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PubMed2004

The quality of drugs in private pharmacies in Lao PDR: a repeat study in 1997 and 1999.

OBJECTIVE: To present a repeated test of the quality of ampicillin, tetracycline, chloroquine and ASA from private pharmacies in Laos in 1997 and 1999, and to discuss the quality in relation to the National Drug Policy Programme. METHOD: A total of 115 of 214 licensed private pharmacies were selected in Savannakhet province, a pilot province in the Lao National Drug Policy Programme. The four drugs, if available, were collected at each pharmacy. Thirty tablets of each drug were taken from a selected container. In 1997, 366 samples were analysed and three hundred in 1999. Identity, assay (content of active component) and measurement of weight variation tests were performed. Drug quality was compared mainly according to the standards of the British and United States' pharmacopoeias. RESULTS: The percentage of substandard drugs decreased significantly from 46% to 22% between 1997 and 1999 (P< 0.001). Substandard ampicillin and tetracycline were reduced significantly from 67% to 9% and from 38% to 12%, respectively (P < 0.001). In total, 3% vs 1% contained no active ingredient, 12% vs 4% had too little or too much active ingredient, and 35% vs 14% had weight variation outside pharmacopoeial limits. CONCLUSION: Drug quality was improved. However, the prevalence of substandard drugs was still unacceptably high, which may result in adverse clinical effect or treatment failure for individual patients.

Ampicillin↗
PubMed2006

Avoiding extinction: successful private psychiatric hospitals in the opening decade of the twenty-first century.

The history of the private psychiatric hospital has been characterized by the rise and demise of scores, if not hundreds of facilities. In recent years some well known, long-standing psychiatric hospitals have closed their doors. What has accounted for the ability of some of the private psychiatric hospitals to flourish? Two strategies are proposed: 1) progressive change through a broadened scope and a geographic spread, and 2) staying true to the institution's core mission with clinical and fiscal modifications at the perimeter of that mission. A case example is provided for each adaptation: Sheppard Pratt Health System (Baltimore) for the former; Austen Riggs Center (Stockbridge, Massachusetts) for the latter.

Health Facility Closure↗
PubMed1991

Stress and well-being in nurses: a comparison of the public and private sectors.

Nurses in the public and private sectors were compared with regard to occupational stress and its sources and self-reported health and well-being. While both groups reported similar high levels of stress experience, most noticeably arising from high work loads and the experience of death and dying, group differences did emerge from an examination of the sources of stress. Whereas N.H.S. nurses were more troubled by high work loads, private sector nurses reported uncertainty over treatment as a more frequent source of stress than did their N.H.S. counterparts. Levels of self-reported mental and physical health symptomatology did not differ between groups. Nevertheless, overall nursing stress scores and symptomatology were significantly correlated, and workload was the best independent predictor of health and well-being status.

Burnout, Professional↗
PubMed1993

Elasticity estimates from a dynamic model of interrelated demands for private and public acute health care.

This paper investigates the private/public mix in acute health care provision in the UK. It uses an interrelated shares model derived from a translog function combined with dynamic adjustment. Using prices for public care constructed from NHS waiting lists, the insurance cost of private care and the retain price index, impact, intermediate and long run elasticities of demand for private and public care are obtained. The role of hospital consultants and of an aging population are also considered.

Acute Disease↗
PubMed1979

Illness behavior and depression compared in pain center and private practice patients.

Recent descriptions of illness behavior and personality factors in chronic pain patients reflect patient populations at clinics dealing with refractory, multiple referral pain problems. Pain patients from the University of Washington Pain Center were compared with patients from a private practice clinic with regard to illness behavior and depression. Private practice patients were significantly less depressed, showed less conviction of disease, general hypochondriasis, affect disturbance and were less somatically focussed than the Pain Center patients. Physicians in general practice treating pain patients should avoid forming stereotypes of chronic pain patients based on the experiences of referral clinics, for such characterizations may lead them to weigh psychologic factors too heavily in diagnosis.

Adolescent↗
PubMedDate not supplied

Private substance abuse treatments: are some programs more effective than others?

There have been few studies of treatments for substance dependence among private programs. The present study compared the patient populations, treatment services provided and six-month outcomes of employed, insured patients referred by an employee assistance program to four private treatment programs (two inpatient and two outpatient). Subjects were alcohol and/or cocaine dependent males referred from a single employer. Ninety-four percent were successfully contacted at six-month follow-up, with confirmatory urinalysis and breathalyzer samples taken. Three results were obtained. First, there were significant and pervasive improvements shown in the total sample at follow-up. Fifty-nine percent were completely abstinent, 82% were working and only 8% required re-treatment. Second, there were significant differences among the programs in levels of improvement and six-month outcomes. Finally, the differences in efficacy were related to the differences in the nature and amount of treatment services provided.

