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PubMed2004

Mental health disorders and sexually transmitted diseases in a privately insured population.

OBJECTIVES: To consider whether patients who use mental health services in privately insured settings are also more likely to have received sexually transmitted disease (STD) or human immunodeficiency virus (HIV) diagnoses and whether this relationship extends to patients with milder mental health disorders. METHODS: Using frequency tables stratified by age and sex, a logistic regression model, and difference of means tests, we examined the relationship between mental health claims and STDs in a sample of 289 604 privately insured people across the United States. RESULTS: Patients with mental health claims were more than twice as likely as other patients to have an STD claim in the same year after controlling for confounding factors (odds ratio, 2.33; 95% confidence interval, 2.11-2.58). This relationship held for severe and milder mental health diagnoses, for male and female patients, and in each age category from 15 to 44 years. Among women, patients aged 20 to 24 years with a mental health claim had the highest predicted probability of STD diagnoses (3.0%); among men, patients aged 25 to 29 years with a mental health claim had the highest predicted probability of STD diagnoses (1.2%). CONCLUSIONS: In this population, patients with mental health claims were more likely to also have claims with diagnoses for STDs than patients without mental health claims, and this relationship applied to severe and milder mental health disorders. This suggests that people with mental health disorders in privately insured populations may benefit from routine STD risk assessments to identify high-risk patients for referral to cost-effective preventive services.

Adolescent↗
PubMed2005

State smoking restrictions for private-sector worksites, restaurants, and bars--United States, 1998 and 2004.

Secondhand smoke is a known carcinogen. Exposure to secondhand smoke causes approximately 35,000 heart disease deaths and 3,000 lung cancer deaths among nonsmokers in the United States every year. Implementing policies that establish smoke-free environments is the most effective approach to reducing secondhand smoke exposure among nonsmokers. Smoking restrictions and smoke-free policies can take the form of laws or regulations implemented at the state or local level or of voluntary policies implemented by private employers and businesses. Smoking restrictions limit smoking to certain areas within a venue; smoke-free policies ban smoking within the entire venue. One of the national health objectives for 2010 is to establish laws in all 50 states and the District of Columbia (DC) that prohibit or restrict smoking in public places and worksites. A related objective calls for all worksites to voluntarily implement policies that prohibit or restrict smoking. To assess progress toward meeting the first objective, CDC reviewed the status of state laws restricting smoking as of December 31, 2004, updating a 1999 study that reported on such laws as of December 31, 1998. This report summarizes the changes in state smoking restrictions for private-sector worksites, restaurants, and bars that occurred during 1999-2004. The findings indicate an increase in the number and restrictiveness of state laws regulating smoking in private-sector worksites, restaurants, and bars from 1999 through 2004. At the end of 2004, however, 16 states still had no restrictions on smoking in any of the three settings considered. Although secondhand smoke exposure among U.S. nonsmokers has decreased sharply in recent years, a substantial portion of nonsmokers continue to be exposed to secondhand smoke.

Restaurants↗
PubMed2005

One-stop shop. The houseworks experience: redefining innovations in private-pay home care.

For more than thirty years, forward-looking gerontologists and entrepreneurs have realized the potential market for private-pay home care services and have proposed creative approaches to meeting the projected demand. Innovative ventures ranging from "life care at home" to "virtual retirement communities" have been launched throughout the country in an attempt to meet a growing need while responding to an unprecedented business opportunity. While these ventures reflect intriguing ideas, the story of an unconventional private-pay home care company in Greater Boston suggests that innovation and creativity are most needed to transform the fundamentals of private-pay service delivery: responsiveness, reliability, customer service, and sales.

Boston↗
PubMed1992

Policy reform as creative destruction: political and administrative challenges in preserving the public-private mix.

As political pressure for affordable universal coverage intensifies, various proposals have been crafted to improve the system without sacrificing the role of the private sector. Some analysts view the preservation of a mixed public-private system as an exercise in incrementalism, avoiding disquieting departures from familiar arrangements. A review of the political and administrative challenges of several main options--market innovation, tax credits, play or pay, and Medicaid expansion--suggests that the path to true reform is a slippery slope. Over time, changes in particular sectors, such as insurance, employers, government, and providers, will very likely implicate the others too. Although redefining the public-private mix may be more incremental than (say) adoption of a Canadian model, it will also entail considerable "creative destruction" of existing patterns and cannot fail to disturb the institutional status quo substantially.

