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PubMed1996

The risks of hip fracture in older people from private homes and institutions.

This study aimed to determine whether the incidence of hip fracture is greater among those living in institutions compared with those living in private homes. Over two and a half years of surveillance, 1832 hip fractures were identified, of which 58% were sustained by those living in private homes and 42% by those living in institutions. The risks of hip fracture, unadjusted for age and sex, were 10.5 times greater for those living in institutions compared with those living in private homes. After adjusting for age and sex, these greatly increased risks were maintained, although for both men and women the risks decreased with age, such that at ages over 90 years the risks were not significantly different. Given these findings, hip fracture prevention strategies that focus particularly on individuals within institutions are highly commended.

Aged↗
PubMed2002

Private prayer and optimism in middle-aged and older patients awaiting cardiac surgery.

PURPOSE: This study investigated the use of private prayer among middle-aged and older patients as a way of coping with cardiac surgery and prayer's relationship to optimism. DESIGN AND METHODS: The measure of prayer included three aspects: (a) belief in the importance of private prayer, (b) faith in the efficacy of prayer on the basis of previous experiences, and (c) intention to use prayer to cope with the distress associated with surgery. The sample was 246 patients awaiting cardiac surgery. The first in-person interview was administered 2 weeks before surgery and optimism was measured the day before surgery by telephone. RESULTS: Private prayer predicted optimism, along with older age, better socioeconomic resources, and healthier affect. Neither measures of general religiosity nor any type of prayers used by patients were associated with optimism. IMPLICATIONS: Suggestions were made for clinicians to improve spiritual assessment and care, and for researchers to address spiritual coping in clinical situations.

Adaptation, Psychological↗
PubMed2000

Public and private hospitals in Bangladesh: service quality and predictors of hospital choice.

This study compares the quality of services provided by public and private hospitals in Bangladesh. The premise of the paper was that the quality of hospital services would be contingent on the incentive structure under which these institutions operate. Since private hospitals are not subsidized and depend on income from clients (i.e. market incentives), they would be more motivated than public hospitals to provide quality services to patients to meet their needs more effectively and efficiently. This premise was supported. Patient perceptions of service quality and key demographic characteristics were also used to predict choice of public or private hospitals. The model, based on discriminant analysis, demonstrated satisfactory predictive power.

Bangladesh↗
PubMed1975

Quality, quantity and distribution of medical education and care: regulation by the private sector or mandate by government?

The public, the federal government and most state governments have become increasingly concerned with the lack of access to primary care as well as the specialty and geographic maldistribution problems. Currently, there is a race in progress between the private sector and the federal government to devise solutions to these problems. In the federal sector, varying pieces of legislation are under active consideration to mandate the correction of specialty and geographic maldistribution; proposals include: 1) setting up federal machinery to regulate the numbers and types of residencies; 2) make obligatory the creation of Departments of Family Practice in each medical school; 3) withdraw current education support from medical schools causing tuition levels to increase substantially--federal student loans would then provide the necessary leverage to obligate the borrower to two years of service in an under-served area in exchange for loan forgiveness. In the private sector, for the first time in the history of the United States, the five major organizations involved in medical care have organized to form the Coordinating Council on Medical Education (CCME) and the Liaison Committee on Graduate Medical Education (LCGME). One of the initial major endeavors of the CCME has been to address itself to the problem of specialty maldistribution. The LCGME has been tooling up to become the accrediting group for residency training thus providing an overview of the quality and quantity of specialty training. It will be the intent of this presentation to bring the membership of the Southern Surgical Association an up-to-date report on these parallel efforts. The author's personal hope is that the private sector can move sufficiently rapidly to set up its own regulatory mechanisms and avert another federally controlled bureaucracy that will forever change the character of the medical profession in the United States.

Allied Health Personnel↗
PubMed1989

Private long-term care insurance. Simulations of a potential market.

Long-term care is now the most common cause of catastrophic illness costs for the elderly. Although acute care health insurance represents a mature market, private long-term care insurance is in its infancy and poised for development. This study presents a comparative analysis of simulation data, generated from the Brookings-ICF Long-Term Care Financing Model, for five alternative private long-term care insurance models. The simulation results indicate 1) the potential market for private long-term care insurance is substantial, 2) moderately comprehensive long-term care policies are affordable by a significant minority of the elderly, 3) policies are considerably more affordable to those under age 65, and 4) long-term care insurance has somewhat less potential to pay for nursing home costs for high risk groups than for other elderly.

Adult↗
PubMed1999

Educational level, voluntary private health insurance and opportunistic cancer screening among women in Catalonia (Spain).