Adult↗
PubMedDate not supplied

Clinical diagnosis of substance use disorders in private psychiatric populations.

The clinical diagnoses of comorbid substance use and psychiatric disorders by psychiatrists in a private psychiatric inpatient setting were analyzed. Two hundred patients consecutively discharged from a private university-affiliated psychiatric service by clinical psychiatrists were examined for concomitant substance use and psychiatric disorders according to DSM-III-R criteria for Axis I and Axis II disorders. Fifty-nine patients (30%) were diagnosed with a comorbid substance use and psychiatric disorder on Axis I, supporting findings of previous studies. Comorbid diagnosis patients were more likely to be male (54%, 32) than were psychiatric only (noncomorbid diagnosis) patients (males 37%, 51). There were no differences between comorbid (dual diagnosis) and noncomorbid diagnoses in age, mean length of stay, or discharge type. Of the 59 patients with comorbid disorders, 83% had Axis I diagnoses, and 64% had Axis II diagnoses. Polysubstance use disorder was the most common dual diagnosis, cooccurring with an Axis I diagnosis in 47% of patients with an Axis II diagnosis in 45%. Psychiatrists in clinical psychiatric inpatient settings diagnose substance use disorders in rates similar to public settings despite absence of specific addiction treatment.

Adult↗
PubMed1990

Radiographic materials, methods, and film-ordering patterns among orthodontic educators and private practitioners.

Orthodontic private practitioners and training institutions were surveyed in regard to the various radiographic materials and methods used in their practices and for ascertaining film-ordering patterns for various types of patients. The reasons for the survey were to assess the degree of acceptance of more radiation-efficient imaging systems into orthodontic practice and to add to the data on orthodontic patient selection criteria and radiographic prescription patterns. All orthodontic programs in the United States and Canada were surveyed, along with all of the practicing orthodontists in the state of North Carolina. The response rates were 61% and 55%, respectively. It was found that a majority of practitioners and training institutions used more radiation-efficient rare earth screen systems, but more institutions used prepatient soft-tissue enhancement beam alteration methods, thus sparing thyroid dose. Lateral cephalometric and panoramic films were found to be the most frequently ordered films, and training institutions ordered more supplemental and follow-up radiographs than private practitioners. In general, patients requiring orthognathic surgery generated a greater number and variety of films than other patient types in both surveyed populations.

Canada↗
PubMedDate not supplied

An analysis of the writings of Janet Geister and Mary Roberts regarding the problems of private duty nursing.

Fifty years ago there were two widely circulated nursing journals, each with a unique purpose and style. The Trained Nurse and Hospital Review was the privately owned older journal, and the American Journal of Nursing was the voice of the professional organization. Each journal was edited by a strong nursing leader, Janet Geister and Mary Roberts, respectively. Each editor had many years of service to the nursing profession in varied capacities. Naturally, each had distinctly different interests, visions, and styles of communication. These editors witnessed and commented on the change in the sphere of nursing practice from a private duty and public health orientation to one that eventually became dominated by the hospital. Although their approaches differed, both recognized the need for organization, versatility, and creative problem solving. However, the legacy of these leaders must be considered in view of the gap that continues to exist between practicing nurses and the American Nurses' Association leadership.

History of Nursing↗
PubMed2005

Petit bourgeois health care? The big small-business of private complementary medical practice.

Although small business private complementary medicine (CAM) has grown to be a significant provider of health care in many Western societies, there has been relatively little research on the sector in business terms and on its wider socio-economic position and role. Using a combined questionnaire and interview survey, and the concept of small business petit bourgeoisie as a framework, this paper considers the character of therapists and their businesses in England and Wales. The findings suggest that typical of the core characteristics of both the petit bourgeoisie and therapists are the selling of goods with a considerable market viability, at the same time financial insecurity; the modest size of businesses; small amounts of direct employment generation and business owners undertaking everyday 'hands-on' work themselves. Certain of the therapists' and business characteristics depart from the stereotypical image of a small businesses class, such as the high incidence of part-time self-employment and incomes being supplemented often by unrelated waged employment. However, given the acknowledged diversity of the petit bourgeoisie between societies and over time, the framework is arguably appropriate in this context, and private CAM a latest guise. Indeed, just as the petit bourgeoisie have traditionally found market niches either neglected or rejected by bigger business, small business CAM has provided the forms of health care neglected and sometimes rejected by orthodox medicine.

Adaptation, Psychological↗
PubMed2005

Implementation of outpatient treatment of deep-vein thrombosis in private practices in Germany.

