. The level of BP allowed the degree of BP control to be described as controlled (< 140/90 mmHg), borderline (140/90-< 160/95 mmHg) and uncontrolled (> or = 160/95 mmHg). RESULTS: Included in the study were 11,696 hypertensive patients (46.3% male and 53.7% female) and the 3,503 doctors who cared for them. The systolic BP showed an age-related increase, but the diastolic BP did not. The level of BP control was high, with less than a quarter of patients having uncontrolled hypertension. The most frequently prescribed drug class was angiotensin-converting enzyme (ACE) inhibitors (32.2%). Beta-blockers accounted for 20.8% and calcium antagonists for 14% of all prescriptions. Thiazide and thiazide-like diuretics on their own accounted for only 7.8% of prescriptions. However, a further 13.8% of prescriptions contained this class of diuretics in combination with other drug classes. Diuretics of all classes taken on their own or in combination were used by 33.9% of patients. CONCLUSIONS: Good levels of hypertension control were reported for hypertensive patients by their private practitioners. Almost half of all prescriptions were for the newer and more costly antihypertensive drugs (ACE inhibitors and calcium antagonists), although their effectiveness in reducing long-term complications of hypertension is still unproven. Furthermore, these prescribing patterns do not conform to those recommended by the Southern African Hypertension Society's hypertension management guidelines.

Cross-Sectional Studies↗
PubMed1985

A comparison of hospital outpatient departments and private practice.

This article addresses cost differences between primary care physicians in private practice and hospital outpatient departments (OPD's). The analysis utilizes ambulatory visit groups (AVG's), the outpatient equivalent of diagnosis-related groups (DRG's), to adjust for case mix. Major findings are that OPD's have higher per visit costs than physicians' private offices; internists are more expensive than general practitioners regardless of site; and ancillary service costs are actually slightly higher in private practice. Any prospective payment system for ambulatory care must consider these costs differences.

Costs and Cost Analysis↗
PubMed1998

[Autonomy accreditation of private Chilean universities (1994-1998)].

BACKGROUND: In 1995, a score to measure the quality of private universities in Chile, using excellency indicators as predictors of autonomy certification, was devised by the author. AIM: To compare this score with autonomy certification results of ensuing years, to assess the usefulness of excellency indicators. MATERIAL AND METHODS: During 1995, the records of 21 private universities in Santiago were studied. These universities were qualified using eight indicators of academic excellency. These results were compared with the Superior Education Council qualification results, obtained between 1996 and 1998. RESULTS: The scores obtained by universities ranged from 19 and 137 points. Universities with the better scores obtained autonomy and those with the worst scores were eliminated. There was a good concordance between the score obtained in 1995 and the fate of autonomy certification. CONCLUSION: The best predictors and indicators of academic excellency to certificate autonomy of private universities were the magnitude of indirect budget contributed by the state, the size of academic list of staff and the percentage of admitted students with scores over 573 in the national academic aptitude tests.

Chile↗
PubMed1999

Why not private health insurance? 1. Insurance made easy.

How realistic are proposals to expand the financing of Canadian health care through private insurance, either in a parallel stream or an expanded supplementary tier? Any successful business requires that revenues exceed expenditures. Under a voluntary health insurance plan those at highest risk would be the most likely to seek coverage; insurers working within a competitive market would have to limit their financial risk through such mechanisms as "risk selection" to avoid clients likely to incur high costs and/or imposing caps on the costs covered. It is unlikely that parallel private plans will have a market if a comprehensive public insurance system continues to exist and function well. Although supplementary plans are more congruous with insurance principles, they would raise costs for purchasers and would probably not provide full open-ended coverage to all potential clients. Insurance principles suggest that voluntary insurance plans that shift costs to the private sector would damage the publicly funded system and would be unable to cover costs for all services required.

Canada↗
PubMed1999

Why not private health insurance? 2. Actuarial principles meet provider dreams.

What do insurers and employers feel about proposals to expand Canadian health care financing through private insurance, in either a parallel stream or a supplementary tier? The authors conducted 10 semistructured, open-ended interviews in the autumn and early winter of 1996 with representatives of the insurance industry and benefits managers working with large employers; respondents were identified using a snowball sampling technique. The respondents felt that proposals for parallel private plans within a competitive market are incompatible with insurance principles, as long as a well-functioning and relatively comprehensive public system continues to exist; the maintenance of a strong public system was both socially and economically desirable. With the exception of serving the niche market for the private management of return-to-work strategies, respondents showed little interest in providing parallel coverage. They were receptive to a larger role for supplementary insurance but cautioned that they are not willing to cover all delisted services. As business executives they stated that they are willing to insure only services and clients that will be profitable.