Health care services in Catalonia (Spain) are organized in a national health service with universal population coverage and include preventive services such as mammography and Pap tests. In addition to a national health service (NHS) coverage, 22% of the population is enrolled in a voluntary private health insurance (VPHI), leading to a double coverage. This situation offers an opportunity to study the impact of this organizational aspect of health care with regard to cancer screening access. The source of data was the Catalan Health Survey (CHS), a cross-sectional survey conducted in a random sample of non-institutionalized population carried out in 1994. Variables analysed were age, educational level and voluntary private health insurance (VPHI). Women were asked if they had ever had a mammography and Pap test for preventive purposes. Logistic regression was used to study the relationship between these variables and the mammography or Pap test participation. The study sample was 5865 women aged 20 years and older. A Pap test and mammography were carried out on 42% and 25% of women, respectively. Participation had a peak between the ages of 30 and 39 years in Pap test and between 40 and 49 years in mammography; it decreased in older women. The percentage of Pap test practice increases according to a higher educational level than it does in mammography. Women who had a VPHI showed a higher percentage of screening tests than the rest of the population. There is also an increase in the mammography practice related to the educational level in older groups, but this fact is not observed in women younger than 40 years . Multivariate logistic regression analysis showed an increase in the likelihood of ever had a mammography and a Pap test according to age and to educational level, although this situation is less pronounced in older age groups. Both variables (educational level and age) remained significant after introducing the VPHI into the model (women who reported having a VPHI were more likely to have had a Pap test and a mammography than the rest of the women). In conclusion the opportunistic screening is associated with age, educational level and VPHI. Educational level is also associated with participation in both screening tests after adjusting by age. Furthermore, screening for cervical cancer shows a higher educational gradient than for breast cancer screening. The influence of VPHI after adjusting by age and by educational level poses the question about the role of private health insurances with regard to preventive practices in the context of a national health service aimed at promoting equity of health care access.

Adult↗
PubMed2001

Pain and dental implantology: sensory quantification and affective aspects. Part I: At the private dental office.

After an extensive review of the dental literature, few articles were found related to pain and implantology. Management of orofacial pain has traditionally been a difficult challenge for the dental-medical profession. Patients may be afraid of dental pain, particularly in cases of dental implantology. Therefore, a study to obtain more conclusive data was developed. Taking into account that the perception of pain and the threshold of pain vary among individuals, a 2-year clinical study was established in private practice utilizing a verbal method (double-blind). The study was used to quantify sensory and affective aspects of pain associated with dental implantology on 75 patients in a private dental office. All of the implants were placed by the same clinician. Data were recorded following a Pain Data Sheet designed for this particular study. The aim of this study was to obtain different aspects of data as follows: 1) Fear of the dentist and fear of dental implant procedures utilizing a descriptive scale of 1 to 10, with 1 indicative of no fear. 2) Dental areas and ridges: Dental pain, pain in edentulous areas, and pain in the implanted area utilizing a scale of 0 to 8, with 0 indicative of no pain. 3) Function and pain: during mastication, swallowing, speech, yawning, opening, closing, and lateral excursions and indication of cervical pain or back pain, each calibrated by the presence or absence of pain. 4) Palpation and pain of the temporomandibular joint, the temporal muscle, the area of the pterygoid muscles, masseter muscle, and sternocleidomastoid muscle, all calibrated on the indication of presence or absence of pain. 5) Others: ear pain, neuralgia, headaches, edema, and hematoma, calibrated on the basis of presence or absence. The aforementioned factors were evaluated immediately before surgery and after surgery, at 24 hours, and during a follow up for a period of 2 years at intervals of 1 week; 1, 2, 3, 4, and 6 months; and 1 and 2 years after surgery. Also recorded were the uses of presurgical and postsurgical medication at the first and second surgical phases, age, sex, buccal opening, number and position of implants, previous dental experiences, and the psychological preparation for dental implant treatment. The results of the statistical analysis indicate no correlation between pain and dental implantology procedures, in a private dental practice, at the level of significance of P > .001.

Adolescent↗
PubMed2004

Rate and predictors of new genital warts claims and genital warts-related healthcare utilization among privately insured patients in the United States.

