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PubMed1979

[Evaluation of the degree of disability for the privately insured patient (author's transl)].

There are marked differences between the public health system and the private insurance system. This paper shows how to evaluate the degree of permanent disability according to "The General Rules for Private Insurances (AUVB 1965)". At the beginning the evaluation of the degree of permanent disability after the visus naturalis or the visus corrected and at unilateral and bilateral aphakia will be discussed. The paper gives detailed information on the degree of disability for: one injured eye, one injured eye with preexisting ocular lesion, bilateral injury, one injured eye with preexisting lesion of the other eye, one injured eye with preexisting ocular lesions of both eyes, bilateral injury with preexisting lesions of both eyes. For bilateral lesions, the degree of disability is calculated as a function of the reduction in activity by the AUVB 1965; this is given in one table. The rules applying to Austria are compared to those valid in the Federal Republic of Germany (AUB). It is very important to understand these methods of calculation, if one wants to secure an objective ophthalmological evaluation of the degree of disability for the privately insured patient.

Austria↗
PubMed1984

Independent expression of common and private tumor-specific cell surface antigens in somatic cell hybrids between Rous sarcoma virus-transformed and normal cells.

Somatic cell hybrids were prepared by fusion of a Rous sarcoma virus (RSV)-induced mouse tumor (CSA1M cl-11) with a Chinese hamster embryo lung fibroblast line (Wg3h X AGr X Ouar). Some hybrid clones showed rapid anchorage-independent growth and intracellular production of RSV-pp60src. Other hybrid clones showed slow anchorage-dependent growth and no production of such a protein. The former expressed both a common tumor-specific cell surface antigen(s) (TSSA) shared with other RSV-induced tumors and a private TSSA not shared with any other tumors; however, the latter lost the common TSSA and expressed only the private TSSA. These results suggest that the common and private TSSA on CSA1M cl-11 cells are independent genetic traits and only the common TSSA is coordinated with other expressions of the RSV src gene phenotype.

Animals↗
PubMed1978

Private psychiatric hospitals: "excellence is their watchword".

Throughout their history private psychiatric hospitals have been a major force in psychiatry, and their humanistic concern for the mentally ill has resulted in numerous innovations in treatment. Over the past two decades the sharp increase in psychiatric patient care episodes has resulted in a greater reliance on private psychiatric hospitals, and they have reponded by modifying their role, broadening the spectrum of patients served, and developing alternatives to inpatient treatment. In addition to continuing to provide high-quality inpatient care, private psychiatric hospitals in the future should expand various alternatives to such care, explore opportunities for collaboration with other health care systems, and provide more patient services to the underserved.

Community Mental Health Services↗
PubMed1983

Value of immunoglobulin E (IgE) in the private practice of allergy. Eight years experience: 1973-1981.

In private practice the majority of patients evaluated by allergists are truly atopic. To assess the clinical value of determining the serum level of immunoglobulin E (IgE) in such patients the records of an individual private allergist were reviewed and all new patients were evaluated. Over an eight year period 7,000 new patients were seen and 5,500 measurements of IgE were performed. An elevated serum IgE value was indicative of the atopic state with few false positives. Successful immunotherapy as determined by patient reports, the decreased use of medications and reduced clinical visits was correlated positively with a decrease in serum IgE levels. This was true regardless of the initial value of the IgE. Unsatisfactory results in immunotherapy were often accompanied by an increase in IgE levels. Serial determinations of serum IgE levels over several years of treatment are of value in the evaluation of allergic patients in private practice.

Adolescent↗
PubMed1995

Role of private insurance in public system source of debate at CHEPA conference.

Supplementary health care insurance is the fastest growing segment of the insurance industry in Canada, but not because of a rise in the number of policy holders. Instead, revenue increase is primarily due to price increases for insured services, such as prescription drugs or semi-private hospital coverage, and the expansion of private coverage into areas vacated by public health insurance. The role of private insurance in the evolving Canadian health care system was debated during a recent conference sponsored by the Centre for Health Economics and Policy Analysis at McMaster University.

Canada↗
PubMed1977

An implementation of therapeutic community in a private mental health center.

