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PubMed1992

Long term care arrangements for elderly persons with disabilities: private and public roles.

When private resources are defined broadly to include informal care as well as private expenditures, 73 percent of the elderly long term care population rely entirely on private resources for their care. The emphasis of current programs on institutional care directs public resources toward those with more serious disability and less family to care for them. Among those with four or five disabilities in ADLS, 35 percent of those without a spouse or children currently receive no public support, compared with nearly 80 percent of those with both a spouse and children. Thus, even if restricted to seriously disabled persons, a new program expanding public long term care financing would increase eligibility for public benefits disproportionately among those with greater informal care resources.

Activities of Daily Living↗

PubMed1998

Involving private voluntary health care providers in 'Better Health for Africa'.

In Sub-Saharan Africa private voluntary health care providers are mostly Church-related or social not for profit organizations. They provide between 40% and 60% of health care services. In the context of Health Care Reforms, the World Bank and others have (re)discovered these non governmental providers. The World Bank document 'Better Health for Africa', promotes prominent roles for them in the execution of basic package of services and public health tasks. Unfortunately, the World Bank does not outline clearly how these roles should be achieved. The danger exists that governments, under pressure to economize, will only take the privatization angle which is in contradiction with the aims and objectives of the not for profit private providers. Thus their potential to contribute to Public Health care will be left unused and the reforms harder to achieve. My argument is that the collaboration between government and NGOs should be approached in the perspective of delegation of public duties and partnership. Thus the autonomy of NGO providers can be respected while their technical capabilities can be used optimally.

Africa South of the Sahara↗

PubMed1981

Income tax; definition of a private foundation--Internal Revenue Service. Final regulations.

This document contains final regulations relating to the definition of a private foundation. Changes to the applicable tax law were made by Pub. L. 94-81, enacted August 9, 1975. The regulations affect certain tax-exempt organizations seeking to qualify as other than private foundations which acquire unrelated trades or businesses after June 30, 1975. The regulations provide such organizations with guidance necessary to determine whether they qualify as other than private foundations.

Foundations↗

PubMed1986

Creating a private association: the St. Francis experience.

The group of laypersons who founded St. Francis Hospital, Memphis, TN, in 1971 were dedicated to upholding Catholic values in health care yet often were questioned about the origins of their "Catholic" identity. "How can a hospital that is not owned by the diocese or sponsored by a religious institute call itself Catholic?" they were asked. The answer, St. Francis found, lies in the revised Code of Canon Law, which provides for a group of laypersons such as theirs to form a private association of the Christian faithful, be officially recognized by the Church, and receive canonical status. A participant in the pilot project through which CHA is studying the feasibility of alternative forms of sponsorship, St. Francis has worked closely with CHA in developing the private association's statutes and coordinating with the bishop provisions for evaluation of its stewardship. According to the statutes, the private association will monitor the hospital's adherence to Church values, and the bishop, serving in a pastoral capacity, will with CHA's assistance assess the association's effectiveness in carrying out its mission.

Catholicism↗

PubMed1985

The future of research in private psychiatric hospitals.

The private psychiatric hospital setting offers some unique advantages as a locus for research. They are often able to serve as settings for clinical research programs which are, in many cases, more pragmatic than research in university settings. Types of studies which might be conducted in the private psychiatric hospital setting include focused diagnostic studies, the recovery process, psychobiological screening, psychopharmacological treatment trials, longitudinal studies, alternative delivery and training systems, and consortium studies. Funding for research exists in both the public and private sectors, with most of the money coming from the federal government. Applicants should be well-versed in the grant application at the National Institute of Mental Health.

Hospitals, Psychiatric↗

PubMed1983

Problems in private psychiatric insurance.

Insurance coverage for hospitalization in a freestanding psychiatric facility faces challenging, but not insurmountable, difficulties currently and in the immediate future. Relevant issues include: possible reductions in health insurance tax deductibility, so-called "consumer choice" and "pro-competition" options, prospective financing, and cost shifting from government insurance onto private patients. Some problems more specific to private psychiatric hospitals include: misuse of insurance coverage for dubious "therapies," the effects of declining coverage, the "dental versus mental" conflict, the effect of non-physicians entering the provider pool, poor coverage for liaison and consultation psychiatry, inappropriate usage, and confidentiality concerns. Positive future possibilities include: implementation of government insurance programs through private sector contracts, continuing improvement in psychiatric scientific technology, increased accountability efforts, public education, and improvements in psychiatry's relationships with labor and management.