BACKGROUND: Little non-clinic-based data are available on incident genital warts rates and related healthcare use. GOAL: : The goal of this study was to describe the incidence and predictors of genital warts and associated healthcare utilization patterns among a group of privately insured patients in the United States. STUDY: Health claims were evaluated prospectively from 5,914,107 privately insured individuals. RESULTS: The rate of new genital warts claims per 100,000 person-years at risk, age-standardized to the 2001 U.S. privately insured population, increased from 117.8 in 1998 to 205.0 in 2001. The highest rates were among 20- to 29-year-olds. The majority of claims came from dermatology and obstetrics/gynecology. CONCLUSIONS: The incidence of genital warts, as measured by the rate of new claims, appears to be rising. Age associations with the rate of new genital warts claims differed by gender; these associations may be influenced by changes in health-seeking behavior, potentially driven by health awareness.

Adolescent↗
PubMed1998

Making women visible in disasters: problematising the private domain.

Gender awareness and sensitivity in disaster research and management remains uncommon and tends to focus on the developing rather than the developed world. This paper uses a feminist oral geography to present some findings about women's experiences in two floods in Scotland. It is conceptualised around public and private (masculinised and feminised) space, problematising the private domain and presenting it, in the feminist research tradition, as a legitimate object of research. It shows the ordinary and everyday to be more opaque and complex than usually imagined and makes recommendations for their recognition and incorporation into disaster management. While there is a specific focus on the private domain of the home, this is not intended to reinforce gender stereotypes but simply to recognise the reality of many of the women interviewed. It concludes that disaster research generally has yet to advance much beyond the earliest stages of feminist studies which merely sought to make women visible in society.

Adaptation, Psychological↗
PubMed1975

The need for approval and the private versus public disclosure of self.

The relationship between need for approval and public and private self-disclosure was evaluated. Sixty female college students discussed their preferences for a steady date with a confederate in confidence or after having given permission for their comments to be cited in lectures or a book. The results showed that high-need-for-approval subjects revealed themselves more intimately in public than in private conditions wheras low- and moderate-need subjects disclosed more intimately in private than in public. The results not only demonstrated the strength of the effect of social evaluation on the behavior of high-need subjects, but also suggested that personality must be accounted for in self-disclosure research before factors influencing self-disclosure may be understood completely.

Adolescent↗
PubMed1998

Health promotion in different medical settings: women's health, community health and private practice.

This paper describes the health promotion role of doctors in two medical practice settings: women's and community health centres, and fee-for-service practice. It proposes the establishment of divisions of primary health care in Australia which would be multi-disciplinary and focus on community-wide health issues. The paper is based on data from an interview survey of medical practitioners who had worked in metropolitan Adelaide women's and community health centres and from a questionnaire survey of GPs in private practice. The types of health promotion activity by the doctors in the different settings are discussed. It is concluded that private practice GPs are involved primarily in providing health education advice to individual patients. Doctors within women's and community health centres are more likely to report involvement in group health promotion activity and broader community development initiatives. The study concludes that health promotion which focuses on the health of the local community is best conducted within multidisciplinary health centres. GPs in private practice are limited by the structure of their setting (particularly the fee-for-service basis and reliance on a single discipline) to health promotion which focuses on the needs of individual patients.

Attitude of Health Personnel↗
PubMed2004

Antiretroviral therapy and health care utilization: a study of privately insured men and women with HIV disease.

OBJECTIVE: To compare the use of antiretroviral therapy and other health care resources by women and men with HIV disease who are privately insured. DATA SOURCES: Data were obtained from the MarketScan Commercial Claims and Encounter Database produced by the Medstat Group, Inc., of Ann Arbor, Michigan. This database includes eligibility files as well as claims data for inpatient care, outpatient care, physician services, and prescription drugs for enrollees in employer-sponsored benefit plans for 24 large employers around the nation. STUDY DESIGN: Examine utilization by 2,026 privately insured persons (1,494 men and 532 women) with HIV disease in calendar year 2000 under the age of 65. PRINCIPAL FINDINGS: Using a simple comparison, we found that 71 percent of men (68.7 to 73.3 percent is 95 percent confidence interval) and 39 percent of women (35.1 to 43.5 percent is 95 percent confidence interval) with HIV disease received antiretroviral therapy. We also found that the average annual drug cost was $9,037 for a man ($8,372 to $9,702 is 95 percent confidence interval) and $3,893 for a woman ($3,476 to $4,490 is 95 percent confidence interval). Furthermore, we found that the out-of-pocket expenses comprised 10 percent of total expenses for men ($1,617 out of $16,405) and 4 percent for women ($405 out of $10,397). CONCLUSION: There are major differences in the utilization and cost of health care between privately insured men and women with HIV disease.

Adult↗
PubMedDate not supplied

A comparison of phenytoin dosing methods in private practice seizure patients.

