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PubMed2002

Household firearm ownership and suicide rates in the United States.

BACKGROUND: In the United States, more people kill themselves with firearms than with all other methods combined. A central question regarding the relation between firearms and suicide is whether the ready availability of firearms increases the suicide rate, rather than merely increasing the proportion of suicides from guns. METHODS: We used publicly available data for the nine regions and 50 states in the United States over a 10-year period (1988-1997) to examine the association between levels of household firearm ownership and rates of suicide, firearm suicide, and non-firearm suicide by age groups and gender. RESULTS: In both regional and state-level analyses, for the U.S. population as a whole, for both males and females, and for virtually every age group, a robust association exists between levels of household firearm ownership and suicide rates. CONCLUSIONS: Where firearm ownership levels are higher, a disproportionately large number of people die from suicide.

Adolescent↗

PubMed2005

The relationship of insurance status, hospital ownership, and teaching status with interhospital transfers in California in 2000.

PURPOSE: Public hospitals and academic medical centers may admit more poorly insured transfer patients than do other institutions. The authors investigated the relationship of patient insurance status, hospital ownership, and hospital teaching status with interhospital transfers in California. METHOD: In 2003, data were derived from the hospital discharge abstract database for the year 2000 from the California Office of Statewide Health Planning and Development. Hospitals were categorized by ownership and teaching status; patients were categorized as being "good" or "poor" payers depending on the level of expected insurance reimbursement. Descriptive and multivariate analyses were used to assess the number of poor payer transfers admitted by each hospital group. RESULTS: In 2000, there were 58,509 transfer and 2,320,479 direct admissions. All hospital groups admitted a higher percentage of good payer than poor payer transfer patients (85% vs. 15% respectively for all groups combined). Adjusted for total number of admissions and teaching status, the number of poor payer transfer patients admitted to county-owned and University of California hospitals was significantly higher than the statewide average (both p values < .001), while the number admitted to independent teaching hospitals was significantly lower than the statewide average (p < .001). The number of poor payer transfer patients admitted to independent teaching hospitals more closely resembled that of for-profit hospitals than that of University of California teaching hospitals. CONCLUSIONS: In 2000, the likelihood of a hospital admitting a transfer patient appears to have been affected by both the patient's insurance status and the hospital's ownership. In general, good payer patients were more likely to be transferred than were poor payer patients, with poor payer transfer patients more likely to be admitted to publicly owned hospitals.

California↗

PubMedDate not supplied

Quality of care differences by ownership in United States renal dialysis facilities.

Recent studies of patient outcomes in the United States have shown mixed conclusions regarding the effect of for-profit ownership on treatment quality. To test whether outcome quality differs across ownership types for patients being treated for end stage renal disease, a cross-sectional study was performed using data from 180,913 end stage renal disease patients receiving center based hemodialysis in 1996. Results indicated that patients in for-profit renal dialysis facilities had slightly higher mortality during the study period than patients in not-for-profit facilities, after controlling for patient case mix and market type. For profit ownership seems to affect not only treatment inputs, according to previous research, but also patient outcomes, as indicated by the results here.

Hemodialysis Units, Hospital↗

PubMed1996

Ownership and uses of human tissue: does the Nuffield bioethics report accord with opinion of surgical inpatients?

OBJECTIVE: To compare opinion of surgical inpatients with the conclusions of the report of the Nuffield Council on Bioethics regarding the ownership and uses of human tissue. DESIGN: Survey of results of questionnaires completed by patients. SETTING: Large teaching hospital. SUBJECTS: 384 postoperative adult surgical patients. RESULTS: There was strong support among patients for the use of tissues in medical education, research, and science with the exception of those tissues which may transmit disease to others. Few patients (39; 10%) believed that they retained ownership of tissue removed at surgery. Most believed that the tissue belonged to the hospital (103; 27%), to nobody (103; 27%), or to the laboratory (77; 20%). Most patients had not been given any information about the possible uses of their tissues after removal. CONCLUSIONS: Surgical inpatients seem to endorse the conclusions of the Nuffield report regarding the ownership and uses of human tissue. The recommendations regarding patient information and consent procedures should be implemented at the earliest opportunity.

Adult↗

PubMed1996

Firearm ownership and storage practices in Pennsylvania homes.