Financing, Government↗
PubMed1992

Public and private responsibility for financing nursing-home care: the effect of Medicaid asset spend-down.

Data from a nationally representative sample of nursing-home residents at the beginning of 1987 are used to assess the interaction of Medicaid asset spend-down, the distribution of nursing-home days by payment source, and the effect of proposed changes in public financing of nursing-home care. Three out of five nursing-home residents were covered by Medicaid in January 1987; nearly all of the remainder were private-pay. Most Medicaid recipients were covered by Medicaid when they entered the care facility at the start of an episode, but 18 percent had spent down and were originally admitted as private-pay. A universal nursing-home benefit that insured the first six months of each nursing-home episode would cover 16 percent of the people in nursing homes on a given day, disproportionately those who are private-pay. A universal benefit with a 24-month waiting period would cover 56 percent of nursing-home residents on a given day, and would tend to favor those financed by Medicaid.

Financing, Government↗
PubMed1992

The role of private organisations in welfare work. The historical perspective.

The Danish welfare measures originated in private initiatives. From the end of the last century, welfare activities have developed through private relief organisations and with support from the State, local governments, and counties. Since the 1960s, many institutions which had been built up by private relief organisations were actually taken over by local governments or counties. By way of illustration, the development of EGV DaneCare (the Danish Association for the Care of the Elderly), from its origin as a voluntary relief organisation based on voluntary work and collected funds, is described. From 1910, EGV was the pioneer within the field of, for example, old people's homes, winter shelters, and holidays in the country for elderly people. In the 1960s, EGV became a professional service organisation which assisted the local governments in developing a wide range of variegated offers within the work for elderly people. Assistance offered to the local governments became the organisation's principal project up to the 1980s. The population's confidence in the ability of the public authorities to cope with the social tasks was at the time undermined by increasing scepticism. That was why EGV founded the DaneAge Association, which soon became a national cause with more than 200,000 members. The DaneAge Association operates as an association independent of the public authorities pursuing both local and national policies concerning the elderly and implementing humanitarian initiatives based on voluntary work. Studies made by the DaneAge Association show, among other things, that 20 per cent of the people aged 60 and over need practical assistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Charities↗
PubMed2006

Management of hypertension by private doctors in Hong Kong.

OBJECTIVE: To investigate the management of hypertension by private doctors in Hong Kong. DESIGN: Self-administered questionnaire survey. SETTING: Hong Kong. PARTICIPANTS: Private doctors from all districts in Hong Kong selected by simple random sampling from the website of "The Hong Kong Doctors Homepage" from March to June 2005. MAIN OUTCOME MEASURES: Practice of blood pressure measurement and the treatment prescribed to hypertensive patients. RESULTS: A total of 225 (46%) completed questionnaires were analysed. Only 24.4% of the respondents measured blood pressure in all new patients aged above 18 years. A total of 28.0% of doctors reported that hypertensive status was unknown in over 30% of their patients prior to their first clinic visit when it was consequently diagnosed. Calcium channel blockers (31%), angiotensin-converting enzyme inhibitors (28.5%), diuretics (27.5%), and beta-blockers (21.2%) were the most commonly prescribed antihypertensive medication. Drug efficacy was the reason cited by more than half (56.9%) of doctors for selecting a given drug. Public education about hypertension was considered insufficient by 66.2% of doctors and 32% believed that self-medication would have a very significant effect on drug compliance. CONCLUSIONS: In private clinics, blood pressure measurement should become a routine procedure. There is a need to raise public awareness of hypertension.

Adult↗
PubMed2006

The utility of the TRUE test in a private practice setting.