In an attempt to evaluate the accuracy of phenytoin (PHT) pharmacokinetic dosage adjustments in a private practice setting, three single dose-concentration pair methods and three multiple point PHT pharmacokinetic dosing methods were studied. Dose and concentration data from 28 patients seen in a private neurology practice were utilized for the study. From a comparison of these methods in private practice seizure patients, it appears that the Bayesian feedback method may be the most accurate in making routine PHT dosage adjustments, perhaps by minimizing the contribution of unknown variables within the Bayesian approach.

Humans↗
PubMed1980

Altruism and economic behavior: II--private charity and public policy.

The relative advantages of private charitable organizations as against government agencies in achieving efficient redistribution of income and supply of services are examined. Central to this discussion is the elasticity of private giving to tax concessions and the proportion of donor dollars being absorbed in overhead. Recent estimates of these magnitudes are summarized. Of parallel concern is to what extent can reliance on altruism by sellers of goods and services serve as a substitute for government regulations to enforce standards, prices or product disclosures. Finally, the ways in which government can use and encourage private charitable impulse to maximize social welfare are examined; of particular interest here is the literature surrounding Richard Titmuss' work on blood donorship which raises the issue of whether or not extension of markets reduces, rather than extends, individual choice. The growing technological complexities of society, it is concluded, render the altruistic virtues of trust and consideration increasingly valuable-if increasingly rare.

Altruism↗
PubMed2006

Insurability and mitigation of flood losses in private households in Germany.

In Germany, flood insurance is provided by private insurers as a supplement to building or contents insurance. This article presents the results of a survey of insurance companies with regard to eligibility conditions for flood insurance changes after August 2002, when a severe flood caused 1.8 billion euro of insured losses in the Elbe and the Danube catchment areas, and the general role of insurance in flood risk management in Germany. Besides insurance coverage, governmental funding and public donations played an important role in loss compensation after the August 2002 flood. Therefore, this article also analyzes flood loss compensation, risk awareness, and mitigation in insured and uninsured private households. Insured households received loss compensation earlier. They also showed slightly better risk awareness and mitigation strategies. Appropriate incentives should be combined with flood insurance in order to strengthen future private flood loss mitigation. However, there is some evidence that the surveyed insurance companies do little to encourage precautionary measures. To overcome this problem, flood hazards and mitigation strategies should be better communicated to both insurance companies and property owners.

Journal Article↗
PubMed1997

Comparison of selected health risk behaviors between adolescents in public and private high schools in South Carolina.

This study examined differences in selected health risk behaviors among 5,517 students attending public high schools (PUBHS) and 1,089 students attending private high schools (PVTHS) in South Carolina. The 1995 CDC Youth Risk Behavior Survey was used to collect self-report information on adolescent risk behaviors. Chi-square analyses were performed for comparing public and private students on selected risk behaviors. Both PUBHS and PVTHS students reported substantial involvement in most of the risk-taking behaviors examined. PUBHS students, in general, were more likely to report higher prevalence rates than PVTHS students for most of the selected health risk behaviors. However, PVTHS students reported even higher prevalence rates than PUBHS students for alcohol use, driving after drinking, and binge drinking; smoking cigarettes (past 30 days); chewing tobacco (males only); marijuana use during the past 30 days (females only); and use of alcohol or other drugs before last act of sexual intercourse. Results suggest attendance at a private high school is not a panacea for protection against adolescent risk behaviors, and that all high school students could benefit from a coordinated school health program.

Adolescent↗
PubMed1993

Genetic testing and the social responsibility of private health insurance companies.

In this paper, I have pressed the general question, "Are private health insurers responsible for preventing the problems of equity and access that genetic discrimination would pose?" I have argued that socially responsible insurance companies will avoid genetic discrimination, even if they conceive of their social responsibility in narrow terms. The significance of this point extends beyond the specific question of genetic testing, and bears relevance to broader debates about reforming the nation's health care system. Ultimately, society's attraction to retaining a private health insurance market depends upon private health insurers affirming and meeting responsibilities to the wider society. How society and the insurance industry respond in the face of new genetic testing capabilities will be a moral guidepost indicating how we as a society should devise and implement health care reform.

Delivery of Health Care↗
PubMed1979

The public and private sector: a developing partnership in human services.

Historically, public and private providers of health and welfare services have functioned in separate, often incompatible, arenas. Drawing from the experience of a private child mental health center, the authors suggest that a more coordinated and collaborative approach would benefit both the public and private sectors, as well as their client populations.

Adult↗