The concepts of milieu therapy have, in the past 20 years, been widely applied to various facilities for treatment of people with emotional and mental illness. One type of milieu therapy, the Therapeutic Community, has gained increasing acceptance, as a means of implementing milieu therapy. This paper describes the application of therapeutic community concepts to the in-hospital population of a private, open-staffed, open-door psychiatric facility, and some of the effects that this has had on both the staff, and the patient population. Since the development of the therapeutic community concept almost 25 years ago, programs have been developed in various centers which implement the concepts of social psychiatry in different ways. This paper describes the development of a particular therapeutic community on the in-patient adult and adolescent psychiatric services of a private psychiatric hospital. Parkwood was developed as a small (40 bed) psychiatric hospital in Atlanta, Georgia in 1966 by a group of physicians wanting to implement the ideas of milieu therapy in an area where no such program was available. In its initial stages, the hospital -- of attractive, middle-class decor -- was built in a wooded setting on the edge of a large metropolis. It was open-staffed, with psychiatrists having an eclectic, though psychoanalytically based, orientation toward treatment. The concepts of milieu therapy were interpreted to mean the following: a warm, pleasant atmosphere, in pleasant surroundings, conducive to the usual brief psychotherapy, chemotherapy, or somatic therapy, which had previously been used in non-milieu psychiatric hospitals. The total hospital patient population was divided in half and met in group sessions with a psychiatrist once each week. The Medical Director, a psychiatrist, had weekly staff meetings, in which he discussed various administrative problems. In 1969, a Medical Director with a therapeutic community orientation was employed. Over a five-year period, the total complexion of the hospital changed to its present state, an open-staffed, open door, comprehensive, community mental health center financed on a private basis. The facility now provides out-patient, partial or total hospitalization, emergency services, and community education for children, adolescents, adults and alcohol addicted patients. This paper deals with the therapeutic community on the adult and adolescent units.

Adolescent↗
PubMed1995

Public and private regulation of reproductive technologies.

Human reproduction is interrelated with privacy. However, in most countries where new reproductive technologies are used public regulations have been passed to provide a legal framework for such technologies. This interference in private life can be justified by the need to control medical intervention in the human reproductive process. But in order to find a balance between public regulations and other social regulations, this article analyses the impact private regulation may have on issues raised by reproductive technologies. It also addresses the issue of the influence of private bodies on the drafting of public regulations.

Bioethics↗
PubMed1996

Evaluation of postoperative complications following elective surgeries of dogs and cats at private practices using computer records.

This study was designed to determine the frequency of postoperative complications following elective surgeries (castration, ovariohysterectomy, onychectomy) of dogs and cats from private practices and to evaluate the use of electronic medical records for this type of research. All elective surgeries performed during the study period at 5 private practices were included. The surgical techniques and materials used for each procedure were similar across practices, but the interpretation of "complication," the amount of detail recorded on the primary medical record, and the intensity of follow-up varied. The frequencies and types of complications varied by species and procedure. The postoperative complication frequencies ranged from 1% to 24% for all complications and 1% to 4% for severe complications. The results of this study describe populations of elective-surgery patients at private practices, provide data for educating clients about the risks associated with these procedures, and demonstrate how computerized records can be used to collect practice-specific medical information.

Age Factors↗
PubMed1997

[Fatal post-traumatic alcohol delirium--compensation responsibility in private accident insurance?].

While several case reports about fatal posttraumatic alcohol withdrawal deliriums after minor traumas and compensation by legal insurance have been published this problem has been hardly addressed regarding private accidance insurance. Based on the very comprehensive definition of an accident in the private insurance law posttraumatic deaths by alcohol withdrawal deliriums can be causally related even to minor traumas and compensations by private insurance are justified. However according to section 8 AUB 88 the contribution of preexisting alcoholism and alcohol related organ damage to the lethal outcome must be subtracted.

Adult↗
PubMed1997

[Disability in the private pension system in Chile].

BACKGROUND: The degree of disability of workers ascribed to the private allowances system in Chile, is judged by Medical Commissions that apply norms that establish percentages of incapacity, without considering prognosis. AIM: To communicate the causes of disability among Chilean workers ascribed to the private allowances system, their mortality and to correlate the causes of death with diagnoses. SUBJECTS AND METHODS: We analyzed 13,456 consecutive cases judged between August 1990 and April 1992. Mortality was registered up to 12 months after judgment. RESULTS: Total incapacity was determined in 4,158 cases (30.9%), partial incapacity in 1,340 (9.9%) and minor incapacity in 7,958 (59.1%). Osteoarticular diseases were the main cause of disability in 4,460 patients (33.1%) and 77.8% of patients with malignant tumors were considered as having total incapacity. Mortality was 17% among subjects with total incapacity, 1.5% among those with partial disability and 1% among those with minor disability. The cause of death was related to the main disabling disease in 94% of subjects with total incapacity and 66.6% of those with partial incapacity. CONCLUSIONS: Osteoarticular diseases are the main cause of inability among workers ascribed to a private pension system.