OBJECTIVE: Implementation of outpatient treatment (OT) of deep-vein thrombosis (DVT) is slow despite clear evidence that it is effective, safe and cost-efficient. DESIGN AND METHOD: An initiative was launched with the help of the Professional Association of Phlebologists of Germany and the industry to familiarize physicians in private practice who had no prior experience with OT of DVT. Data on quality of treatment with the low-molecular-weight heparin tinzaparin and phenprocoumon, compliance, clinical outcome, venous ultrasound, patients' satisfaction and quality of life were collected in a registry, which was open from July 1999 to December 2000. The results were published and their impact on further management of patients was assessed in second survey reported here. Patients of both series were followed-up clinically and with ultrasound over the 1st month of treatment. RESULTS: Of 67 physicians entering 827 patients into the registry 26 answered a questionnaire on how they treated further patients. Their case load had increased by 450% and data were provided on 540 consecutive patients managed between January and June 2002. OT increased overall from 76 to 92%, that of popliteo-femoral DVT from 71 to 92%, and that of pelvic DVT from 38 to 65%. Medical reasons to decide against OT decreased from 89 to 56% (p<.01). Immediate leg compression was changed from bandaging to medical compression stockings in 20 of the 26 centres (p<.05). In total, data were gathered from OT of 1124 patients. No secondary hospitalisations were required and only one patient had a documented progression of the DVT. CONCLUSIONS: OT was successfully implemented in private practices through the initiative of individual physicians with support of the professional association and sponsoring by the industry-to the benefit of the providers but as much of the patients and their cost bearers.

Ambulatory Care↗
PubMed2005

Health care reform and change in public-private mix of financing: a Korean case.

The objective of this paper is to examine the changes in the Korean health care system invoked by the reform (in the latter part of 2000) in regard to the separation of drug prescription and dispensation, especially from the point of view of the public-private financing mix. It seeks particularly to estimate and analyse the relative financing mix in terms of both modes of production and types of medical provider. The data used to estimate health care expenditure financed by out-of-pocket expenditure by were sourced from the National Health and Nutritional Survey (conducted by interviewing representatives of households) and the General Household Survey (a household diary survey). National Health Insurance data, etc. were used to estimate health expenditure financed by public sources. This study concentrates on the short-run empirical links between the reform and the public-private mix in finance. The reform increased remarkably the public share in total health expenditure. This public share increase has been prominent particularly in the case of expenditure on drugs since the reform has absorbed much of the previously uncovered drugs into the National Health Insurance coverage. However, a higher public share in medical goods than in out-patient care would raise an issue in terms of prioritization of benefit packages. The five-fold increase in the public share of expenditure at pharmacies reflects not only the fact that drugs previously not covered by NHI are covered now but also the fact that prescribed drugs are currently purchased mainly at pharmacies, as opposed to in doctors' clinics, as a result of the reform.

Delivery of Health Care↗
PubMed2006

Time costs of waiting, doctor-shopping and private-public sector imbalance: microdata evidence from Hong Kong.

OBJECTIVE: To quantify the disutility of waiting for a specialist consultation and to examine whether individuals' willingness-to-pay (WTP) to reduce waiting time is associated with doctor-shopping behavior in outpatient clinics of four large, public hospitals in Hong Kong. METHODS: We performed a cross-sectional survey of 6495 outpatients on public sector waiting lists enrolled from July 2000 to October 2001. Main outcome measures were WTP to reduce queue time and odds ratios (ORs) for doctor-shopping according to WTP status. RESULTS: The majority (74.5%) of respondents, excluding those registering "protest zeros", was willing to pay a median of 100HK Dollar (13US Dollar ) to reduce queue time by 2 weeks, which represents 14.6% of the total costs of care for a specialist outpatient visit. Respondents' WTP decreased as their expected waiting period increased. Multivariate regression modeling showed that those who were willing to pay more were also more likely to "doctor-shop" (ORs and 95% confidence intervals for doctor-shopping for the 1st through 4th quartile of WTP values respectively = 1.00; 0.88 (0.63, 1.23); 1.19 (0.57, 2.48); 1.52 (1.05, 2.20); p for linear trend = 0.009), in effect reducing waiting time to see a specialist by seeking and paying for care in the private sector. CONCLUSIONS: Based on this preliminary evidence, we propose the further examination of a new policy of outsourcing some specialist care services to the private sector to improve allocative and technical efficiency.

Aged↗
PubMed2003

Comparison of private versus academic practice for general surgeons: a guide for medical students and residents.