Cost Allocation↗

PubMed1979

Private health insurance plans in 1977: coverage, enrollment, and financial experience.

The private health insurance industry collected $47.1 billion in premiums in 1977 and returned $41.6 billion in benefits to their subscribers. Premiums rose 16.3 percent as a direct consequence of rapid claims growth in 1976. After operating expenses were deducted, the industry showed a small, $.4 billion underwriting loss. About 78 percent of the population were insured for hospital care, and about 76 percent for surgical services. Smaller percentages had coverage for other types of care. An estimated 61.8 percent of the aged bought private hospital insurance, and 47.1 percent bought surgical insurance, mostly to supplement Medicare benefits. About 12 percent of persons under age 65 had no protection against the cost of hospital care either through private insurance or a public program such as Medicare or Medicaid.

Data Collection↗

PubMed1981

Private health insurance plans in 1978 and 1979: a review of coverage, enrollment, and financial experience.

The private health insurance industry collected $55.9 billion in premiums in 1979 and returned $50.2 billion in benefits to its subscribers. Premiums rose 12.4 percent, slightly faster than in 1978 when premiums rose 11.4 percent, to $49.7 billion. Benefits rose 11.4 percent in 1979, down from the 12.6 rate in 1978. After operating expenses were deducted, the industry showed underwriting losses of $1.4 billion in 1979 and $1.5 billion in 1978. About 78 percent of the population was insured for hospital care, 76 percent for x-ray and laboratory examinations, and about 76 percent for surgical services in 1979. Smaller percentages had coverage for other types of care. An estimated 64 percent of the aged bought private hospital insurance, and about 43 percent bought surgical insurance, mostly to supplement Medicare benefits. An estimated 12 percent of persons under age 65 had no protection against the cost of hospital care either through private insurance or a public program such as Medicare or Medicaid.

Insurance↗

PubMed1984

Private health insurance: new measures of a complex and changing industry.

Private health insurance benefit payments are an integral component of estimates of national health expenditures. Recent analyses indicate that the insurance industry has undergone significant changes since the mid-1970's. As a result of these study findings and corresponding changes to estimating techniques, private health insurance estimates have been revised upward. This has had a major impact on national health expenditure estimates. This article describes the changes that have occurred in the industry, discusses some of the implications of those changes, presents a new methodology to measure private health insurance and the resulting estimate levels, and then examines concepts that underpin these estimates.

Evaluation Studies as Topic↗

PubMed1988

Long-term care: the public role and the private initiatives.

The ongoing effort of the U.S. Department of Health and Human Services to identify private financing mechanisms that can effectively assist the rapidly growing population of older persons in paying for long-term care expenses is discussed in this article. The focus on private strategies stems from the recognition that Federal and State sectors already pay almost one-half of all long-term care expenses, the proclivity of liberalized financing structures to raise total costs, and the tendency of public financing to dampen choice, flexibility, and access to care. In view of the improved economic situation of most older persons in our Nation today, the potential for market development of private financing options is thought to be excellent, particularly the market for long-term care insurance.

Aged↗

PubMed1999

Black and white middle class children who have private health insurance in the United States.

OBJECTIVE: To compare the health, behavior and school problems, and use of medical, mental health, and special education services of privately insured, middle class black and white children in the United States. DESIGN/METHODS: Analyses of the Child Health Supplement to the 1988 National Health Interview Survey, with a nationally representative sample of 17 110 children age 0-17 years. RESULTS: Privately insured middle class black children had fewer chronic health conditions, but were less likely to be reported to be in excellent health (46.2% vs 57.3%) and more likely to have had asthma (8.5% vs 5.8%) or to have been of low birth weight (10.7% vs 5.6%). There were no differences in rates of having a usual source of routine care (92.2% vs 93.8%) or of being up to date with well-child care (79.3% vs 78.2%), but black children made fewer physician visits, were less likely to use physicians' offices, were more likely to lack continuity of care, and were twice as likely to use emergency departments. These differences in use of medical services persisted in multivariate analyses and analyses restricted to more affluent children. Despite similar rates of behavior problems, black children were more likely to repeat a grade (20.0% vs 12.3%) and to have been suspended from school (11.3% vs 5.0%). Although significantly fewer black middle class children received mental health or special education services in bivariate analyses, no differences in receipt of these services were noted in multivariate analyses. All differences reported were significant. CONCLUSIONS: Among middle class children in the United States, black and white children have similar rates of health and behavior problems, but black children experience substantially increased rates of asthma, low birth weight, and school difficulties. Although not differing in the receipt of mental health or special education services, middle class black children, even in the presence of private health insurance, have markedly different sources and patterns of use of medical services.

