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PubMed2000

Comparative efficiency ratings between public and private acute inpatient facilities.

OBJECTIVES: The aims of this study are to compare clinical outcomes and efficiency ratings in an acute psychiatric inpatient facility with findings from other studies, and to examine relationships between symptom severity, admission medico-legal status and length of stay. METHOD: The Health of the Nation Outcome Scales was administered at admission and discharge and analysed against admission medico-legal status and length of stay. Efficiency ratings were calculated and compared with those from other acute psychiatric inpatient settings. RESULTS: Clinical outcomes and efficiency ratings were similar to those from other public acute inpatient facilities, with greater admission severities and higher efficiency ratings than those found in private facilities. Involuntary hospitalisation was found to be associated with higher admission severities and longer lengths of stay. CONCLUSIONS: Outcome or effect size is enhanced by higher admission severities, however, mean outcome per 10 days of stay is decreased by involuntary admission legal status. Factors unrelated to admission legal status effect differences in efficiency ratings found between public and private acute psychiatric inpatient facilities.

Acute Disease↗
PubMed2006

Changes in private sector electroconvulsive treatment in Australia.

OBJECTIVES: This paper reports on changes, over time and between states, in the use of electroconvulsive therapy (ECT) in the private psychiatric sector in Australia between 1984 and 2004. METHOD: Data for ECT services, and all specialist psychiatry services provided under the Medicare system, have been analysed in absolute numbers and as utilization rates. RESULTS: Changes in the use of ECT over time are different from other services provided by private psychiatrists. As in other countries, the use of ECT initially declined in period studied but has increased in recent years. In addition, there is a clear pattern of differential use of ECT between the states and territories. CONCLUSIONS: This descriptive study cannot 'explain' the results obtained: other data, incorporated into an explanatory model using regression analysis, are needed to determine the factors underlying the utilization patterns obtained in this study. Thus, further work is needed. Furthermore, it is important to analyse data at a lower level of geographical aggregation than that of the state/territory: this (state/territory) aggregation conceals differences in utilization between metropolitan, minor city, rural and remote regions of the country.

Australia↗
PubMed1988

Special report--National Manpower Survey of 1987. Manpower needs in community hospital and private laboratory practice of pathology.

A new survey of manpower requirements in the community hospital and private laboratory practice of pathology has been completed and analyzed. The survey used a new instrument, the National Pathology Manpower Database, which will be useful in conducting longitudinal surveys. This instrument will permit organized pathology to monitor changes in pathology manpower needs in the years ahead, which are likely to be fraught with change. The results of this survey foretell a significant deficit of pathologists in community hospital and private laboratory practice within the next five years.

American Medical Association↗
PubMed1997

A critique of the case for privatizing Social Security.

This article presents and then critiques arguments made by those advocating the privatization of Social Security. It refutes the argument that baby boomers will find themselves without Social Security pensions unless fundamental changes are made. It questions the claims that privatization would increase economic growth, reduce the federal deficit, make the nation more competitive in the global economy, protect workers against payroll tax increases, protect boomers against pension benefit cuts, and increase confidence in Social Security. It argues that for low-wage workers, returns on contributions would probably decrease and future benefits would become politically more vulnerable.

Aged↗
PubMed2001

The policy on public-private mix in the Ugandan health sector: catching up with reality.

An informal public-private mix in the health sector has always existed in Uganda, and policymakers, planners and the public in general have taken this for granted. There is now renewed effort to develop a comprehensive policy on the mix, but the policy process has proved to be tortuous and the mix has been interpreted differently by different stakeholders. While significant differences in opinion on the mix still remain, it is becoming clear that the new policy should enable health institutions, whether in the public or the private sector, to play roles in which they have clear comparative advantage over others.

Cooperative Behavior↗
PubMed2002

Quality and equity of private sector care for sexually transmitted diseases in South Africa.