BACKGROUND: Studies suggest that the Thin-Layer Rapid-Use Epicutaneous Test (TRUE Test) may be inadequate to completely diagnose a significant number of patients with allergic contact dermatitis (ACD). OBJECTIVE: To study the usefulness of the TRUE Test as a triage tool in a private practice setting. METHODS: A retrospective chart review of patients who were patch-tested with the TRUE Test between July 1, 2000, and June 30, 2004, in four private dermatology practices was conducted. RESULTS: Of the 183 patients evaluated, 50.8% had at least one positive reaction, 31.7% had a diagnosis of ACD, and 24.0% were suspected to have ACD from other allergens. Of the patients with positive reactions, 62.4% were determined to have reactions that were of present relevance. CONCLUSIONS: The TRUE Test allows patients with dermatitis to be triaged systematically in a private practice setting. It is important to supplement patch testing with the patients' personal products, especially in cases of facial or periorbital dermatitis, and to be aware of potential false negatives, particularly with fragrance and rubber additives.

Adolescent↗
PubMedDate not supplied

[Privation as a measure of the irreversibility of biological aging].

Privation (imperfection) means the error-containing part of the structural and functional organization of an organismic system. Privation is used to measure the irreversibility of aging processes. Knowing the age rate beta it is possible to estimate the privation. Using the hypothesis that the biodynamical efficiency may not be greater than the inverse age rate beta, a dimensionless number is constructed, which is given by the product of age rate beta and the theoretical lifespan T.

Aging↗
PubMed1990

Private health insurance of chronically ill children.

Accurate information regarding the adequacy of private health insurance coverage available to the families of chronically ill children is scarce. A national survey was conducted of firms offering health insurance to employees and their dependents. Data were collected concerning private health insurance coverage of services needed by chronically ill children, including basic medical care services, ancillary therapies, mental health services, and long-term care. Nearly all surveyed firms offered health insurance. Coverage of inpatient hospital care, outpatient physician services, medical supplies and equipment, x-ray studies, laboratory services, and prescription medications was widespread, but coverage of services such as physical therapy, speech therapy, occupational therapy, and nutrition services was much less prevalent. More than two thirds of the firms covered comprehensive home health services but often with limits and only in lieu of more expensive inpatient care. Long-term care, such as skilled nursing home care, was covered by only one third of firms. Overall, the survey results, combined with information concerning recent trends in private health insurance, reveal increasing coverage of lower cost alternatives to hospital or institutional care and improved maximum lifetime benefits and stop-loss coverage but also increased cost-sharing requirements. These results suggest that, although families with chronically ill children may have access to a widening range of services such as home health care or individual benefits management, they may be forced to bear an increasing proportion of the cost.

Child↗
PubMed1989

[Physical exertion of agricultural workers with reference to work in private farms--consequences for occupational health services].

In terms of social-insurance legislation, the small-scale private work of cooperative agricultural and horticultural workers has the same status as their cooperative-farm work. Therefore, it must be included in occupational-hygiene analyses for the evaluation of the physical work load. Continuous heart-rate measurements were carried out in 64 people-workers operating can-to-can or pipeline milking facilities, agricultural-machinery mechanics, female horticultural workers and tractor or harvester drivers-covering a total of 138 working days. Only considering the cooperative-farm work-load, it is only the milking-facility workers whose work can be evaluated as hard. Including the additional private agricultural work too, the work of the female horticultural workers also must be evaluated as hard, and that of the agricultural-machinery mechanics as moderately hard. In the case of the tractor and harvester drivers, the private small-scale agricultural work in occupational-health terms is regarded as a favourable counter-balance to the hypokinesia involved in driving.

Agricultural Workers' Diseases↗
PubMed1987

Utilisation of private hospital beds in Auckland for long term geriatric care.

A cross-sectional survey at 25 February 1985 was conducted to determine the utilisation of beds in Auckland's private hospitals. Fifty-three licensed private hospitals accepted patients under the geriatric hospital special assistance scheme (GHSAS). Eighty point eight percent of all patients were receiving public subsidies additional to the universal Department of Health benefit. Ninety-five percent of patients were aged 65 years or more and receiving long term care; of these nearly all had been assessed by a geriatrician and 81.5% were subsidised by the GHSAS. The actual proportion of elderly receiving long term hospital care in Auckland, at 23.3/1000 aged 65 years and over, corresponded closely to newly proposed national guidelines; a previously unrecognised use of private beds for psychogeriatric patients was demonstrated.

Aged↗
PubMed1987

Private financing options for long-term care.