Canada↗
PubMed1999

Independent sector regulation. Privates on parade.

The government's proposal to set up a new regulatory body for the private and voluntary sectors is regrettable. The major hospital groups in the private sector could undertake some system of clinical governance. Whatever form regulation takes, it must be supported by much better information on the private sector, including consultants' activity rates and rates of re-admission and numbers of transfers to NHS hospitals.

Facility Regulation and Control↗
PubMed1999

Private finance. Oz trials.

Privatization of a public sector general hospital in Adelaide, Australia, five years ago has revealed the strengths of the model and the difficulties of contracting with the private sector. Managers believe the new model has reduced overstaffing and increased local management. There have been continual contracting problems and the hospital has made losses, almost from the start. Private finance initiative contracts may always be difficult to negotiate and sustain.

Capital Financing↗
PubMed2000

[Is there a role for infectious disease specialists in private practice?].

For the last 20 years infectious diseases have gained increasing importance for hospital medicine. As a specialty, infectious diseases have been recognized only recently by the Swiss medical association. However, the precise role of infectious disease specialist operating in private practice remain to be defined. The medical community faces many challenges for which infectious disease specialist must provide answers. Knowledge in microbiology has progressed enormously and many very sophisticated and, partly, expensive diagnostic techniques are widely available. New treatment options are introduced while numerous microbial species demonstrate increasing resistance to antimicrobial agents. The intervention of infectious disease specialist could thus contribute to optimize treatment and limit the use of economic resources. Infectious disease specialist in private practice are also facing new activities such as parenteral outpatient treatment for severe infections and HIV infection, which clearly require a specialized professional approach. Infectious disease specialist in private practice will need great care to find a responsible equilibrium between clinical consultation and telephone consultation.

Communicable Diseases↗
PubMed2000

The Medicare mix: efficient and inefficient combinations of social and private health insurance for U.S. elderly.

This paper explores two theories about the reason why the United States provides mixed public (Medicare) and private (Medigap) insurance for the elderly: that this represents an efficient combination of financing methods for a public good, or that it represents public provision of a private good for distributional reasons. It is argued that the first theory has more support than the second, but that the current configuration of Medicare and Medigap is not optimal. Two main problems are identified: the absence of coordination between public and private insurers, and the provision of overly generous coverage to the well off. Recent Medicare reforms have helped with the first problem, but the second remains to be solved.

Aged↗
PubMed1999

Are dermatologists in private practice interested in teledermatological services?

Diagnosing dermatologic skin conditions can be difficult, especially in pigmented skin lesions. Therefore, the consultation of an expert via teledermatology could prove vital. For this purpose, a rapid transfer of medical data including high resolution images is essential. This transfer can be performed with a variety of modern telecommunication technologies, including ISDN, highspeed-ISDN, Internet, and Intranet. As the levels of both communication software and camera-systems can be quite different, our survey investigated the equipment of 84 dermatologists in private practice. A questionnaire was distributed on computer equipment, operating system software, and any image documentation systems used, as well as required telecommunications equipment and possible applications of tele-dermatology. This survey showed a response rate of 54% and proves that dermatologists in private practice are interested in telemedicine services. Most dermatologists surveyed use Windows 95 operating software and 74% have access to modern ISDN modems or PC-cards. Dermatologists currently prefer applications with low-tech communication hardware and software requirements. Consultation of dermatological centers was the favored application with 59%. Our survey clearly demonstrates that a high percentage of dermatologists in private practice would use tele-dermatology. In our experience, for the excellence of this service an image documentation system is essential to provide the tele-dermatological expert with standardized images with constant illumination.

Dermatology↗
PubMed1998

Intention of private hospitals to become contractors in the prepaid social security scheme in Thailand: why and why not?

The objective of the study was to examine whether private hospitals wanted be main contractors (MCs) under the social security scheme. Data were obtained from a cross-sectional survey of 94 private hospitals in Bangkok and its vicinity area conducted between August 1995 and May 1996 using in-person interview and hospital survey forms. The overall response rate was 88.3%. The results showed that some 46 hospitals (55%) expressed their intention to become MCs. However, nearly 40% of MCs in 1995 indicated that they really did not want to join the scheme while several non-MC hospitals said that they wanted to participate. The most prevalent justifications for the intention of the hospitals to become MCs, or not, were operational and marketing-related in nature. While the scheme was considered a profitable market opportunity by many, it affected hospital positioning. Participation in the scheme might also complicate health services delivery. Whether private hospitals wanted, or did not want, to become MCs was associated with ownership status (p = 0.001) and leading competitive strategies of the hospitals (p = 0.041).

Adult↗