Chile↗
PubMedDate not supplied

Evaluation of curing units used in private dental offices.

It is well known that numerous factors influence the light output of curing units, but many dentists are unaware that the output of their curing lights are inadequate. This study was conducted to evaluate the light intensity of visible-light curing units in private dental offices and to assess their curing efficiency by measuring compressive strength of a light-cured resin. Also, in order to determine the maximum light intensity of the curing units, lamps, filters, and fiber optic bundles were replaced by new ones and curing efficiency remeasured. Light intensity was measured by employing a Quantum Radiometer LI-189 at a wavelength of 470 +/- 40 nm using a bandpass filter. Compressive strength of a light-cured resin using the light units was measured employing an Instron Testing Machine at a crosshead speed of 1.0 mm/min. From the evaluation of 105 light units, the light intensity ranged from 28 to 1368 W/m2 (0 approximately 500 W/m2; 41.9%, 500 approximately 1000 W/ m2; 45.7%, 1000 approximately 1500 W/m2; 12.4%). Light intensity of the light unit in private offices decreased 15.9 approximately 82.1% compared to brand-new units. Reduction of light intensity impaired compressive strength of the light-cured resin to varying degrees (148.3 approximately 279.9 MPa) compared with the highest value (317 MPa) obtained from brand-new light units. The replacement of the parts increased the light intensity, with maximum increases of 36.0% for lamps, 157.7% for filters, 46.2% for fiber optics, and 322.7% for all three parts. The results of this study indicated that the light intensities of the curing units used in private practice were lower than expected.

Composite Resins↗
PubMedDate not supplied

[Health care provided by national health services and private insurance].

Italy, as well as other European countries and the USA, is facing the necessity of a radical reform of the National Health Service in the context of more general social reforms. Two types of management, state- or private-funded, are coming under analysis in the attempt to define how to provide effective assistance to all citizens in need. The efficient but restrictive services provided by private insurances are compared here to the somehow inefficient but more supportive forms of care provided by state-financed services. The necessity to implement a cost-effective but well-operating system will most probably rely on a tight linkage between the public and the private care providers. Such mixed forms of Health Services, with the additional help of charities, will be able to provide the essential assistance to all in need, and an effective care to citizens full aware of the necessity to fairly contribute to their personal and community care.

Health Care Reform↗
PubMed2004

Shifting the burden of health care finance: a case study of public-private partnership in Singapore.

Since becoming independent in 1965, Singapore has attained high standards in health care provision while successfully transferring a substantial portion of the health care burden to the private sector. The government's share of total health care expenditure contracted from 50% in 1965 to 25% in 2000. At first glance, the efficiency-driven health care financing reforms which emphasize individual over state responsibility appear to have been implemented at the expense of equity. On closer examination, however, Singaporeans themselves seem unconcerned about any perceived inequity of the system. Indeed, they appear content to pay part of their medical expenses, plus additional monies if they demand a higher level of services. In fact, access to needed care for the poor is explicitly guaranteed. Mechanisms also exist to protect against financial impoverishment resulting from catastrophic illness. Singapore's experience provides an interesting case study in public-private partnership, illustrating how a hard-headed approach to health policy can achieve national health goals while balancing efficiency and equity concerns.

Attitude to Health↗
PubMed1999

Private clinics for employees as a Dutch solution for waiting lists: economic and legal arguments.

Private clinics for employees have emerged on a small scale during the last few years in Dutch health care. They represent new possibilities for ill employees who have to wait for medical treatments on waiting lists. Earlier proposals to allow employers in close co-operation with health insurers to start initiatives for special clinics for employees have been confronted with all kind of arguments which were considered to form serious obstacles, from theoretical, legal and economic perspectives. The European Court of Justice plays a decisive role in deciding whether free establishment and access is approved according to the rules of the EC Treaty. Private clinics can be legally allowed in the interests of the common good. However, priority treatment of a person can only be justified if the intended purpose is justified and if the priority treatment is suited as a means to (partly) realise this purpose. Furthermore, possible negative consequences may not be unreasonable in the light of the intended consequences. In this article it will be argued that both from an economic and from a legal perspective, based on national and European law, the introduction of special clinics for employees could be allowed. The main argument is that they could be introduced on a just and equitable basis.

Ambulatory Care Facilities↗
PubMed2002

Private health insurance: the problem child faces adulthood.