Adolescent↗

PubMed1999

Mother-child interaction, private speech, and task performance in preschool children with behavior problems.

The purpose of the present study was to explore patterns of mother-child interaction, children's private speech use, and behavioral self-regulation among a sample of preschool children identified by their preschool teachers as evidencing behavior problems. Forty preschoolers were classified into two groups (behaviorally at-risk and a matched comparison group) on the basis of teacher ratings of impulsivity, inattention, and hyperactivity. Children completed a magnet board puzzle task once in collaboration with their mother and once individually, and maternal and child speech and behavior were coded from videotapes. Although there were no group differences in children's behavior or speech during the collaborative session, nor were there differences in children's individual task performance or on-task attention, mother-child interaction involving behaviorally at-risk children was characterized by more other-regulation, negative control, less praise, and less physical withdrawal over time, compared to interactions involving comparison children. Behaviorally at-risk children, compared to controls, used more overt, task-relevant private speech during individual problem solving. Partially internalized private speech use among at-risk preschoolers was positively associated with task performance. Group differences rather than similarities prevailed in terms of the relations between maternal behavior, child speech, and child performance.

Adult↗

PubMed2000

The "double discourse" on sexual and reproductive rights in Latin America: the chasm between public policy and private actions.

This article examines how political controversies affect citizens' ability to exercise sexual and reproductive rights in Latin America. The article argues that societies accommodate conflicting views on sexuality and reproduction with a "double discourse system," which defends repressive or negligent public policies while privately tolerating unofficial and often illegal mechanisms that expand private sexual and reproductive choices. The examples of divorce policy in Chile and abortion policy in Colombia and Chile are highlighted to illustrate how this breach between public discourse and private actions operates in practice, and who is harmed by it. The article concludes by discussing the implications of this system for rights advocacy.

Abortion, Legal↗

PubMed1999

Pattern of lymph node pathology in a private pathology laboratory.

Lymph node excision biopsy is commonly carried out for the investigation of lymphadenopathy. The objective of this study is to elucidate the pattern of nodal pathology seen in a private pathology practice. A total of 137 nodal biopsies for primary investigation of nodal enlargement were retrieved from the files in a private diagnostic pathology laboratory in the year 1997. Lymph nodes excised for cancer staging were excluded from this study. The histology was reviewed based on H&E stained sections, and with additional histochemical and immunoperoxidase stains when deemed necessary. Cases of malignant lymphomas were sub-classified with the aid of further immunophenotyping using a panel of monoclonal and polyclonal lymphoid antibodies. One case was excluded from this study due to inadequate tissue for further assessment. There were 58 males and 78 females, giving a ratio of 1:1.3 in the remaining 136 cases. They consisted of 13 Malays (M), 108 Chinese (C), 14 Indians (I) and 1 other ethnic group (O). The ratio of M:C:I:O was 1:8.3:1.1:0.1. The majority of the cases were in the age range of 20 to 50 years. The pathology consisted of 17 (12.5%) malignant lymphomas [6 Hodgkin's lymphoma, 11 non-Hodgkin's lymphoma], 35 (25.7%) metastatic carcinomas, 45 (33.1%) reactive hyperplasia, 19 (13.9%) tuberculosis, 11 (8.2%) Kikuchi's disease and 9 (6.6%) others (Castleman's disease 2, cat scratch disease 2, Kimura's disease 1, sarcoidosis 1, non-specific lymphadenitis 3). All categories of nodal disease showed approximately similar ratio of ethnic and gender distribution as above, except for Kikuchi's disease, for which 100% of the patients were female. The most common site of biopsy was from the head and neck region, particularly the cervical group of nodes. The most common nodal pathology seen in the private laboratory was reactive hyperplasia, followed by metastatic carcinoma. Malignant lymphoma constituted only 12.5% of the cases.

Adolescent↗

PubMed2001

[Psychological reaction in private accident insurance. Differences in legal apprehension].

According to the provisions of private accident insurance, mental or psychological reactions are in contrast to basically not covered by insurance. The body is the object of insurance, not like third party insurance, which covers health. Since 1993 private accident insurance companies have been able to offer better coverage for mental or psychological reactions. But these possibilities for modifications of the AUB (terms and conditions of private accident insurance) introduced in 1993 constitute a departure from the traditional terms and conditions of the AUB.