OBJECTIVE: To determine the household prevalence of firearms in Pennsylvania, and describe the storage practices for these weapons. DESIGN: A statewide telephone survey of 3,620 Pennsylvania adults selected from households by random digit dialing in 1994. MAIN OUTCOME MEASURES: Firearm ownership and storage practices were computed by household characteristics using logistic regression. RESULTS: The prevalence of firearm ownership was 37% (95% confidence interval = 35.4 to 38.6). Ownership of firearms was significantly higher for white residents, households with annual income of $20,000 or more, those in rural counties, and those with children and adolescents. Of the households with firearms, 23% contained a single firearm, the majority of which were handguns (40%) or rifles (40%); 76% had two or more firearms, with 57% reporting one handgun or more and 83% reporting one rifle or more. Storage of firearms in 72% of households involved two or more of these barriers: (1) taken apart; (2) trigger lock applied; (3) kept in a locked place; (4) unloaded; (5) no other ammunition; (6) locked ammunition; 6% stored at least one of their firearms with none of these barriers. The strongest predictor of storing a firearm with fewer than two protective barriers was households with no children or adolescents. CONCLUSIONS: Firearms are present in a large number of Pennsylvania homes. Many of these homes also contain children. To reduce the potential risks of firearms, optimal methods of storage of firearms in the home need to be determined.

Adult↗

PubMed2000

The experience of pet ownership as a meaningful occupation.

This qualitative study examined the experience of pet ownership in the everyday lives of seven men with human immuno-deficiency virus or acquired immune deficiency syndrome. Interviews and field observations were analyzed using a grounded theory approach. The findings demonstrate that the experience of pet ownership is both typical of any pet owner and yet profoundly impacted by the illness of the owners. The results of this preliminary study indicate pet ownership can be a highly valued occupation for some, and thus has implications for occupational therapy intervention.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Ownership of high-risk ("vicious") dogs as a marker for deviant behaviors: implications for risk assessment.

This study examined the association between ownership of high-risk ("vicious") dogs and the presence of deviant behaviors in the owners as indicated by court convictions. We also explored whether two characteristics of dog ownership (abiding licensing laws and choice of breed) could be useful areas of inquiry when assessing risk status in settings where children are present. Our matched sample consisted of 355 owners of either licensed or cited dogs that represented high or low-risk breeds. Categories of criminal convictions examined were aggressive crimes, drugs, alcohol, domestic violence, crimes involving children, firearm convictions, and major and minor traffic citations. Owners of cited high-risk ("vicious") dogs had significantly more criminal convictions than owners of licensed low-risk dogs. Findings suggest that the ownership of a high-risk ("vicious") dog can be a significant marker for general deviance and should be an element considered when assessing risk for child endangerment.

Adult↗

PubMed1997

Potential benefits of pet ownership in health promotion.

Pet ownership provides an opportunity to improve health. A pet may become a stimulus for exercise, reduce anxiety, and provide an external focus of attention. Pets are also a source of physical contact and comfort and may decrease loneliness and depression while promoting an interesting lifestyle. The benefits of pet ownership are consistent with the health promotion and disease prevention goals outlined in Healthy People 2000. These goals include (a) increasing physical activity and fitness and (b) improving mental health and preventing mental disorders. Assessment of pet ownership and discussion of potential health benefits facilitates a holistic understanding of our patients and ourselves.

Animals↗

PubMed2005

Determinants of health insurance ownership among South African women.

BACKGROUND: Studies conducted in developed countries using economic models show that individual- and household- level variables are important determinants of health insurance ownership. There is however a dearth of such studies in sub-Saharan Africa. The objective of this study was to examine the relationship between health insurance ownership and the demographic, economic and educational characteristics of South African women. METHODS: The analysis was based on data from a cross-sectional national household sample derived from the South African Health Inequalities Survey (SANHIS). The study subjects consisted of 3,489 women, aged between 16 and 64 years. It was a non-interventional, qualitative response econometric study. The outcome measure was the probability of a respondent's ownership of a health insurance policy. RESULTS: The chi2 test for goodness of fit indicated satisfactory prediction of the estimated logit model. The coefficients of the covariates for area of residence, income, education, environment rating, age, smoking and marital status were positive, and all statistically significant at p < or = 0.05. Women who had standard 10 education and above (secondary), high incomes and lived in affluent provinces and permanent accommodations, had a higher likelihood of being insured. CONCLUSION: Poverty reduction programmes aimed at increasing women's incomes in poor provinces; improving living environment (e.g. potable water supplies, sanitation, electricity and housing) for women in urban informal settlements; enhancing women's access to education; reducing unemployment among women; and increasing effective coverage of family planning services, will empower South African women to reach a higher standard of living and in doing so increase their economic access to health insurance policies and the associated health services.

Adolescent↗

PubMed2005

Staffing levels in not-for-profit and for-profit long-term care facilities: does type of ownership matter?