Since its election to office in 1996, reform of Private Health Insurance (PHI) has been the most obvious health policy focus of the Howard Government. The reform process has focussed on price, product, promotion, legislation and regulation. It has resulted in one of the largest new Commonwealth health outlays in recent memory. Health insurance funds have emerged as active purchasers of care, not just passive reimbursers of costs. PHI fund reserves have moved from precarious liquidity to healthy surplus. Private hospitals are busier than ever before, but margins are slim. Anecdotally, public hospitals report little benefit to date. Waiting lists have not been reduced, and their budgets are unchanged as a result of the $2 Bn allocated under the 30% Rebate scheme. The paper begins by describing the origins of the PHI reform. Its objectives, policy initiatives, results to date and criticisms are analysed. Criticisms include the actual and opportunity costs. Specific concerns remain as to its effectiveness to date in reducing pressure on public hospitals, and perceived lack of equity for certain client groups. The most significant result is that much of the reform package is here to stay including the expensive and much criticised 30% rebate. Like Medicare before it, the PHI reforms have achieved bipartisan support. The paper concludes by describing future implications for Government, industry, consumers and the medical profession.

Australia↗
PubMed2001

Specialists as consultants to GPs. Private sector services as an alternative way of organising consultant services in health care.

OBJECTIVE: To assess the effect on referral rate when GPs are given a better opportunity to send their patients to specialists for consultation. DESIGN: Intervention study with a control group. SETTING AND SUBJECTS: A 34-month experiment in the City of Turku. The experimental group consisted of 10 GPs working in municipal health centres with a list system and serving 23000 residents. As a control group, there were four GPs without a list system serving 10800 residents. OUTCOME MEASURES: GP visits and their referrals to specialists. RESULTS: The number of patient visits was higher among GPs in the experimental group than among those in the control group. During the experiment, the referral rate of GPs in the experimental group increased from 5.7% to 6.8%, but there was no change among the control GPs. Of all referrals to specialists, the share to the private sector increased from 5% to 35%, while at the same time the share to the hospital outpatient clinic decreased. CONCLUSIONS: An enhanced possibility to consult private specialists increases the number of referrals, but there are no consequent changes in the relative shares of the consulted specialties.

Cooperative Behavior↗
PubMed2001

Private practice in Slovenia after the health care reform.

BACKGROUND: Slovenia is one of the many post-socialist countries which started its reorientation of the health care system in the early 1990s. One of the aspects of the reform was the introduction of independent practice, which is performed either as a purely private practice on the basis of out of pocket payment or through contract with the National Health Insurance. A combination of both is also possible. In 1992 and 1993 the first physicians started to work in that way. The physicians that took this opportunity belonged to three main groups: dentists, primary health care physicians and secondary care specialists. The groups differ regarding their style of work and possibilities for running a profitable service. No studies have been done to evaluate the success of their decision. OBJECTIVES: The aim of the study was to evaluate the motives for leaving salaried posts, practice organization, perceived improvements and satisfaction with their choice of the practitioners who started to work independently in Slovenia in 1992 and 1993. METHODS: An anonymous questionnaire was sent to all self-employed physicians that started their independent practice in 1992 and 1993. A 54.5% response rate was achieved. The analysis of non-responders has shown that they did not differ significantly according to sex, location of practice, speciality or method of payment, from the responders. RESULTS: The analysis shows that the reported reasons for choosing independent practice are not different across the groups. Possibility for greater income was not reported as a major reason for leaving public service. There are important differences in organization of work: general practitioners reported spending more time on patient contacts and administration than the other two groups; they also work exclusively for the National Health Insurance, which is not the case for the other two groups. The perceived areas of improvement differ substantially. Regardless, the overall satisfaction with their choice is high (over 90% would make the same decision again), the general practitioners are the most dissatisfied group. CONCLUSIONS: The analysis shows that self-employed physicians in Slovenia represent three different groups with different positions regarding how they earn their money. Their expectations have largely been met, since they claim that the doctor/patient relationship is better, as well as some conditions for the patients. A follow-up study that would take into account the long-term effects of privatization, and analysis of economic functioning and patient satisfaction would be necessary in order to verify these claims.

Attitude of Health Personnel↗
PubMed2003

Melting public-private boundaries in European health systems.

Renewed debates about the superiority of either predominantly public or predominantly private health services arrangements have tended to be more ideologically charged than conceptually precise. Historically, the public/private split in European systems has often been more sharply defined in principle than in practice. This real-world variation was further complicated during the 1990s by reforms that enabled publicly owned hospitals and health centres to manage their daily operations more independently. Most recently, several new initiatives have established complex cross-boundary arrangements that cannot easily be characterized as either public or private. This article presents a conceptually rigorous four-part classification of past public/private arrangements that can provide a theoretical baseline from which to judge future cross-boundary developments.

Delivery of Health Care↗