Accidents↗

PubMed2002

[Introduction of the DRG system from the point of view of private health insurers].

For the first time, there has been a worldwide attempt to fund all hospital services almost completely by a DRG system supplemented by additional charges, rebates, and procedural rates. In the interest of the efficiency and transparency of hospital services the introduction of a German DRG system settling the current implausible price differences would be welcome. The system selected by the medical self-governing bodies in Germany is based upon the Australian AR-DRG classification. In contrast to other systems, the latter provides the best medical plausibility, the highest transparency of the assignment algorithm and the highest potential for flexibility and adaptations to changing morbidity patterns and medical progress. The adaptation to the conditions of the German health care system requires considerable efforts on the part of hospitals as well as sickness funds and health insurers. Hospitals need to establish a cost unit accounting system satisfying the rules of Applied Economics to allow, among other things, the calculation of relative cost weights. The self-governing bodies will have to consent on a complex regulation system. The German Hospital Federation declared the break down of negotiations concerning a provisional DRG system to be optionally available to hospitals in 2003. The Federal Ministry of Health will now have to decide whether to implement the system through executive fiat. The comprehensive DRG system will introduce new risks. The economic risks of the individual hospital, though not the individual insurer's risks, will be partially compensated for in the introductory phase by revenue balance mechanisms, for example. In particular, both the privately insured and civil servants will face a rise in costs as they will no longer benefit from a shorter length of hospital stay. To end this discrimination against private health insurers, the double counting of the costs associated with medical treatment (included in the DRG price and additionally invoiced by the physician) must be avoided: Once the current reimbursement for costs of optional medical services--being mainly a subsidy borne by private patients--is discontinued, the fee reduction according to Sect. 6a GOAe (medical fee schedule) must be adjusted definitely. This new primacy of economics could pose a threat to the quality of medical treatment. Therefore, quality assurance directives find increasing relevance. Preferably, healthcare providers should rigorously adhere to their scientific standards. Only a strictly rule-based introduction and the system's annual adaptation can keep the risks calculable.

Diagnosis-Related Groups↗

PubMed2003

Words used by children and their primary caregivers for private body parts and functions.

BACKGROUND: Effective patient-physician communication requires the use of words that are clearly understood by both parties. We conducted this study to compile a list of words used by children and caregivers to describe "private" anatomical structures and physiological functions, to document the frequency of such usage and to examine the relation between correct word usage and caregiver's level of education. METHODS: In a large urban pediatric emergency department, a convenience sample of 156 children at least 3 years old were asked to name the body parts (penis, testes, vagina, buttocks, breasts) pointed to in 4 simple, explicit line drawings of an unclothed boy or girl, and to name the bodily functions (vomiting, defecation, urination) depicted in 3 drawings of children. Eighty-seven patients sufficiently fluent in English were included in the study. Their caregivers were asked separately what words they currently use with their child and with other adults for these body parts and functions and what words they remembered using as children. RESULTS: The children used a mean of 1.2 correct anatomical and physiological terms out of a possible 8 to describe the private parts and functions in the drawings. The mean number of correct words used by the caregivers was 2.3 when talking with their children, 3.6 when talking with their peers and 1.5 when they were children. There was no correlation between the caregiver's level of education and the frequency of correct word usage by their children. We identified slang words used by at least 5% of the respondents; however, some used the same slang words to refer to different body parts. INTERPRETATION: Given the variety of slang words used by children and their caregivers to describe private parts and functions, the meaning of the words should be clarified during history taking.

Body Image↗

PubMed2002

The impact of private long-term care insurance on claimants: formal and informal care in the community.

Policy makers show continuing interest in the potential for long-term care (LTC) insurance to save public money by reducing pressure on the Medicare and Medicaid programs. Although the purchase of LTC insurance is being encouraged by government - through tax incentives and the offering of private LTC insurance as an option for public employees - little is known about how benefits are used, whether those claiming benefits feel they are getting good value for their money, and whether the patterns of formal (paid) and informal (unpaid) service use differ for insurance claimants compared to similarly disabled persons without private LTC insurance. This brief provides information on older people claiming LTC insurance benefits and compares their experiences to those of non-privately insured older people who need LTC. We conclude that LTC insurance is an important source of support for those who lack informal support from family and friends. However, LTC insurance remains a complex product; claimants need help in using their benefits to obtain the appropriate level and quality of care and in understanding at the time of purchase how much protection they need.

Activities of Daily Living↗