BACKGROUND: Currently there is a lot of debate about the advantages and disadvantages of for-profit health care delivery. We examined staffing ratios for direct-care and support staff in publicly funded not-for-profit and for-profit nursing homes in British Columbia. METHODS: We obtained staffing data for 167 long-term care facilities and linked these to the type of facility and ownership of the facility. All staff were members of the same bargaining association and received identical wages in both not-for-profit and for-profit facilities. Similar public funding is provided to both types of facilities, although the amounts vary by the level of functional dependence of the residents. We compared the mean number of hours per resident-day provided by direct-care staff (registered nurses, licensed practical nurses and resident care aides) and support staff (housekeeping, dietary and laundry staff) in not-for-profit versus for-profit facilities, after adjusting for facility size (number of beds) and level of care. RESULTS: The nursing homes included in our study comprised 76% of all such facilities in the province. Of the 167 nursing homes examined, 109 (65%) were not-for-profit and 58 (35%) were for-profit; 24% of the for-profit homes were part of a chain, and the remaining homes were owned by a single operator. The mean number of hours per resident-day was higher in the not-for-profit facilities than in the for-profit facilities for both direct-care and support staff and for all facility levels of care. Compared with for-profit ownership, not-for-profit status was associated with an estimated 0.34 more hours per resident-day (95% confidence interval [CI] 0.18-0.49, p < 0.001) provided by direct-care staff and 0.23 more hours per resident-day (95% CI 0.15-0.30, p < 0.001) provided by support staff. INTERPRETATION: Not-for-profit facility ownership is associated with higher staffing levels. This finding suggests that public money used to provide care to frail eldery people purchases significantly fewer direct-care and support staff hours per resident-day in for-profit long-term care facilities than in not-for-profit facilities.

Analysis of Variance↗

PubMed1998

The gender gap in reporting household gun ownership.

OBJECTIVES: This study examined errors in estimating household gun ownership that result from interviewing only 1 adult per household. METHODS: Data from 2 recent telephone surveys and a series of in-person surveys were used to compare reports of household gun ownership by husbands and wives. RESULTS: In the telephone surveys, the rate of household gun ownership reported by husbands exceeded wives' reports by an average of 12 percentage points; husbands' reports also implied 43.3 million more guns. The median "gender gap" in recent in-person surveys is 7 percentage points. CONCLUSIONS: Future research should focus on respondents' reports about personally owned guns.

Adult↗

PubMed2001

Does investor ownership of nursing homes compromise the quality of care?

OBJECTIVES: Two thirds of nursing homes are investor owned. This study examined whether investor ownership affects quality. METHODS: We analyzed 1998 data from state inspections of 13,693 nursing facilities. We used a multivariate model and controlled for case mix, facility characteristics, and location. RESULTS: Investor-owned facilities averaged 5.89 deficiencies per home, 46.5% higher than nonprofit facilities and 43.0% higher than public facilities. In multivariate analysis, investor ownership predicted 0.679 additional deficiencies per home; chain ownership predicted an additional 0.633 deficiencies. Nurse staffing was lower at investor-owned nursing homes. CONCLUSIONS: Investor-owned nursing homes provide worse care and less nursing care than do not-for-profit or public homes.

Activities of Daily Living↗

PubMed1986

The diffusion of MRI: patterns of siting and ownership in an era of changing incentives.

The rate and pattern of magnetic resonance imaging (MRI) siting and ownership are examined in the context of the current turbulent health-care environment. By the end of 1984, 151 MRI units were located at 134 different sites. There was one MRI unit for every 1.55 million Americans. Most of the largest metropolitan areas had at least one unit. Overall, however, the diffusion rate of MRI has lagged behind that of computed tomography (CT). Trends in magnet preference, siting, and ownership are evolving. While the majority of all units are located within hospitals, the diffusion of nonhospital-based MRI units is accelerating. The deployment of hospital-based units is progressing at a slower rate, largely limited to academic institutions and urban centers. Purchase of superconducting and permanent magnets is accelerating, while that of resistive units is decreasing. Likewise, there is a trend toward adoption of intermediate (0.5 T-0.6 T) and large (1.0 T or 1.5 T) magnets. Ownership arrangements are highly varied and characterized by increased efforts at risk-sharing, trends that reflect a more competitive, profit-oriented medical-care environment. An analysis of recent health-policy initiatives and evolving market factors helps to explain some of these observations. Increased cost-consciousness, prospective reimbursement systems, loopholes in current regulations, and increased competition among health-care providers are influencing the diffusion of MRI and may herald the fate of other expensive medical technologies in the near future.

Delivery of Health Care↗

PubMed1990

Developing employee ownership of the quality improvement process.