The private sector plays a major role in the delivery of health care in South Africa. Over the past two decades, the quality and equity of such provision has been questioned internationally. A study was conducted in Gauteng Province to explore these issues, using care for sexually transmitted disease (STD) as a case study. Private general practitioners (GPs) were interviewed by telephone. Each was presented with a set of STD syndromes and requested to describe how s/he would manage the patient, first if the patient was insured, then secondly if the patient was paying cash (uninsured). Reported prescriptions were costed and assessed for effectiveness against main causative pathogens using local standard clinical guidelines. Knowledge of recent developments in STD syndromic management and effectiveness of prescribed drugs was poor, especially for genital ulcer and pelvic inflammatory disease, and less than half the prescriptions overall were judged as effective. Although the effectiveness of prescriptions for insured and uninsured patients were similar, for most syndromes uninsured patients were offered significantly cheaper and less convenient antibiotic regimens. Effective regimens were also significantly more expensive than ineffective regimens. The results suggest that GPs' perceptions of patients' willingness or ability to pay for drugs have a bearing on quality of care. The paper concludes that STD patients who present to GPs are often offered poor quality of care, and the choice of inconvenient antibiotics impacts disproportionately on the poor. Improvements in the quality and equity of GP care will require interventions that address the factors that determine their behaviour.

Anti-Bacterial Agents↗
PubMed2006

Childhood diarrhoea management practices in Bangladesh: private sector dominance and continued inequities in care.

BACKGROUND: Monitoring for disparities in health and services received based upon gender, income, and geography should continue as renewed efforts to reduce under-five mortality are made in response to millennium development goal #4. The purpose of this survey was to provide a nationally representative description of current childhood diarrhoea management practices and disparities in Bangladesh. METHODS: A nationally representative, cross-sectional, cluster-sample survey was carried out in randomly selected rural and urban populations across Bangladesh. The survey was completed over an 8 month period between November 2003 and June 2004. RESULTS: A total of 7308 children with a prevalent diarrhoeal illness episode within 560 clusters were identified and enrolled in the survey. In 61% of the cases help was sought from a health care provider, with over 90% practicing in the private sector. Caretaker practice disparities favouring males and higher income households were identified. Significant trends (P < 0.001) favouring higher income households were found for having sought help from any provider or a licensed doctor and for treating their child with oral rehydration solution or an antibiotic. Female children in urban households were less likely to be seen by a licensed allopath, adj OR 0.73 (95% CI 0.57, 0.94). Among rural households gender disparities were limited to females being less likely to receive an antibiotic, adj OR 0.74 (95% CI 0.65, 0.86). CONCLUSION: Households seeking help from a health provider overwhelmingly utilize the private sector in Bangladesh. Gender inequities in the utilization of licensed providers and purchase of antibiotics, favouring males were identified. Findings suggest that higher income, urban households tend to practice greater gender discrimination. In order to better understand health dynamics in urban populations, in particular slum-dwellers, there is a need to disaggregate survey data by household location.

Anti-Infective Agents↗
PubMed2001

Privately funded quality health care in India: a sustainable and equitable model.

OBJECTIVE: As the cost and degree of training necessary to provide state of the art health care has increased throughout the world, the present challenge in health care is to establish institutions that are financially sound and responsive to the dynamic needs of the communities in which they exist. As public funds have diminished, the role of the private sector in estabhshing innovative health care institutions has increased. SETTING AND STUDY PARTICIPANTS: This paper reviews the case of the LV Prasad Eye Institute (LVPEI), an ophthalmologic institute in Hyderabad, India, that is financially sound and medically vital. With an annual budget of US$3 million, 180 000 patients are seen and 23 000 surgeries are performed at the Institute and its satellites each year. MAIN MEASURES: The Institute provides patient care at a ratio of 1:1 non-paying to paying patients through fee cross-subsidization. The Institute uses a combination of financial modalities, including donations, grants and fees to administer its non-patient care programs. Non-clinical programs of the Institute include a paramedical training program and a fellowship in ophthalmology, an internationally accredited eye bank for the preservation of corneal tissues, a rural out-reach and education program, a basic science and epidemiology program that directs health policy activities of the Institute and a rehabilitation program for patients with incurable visual deficits. To evaluate its effectiveness, LVPEI uses quality improvement measures, including patient surveys, post-operative outcomes studies and service utlization reviews. CONCLUSION: This case report of a privately-funded medical institution describes a successful model through which high-quality, equitable health care can be provided in a developing country. The LVPEI's active program of quality management, its academic commitment and programmatic relevance to the needs of its community should be modularized and replicated to establish equitable, efficient and effective health care institutions in the developing world.