BACKGROUND: Medical students and residents often make specialty and practice choices with limited exposure to aspects of professional and personal life in general surgery. The purpose of this study was to portray practice composition, career choices, professional experiences, job satisfaction, and personal life characteristics specific to practicing general surgeons in the United States. STUDY DESIGN: A 131-question survey was mailed to all female members (n = 1,076) and a random 2:1 sample of male members (n = 2,152) of the American College of Surgeons in three mailings between September 1998 and March 1999. Respondents who were not actively practicing general surgery in the United States and both trainees and surgeons who did not fit the definition of private or academic practice were excluded. Detailed questions regarding practice attributes, surgical training, professional choices, harassment, malpractice, career satisfaction, and personal life characteristics were included. Separate five-point Likert scales were designed to measure influences on career choices and satisfaction with professional and personal matters. Univariate analyses were used to analyze responses by surgeon age, gender, and practice type. RESULTS: A response rate of 57% resulted in 1,532 eligible responses. Significant differences between private and academic practice were noted in case composition, practice structure, and income potential; no major differences were seen in malpractice experience. Propensity for marriage and parenthood differed significantly between men and women surgeons. Overall career satisfaction was very high regardless of practice type. Some differences by surgeon gender in perceptions of equal career advancement opportunities and of professional isolation were noted. CONCLUSIONS: This study offers a comprehensive view of general surgery to enable more informed decisions among medical students and residents regarding specialty choice or practice opportunities.

Academic Medical Centers↗
PubMed2005

A Colombian survey found intensive care mortality ratios were better in private vs. public hospitals.

BACKGROUND: Our main outcome was to identify organizational characteristics that help to evaluate the differences between the intensive care mortality ratios adjusted by APACHE II. We incorporated the variation associated with the ranking of institutions simulating its random effects under a binomial distribution. METHODS: A nationwide survey on structure, technology, and staffing resources available in Colombian intensive care units during 1997-1998 was conducted. We collected data on admissions from 20 randomly selected adult medical and surgical intensive care units. RESULTS: The mortality ratio from the 20 intensive care units ranged from 0.59 to 2.36; 80% of the intensive care units had a mortality ratio greater than 1. All four intensive care units with the lowest mortality ratio belonged to private institutions, while four of five institutions with the highest mortality belonged to the public sector. Intensive care units in private institutions also had fewer number of beds, lower median length of stay, lower occupancy rates, higher education training for specialists and nurses and fewer emergency nonelective surgical procedures. CONCLUSION: We successfully accounted for intensive care mortality baseline differences and random effects variations. There were substantial differences between intensive care units in institution type, bed availability, technology, staffing resources, and degree of training, which may have been associated with patient outcome. These results are of crucial importance to track, detect and assess future changes.

Adult↗
PubMed2004

On the international stability of health care expenditure functions: are government and private functions similar?

This paper studies the stability of health care expenditure functions in a sample of OECD countries. We adopt the cointegration approach and the results show that there is a long-term relationship between total health care expenditure (HCE) and gross domestic product (GDP). However, the existence of cointegration is only shown when we admit the presence of some changes in the elasticities of the model. Our results also provide evidence against the existence of a unique relationship between health and GDP for the sample. Thus, we can conclude that the differences in health systems may cause differences in the aggregate functions. Additionally, we examine aggregate health functions for government (GHCE) and private expenditures (PHCE), again finding evidence of different patterns of behaviour. Finally, we open a discussion on the character of health as a necessary or luxury good. In this context, we find differences between the government and the private function. In order to illustrate these findings, we propose a theoretical model as an example of the influence of political decisions on income elasticity.

Global Health↗
PubMed2006

Early adoption of buprenorphine in substance abuse treatment centers: data from the private and public sectors.

The recent approval of buprenorphine for the treatment of opiate dependence offers an opportunity to analyze innovation adoption in community-based treatment. Using data collected from national samples of 299 privately funded and 277 publicly funded treatment centers, this research examines buprenorphine adoption using baseline data collected between 2002 and 2004 as well as follow-up data collected 12 months later. Private centers were significantly more likely than public centers to report current use of buprenorphine. The baseline data indicated that early adoption was positively associated with center accreditation, physician services, availability of detoxification services, current use of naltrexone, and the percentage of opiate-dependent clients. Multivariate analyses of follow-up data suggest that adoption was greater in accredited centers, for-profit facilities, organizations offering detoxification services, and naltrexone-using centers. Future research should continue to monitor the extent to which buprenorphine is adopted in these settings.

Buprenorphine↗
PubMed2006

Patterns of organization and management in private and public substance abuse treatment programs.

As an organizational field, substance abuse treatment clearly includes a remarkable range of organizations. Yet only in the past two decades has there been research interest in the organizational context in which treatment is delivered. The goal of this article is to promote the concept of organizational field by summarizing findings from an ongoing research program and by examining the organizational structure, service delivery, and patterns of innovation adoption in two large samples of substance abuse treatment programs in the United States. Among highlighted findings, there are notable differences between the public and private sectors in structural and staffing characteristics, as well as in the characteristics of clients receiving substance abuse treatment. With regard to the use of evidence-based practices, our findings suggest that pharmacotherapies are more likely to be adopted in private centers, whereas notably effective voucher approaches are more common in public centers. Future research directions are discussed.

Counseling↗