Developing true employee ownership of quality improvement is a process in itself. It begins with sending clear signals to employees that management fully supports the process and is committed to making it successful. It is reinforced when managers provide for the progressive education of all employees to ensure that job requirements are known and are achievable. Employee ownership of quality improvement continues to develop with ongoing management action that makes it clear that doing things right the first time is a part of the organizational culture. Encouraging the use of prevention--including quality improvement responsibilities in job descriptions and performance appraisals; the use of problem identification systems; and employee involvement in corrective action teams, quality improvement teams, and the management of the process--sends the message to employees that employee ownership of the process is a way of life in the organization. When success of the quality improvement effort is related to and understood as the key to the organization's success, as well as that of individual employees, and when each employee personally accepts the importance of his or her own role in making quality happen, the organization is well on its way to achieving its quality improvement objectives.

Consumer Behavior↗

PubMed1993

Contemporary issues in HIM. Costs of ownership.

Cost of ownership includes (among others) initial cost, cost of operation, cost of maintenance, and cost of training. Two important components of initial cost are the cost of design and the cost of manufacturing. In this article, we have looked at how factors other than initial cost affect the total cost of ownership of a product. We also discussed how trade-offs can affect performance and cost. Before making any decision on purchasing a complicated new system, the user needs to evaluate the total cost of ownership to determine which product to buy. Unfortunately, it is not always easy to find all the information needed to make these decisions.

Computer Systems↗

PubMed1994

How hospital ownership affects access to care for the uninsured.

This article addresses the effect of hospital ownership on the delivery of service to uninsured patients. It compares the volume of uninsured patients treated in for-profit and nonprofit hospitals by regarding hospital ownership and service as endogenous. Instrumental variable estimates are used to predict the percentage of patients who are uninsured, controlling for hospital ownership and service. The study shows that when for-profit and nonprofit hospitals are located in the same area, they serve an equivalent number of uninsured patients, but for-profit hospitals indirectly avoid the uninsured by locating more often in better-insured areas.

Chi-Square Distribution↗

PubMed1987

Diversification of health care services: the effects of ownership, environment, and strategy.

The present findings suggest that the trend toward greater diversification of hospital services is likely to be most strongly influenced by state Medicaid policies and certain hospital characteristics. Increasing Medicaid eligibility and payment levels is likely to have a positive effect on services diversification. Growth in the number of inpatient services provided and a more severe case mix are also likely to be involved with greater service diversification. Affiliation with a not-for-profit hospital system is likely to be associated with more diversified hospital services but not affiliation with an investor-owned system. There is also some indication that the overall portfolio of services which a hospital offers in regard to market share and market growth characteristics influences diversification. Specifically, a low market share portfolio is likely to be associated with less diversification. Competition is likely to be associated with more diversification; particularly for hospitals belonging to systems. The effect of competition on hospital strategy and services diversification is a particularly important area for further investigation. Increasing Medicaid payment and eligibility levels are also likely to have a positive effect on the provision of services which are usually unprofitable. Raising such levels is likely to be particularly beneficial to inner-city hospitals who are already providing a greater number of such services. However, the present data suggest that investor-owned hospitals are least likely to provide such services. Increasing Medicaid eligibility levels is also likely to be associated with fewer services for which charity care has to be provided. State regulation in the form of rate review and certificate of need is likely to be associated with more services for which hospitals provide some charity care. But such policies alone do not deal with the larger issue of how to finance care for the medically indigent. Present data suggest the charity care issue may be particularly salient in markets characterized by a relatively high degree of competition. Finally, investor-owned hospitals provide as many services involving charity care as not-for-profit system hospitals, although investor-owned system hospitals provide fewer such services than not-for-profit freestanding hospitals. Throughout, the findings indicate the importance of distinguishing between ownership and system affiliation. Previous research has failed to make a distinction between ownership form and system affiliation, thus attributing to ownership form differences which, as present findings suggest, appear to be more associated with system affiliation.(ABSTRACT TRUNCATED AT 400 WORDS)

Factor Analysis, Statistical↗

PubMed1992

Ownership and organizational performance. A comparison of technical efficiency across hospital types.

Using a national data base of urban hospitals, the effect of ownership (government, nonprofit, and for-profit) on the technical efficiency of hospitals was examined. Efficiency scores were computed using a method called data envelopment analysis. Controlling for environmental and hospital characteristics, for-profit hospitals were found somewhat less frequently and government hospitals consistently more frequently in the efficient category. When examining highly inefficient hospitals as a percentage of those receiving inefficient scores, for-profit hospitals appeared to be highly inefficient relative to the other ownership forms. Government and nonprofit hospitals were somewhat indistinguishable from one another regarding their percentages of highly inefficient scores. For-profit hospitals also tended to use supply and capital asset (hospital size) inputs less efficiently, and service and labor inputs more efficiently than hospitals in the other ownership categories.

Efficiency↗