Private financing for long-term care now comes almost exclusively from out-of-pocket payments. Long-term-care costs quickly impoverish most elderly, resulting in Medicaid dependency. The consequences are profound for the western Sun Belt with its rapidly growing elderly population. Key private financing options are long-term-care individual retirement accounts (LTC/IRAs), home equity conversion, social-health maintenance organizations and long-term-care insurance. Study of data from the past half century suggests that the LTC/IRA approach would prove unsatisfactory for the purpose despite the intuitive appeal of this mechanism. Experience with home equity conversions is still very limited, and unresolved questions limit this approach to the role of a reserve option for now. While promising, social-health maintenance organizations are still in the experimental stages and not yet commercially available. Long-term-care insurance is currently sold on a thin market and emphasizes nursing home coverage. New approaches to private financing through long-term-care insurance seem to offer the best approach for immediate implementation.

Aged↗
PubMed1979

The private initiative in PSRO.

Private Initiative in Professional Standards Review Organizations (PIPSRO), a privately funded project sponsored by four major health care associations, has developed principles to guide the formulation of the respective responsibilities of HEW and the private sector in regulating quality assurance. The management committee of PIPSRO studied alternatives to the federal government's approach to regulation and concluded from the results that the special function of PSROs in regulating quality assurance should be to ensure that a basic standard of care is maintained for all Medicare and Medicaid patients.

Hospitals↗
PubMed1987

Policy implications of private sector involvement in correctional services and programs.

The movement toward private sector involvement in our correctional services and programs is growing. Before our focus is turned completely to privatization of these services, it would be prudent to analyze the "policy impact of such change. It is evident that the diverse and incompatible policies guiding the government approach to corrections and the absence of any rational planning to answer public interest goals is costly. Moreover, despite the increasing complexity of problems now confronting public authorities, little change has been made in their approach to resolving them. However, is it realistic to assume that the profit/loss barometer of the private sector can be applied in an area of social problems that are so pluralistic and ill defined? What of the many areas of potential legal concern, that is, vicarious litigation, First Amendment right of prisoners, and so forth? These are all areas that need to be researched so that any judgements or decisions made will be sound.

Humans↗
PubMed1985

Private medical insurance and elective surgery during early childhood.

The relationship between private medical insurance coverage and rates of elective ENT surgery was studied in a birth cohort of seven-year-old children. This analysis suggested that private medical insurance coverage was associated with differences in patterns of elective surgery with children whose families were covered by insurance being more likely to receive elective ENT surgery by seven years and far more likely to receive this treatment at a private hospital. These trends persisted when the child's history of ear/throat infections and family social and economic background were taken into account statistically.

Adenoidectomy↗
PubMed1985

Social security and private saving: theory and historical evidence.

This article is a nontechnical presentation of the debate that has gone on during the past decade over whether the U.S. social security system has depressed private saving in the economy. The heart of the article is an assessment of economist Martin Feldstein's original evidence, presentation of the alternative evidence that concluded that currently available historical data do not support the proposition that social security reduces private saving, and an evaluation of the contradictory evidence presented by Feldstein in response to the alternative evidence. The article concludes that, although the total body of evidence is inconclusive, the historical evidence fails to support the hypothesis that social security has reduced private saving. The Office of Research, Statistics, and International Policy, as part of its ongoing research mission, investigates the interrelationship between social security and the economy. This article presents an examination of one of several aspects of this relationship relevant to public policy considerations and is intended to make previously published technical papers available to a broader audience.

Aged↗
PubMed1977

Private health insurance in 1975: coverage, enrollment, and financial experience.

More improvement in the scope than in the quality of private health insurance coverage took place during 1975. Four-fifths of the population under age 65 was covered for hospital and surgical care, and nearly that proportion was protected against the costs of physicians' in-hospital visits, X-ray and laboratory examinations, and prescribed out-of-hospital drugs. The $33.6 billion in premiums paid by consumers resulted in the return of only $28.9 billion in benefits, which covered just 44% of their total personal health care expenditures. Major-medical insurance, held by an estimated 43% of the population, helped to overcome some of the deficiencies of private insurance--dollar limitations on health care services, ceilings on the duration of hospital stays, and exclusions for some types of care. It also provided economic protection against catastrophic expenses. Premiums and subscription income rose faster than benefits as private insurers attempted to keep their coverage in line with rising health care costs. The overall underwriting gain was due largely to a $952.4 million gain in group business by the insurance companies.

Adult↗