Budgets↗
PubMed2003

The primary care delivery system in New York's low-income communities: private physicians and institutional providers in nine neighborhoods.

Despite a recent policy emphasis on managed care as the preferred method of financing and delivering care to Medicaid beneficiaries and other indigent populations, there is little information on the availability or the characteristics of primary care providers in low-income neighborhoods. Data from two independent surveys of primary care were analyzed. A 1998 street canvass of each of nine neighborhoods identified 367 primary care offices and 567 private-practice primary care physicians. Survey data on primary care were collected from a total of 280 ambulatory care sites across the city in 1997 and 1999. Information on services, hours, and other data on primary care offered at sites in these nine neighborhoods was compiled to develop a profile of the primary care delivery system. There are relatively few private practice physicians providing primary care in these neighborhoods. While there are considerably more primary care physicians at the ambulatory care sites, there is a wide variation in supply across neighborhoods, driven largely by the presence of sizeable safety-net facilities in several of the neighborhoods. Several indicators of access to primary care across these neighborhoods show similar neighborhood variations. Without primary care availability, managed care's promise of greater access to quality care for low-income populations may fall short.

Ambulatory Care↗
PubMed1997

The changing role of the occupational physician in the private sector: the Canadian experience.

The role of the occupational physician in the private sector is changing. Fewer large corporations maintain medical departments following the 'downsizing' trend of the late 1980's and early 1990's and those that do have extensively redefined the duties of the corporate medical director, often extending these duties to include responsibility for environmental health. Occupational medical services for employees previously covered by in-house services are now often provided by outsourcing. The private practice of occupational medicine has become the major growth area of the specialty in both the US and Canada. These trends have been driven primarily by economic imperatives and new management philosophies; the trend may have gone too far and a 'rightsizing' correction may be in progress. However, it is not clear that corporations in general are deriving the greatest value they can from their physicians or that the current generation of senior managers is utilizing its health professionals as effectively as they might. This is in part because the training, qualifications and capabilities of occupational physicians are not well understood. At least as important, however, is persistent confusion over desirable and appropriate roles that obscures the potential contribution of the medical professional within a management structure. We suggest that the greatest value in occupational medical services may be in the anticipation of risk related to health issues and the flexibility this gives the organization to manage the problem.

Attitude of Health Personnel↗
PubMed1999

Frequency of sepsis after local corticosteroid injection (an inquiry on 1160000 injections in rheumatological private practice in France).

OBJECTIVES: The principal aims of this study were to determine the frequency of sepsis after local corticosteroid injection (SALCSI), to compare the results with those of the literature and to determine the main factors leading to a decrease in the frequency of SALCSI. METHODS: A retrospective study was conducted among 69 rheumatologists in private practice. Sixteen items were studied and are reported. RESULTS: The mean number of years of private practice in rheumatology was 20.9. The total number of CS injections (CSI) was 1160000 for an average of 809 CSI per year and per therapist. The mean number of CSI performed by one rheumatologist was 16 800. Fifteen SALCSI had occurred, which corresponds to a frequency of 1/77300 CSI. The rate of SALCSI for the older rheumatologists was lower than that of their younger colleagues. The frequency of use of corticosteroid packaged in a sterile syringe (CSPSS) was approximately 85%. Nine out of the 15 cases of sepsis had occurred after the use of CS not packaged in a sterile syringe and six after the use of CSPSS. Thus, the frequency of SALCSI was 1/162000 after the use of CSPSS and 1/21000 after the use of CS not packaged in a sterile syringe. CONCLUSIONS: The mean frequency of SALCSI in Paris and the surrounding area was 1/77300 during the last 21 yr, a decrease since the 1960s and 1970s. This decreased incidence is in part due to the greater experience of the rheumatologist, but even more to the use of CSPSS.

Adrenal Cortex Hormones↗
PubMed1999

Improving nursing documentation for private-duty home health care.

Private-duty, home health care agencies have struggled in assuring compliance with accurate and complete nursing documentation. In this descriptive study, the author reports on an improvement and innovation project in a private-duty, home health care agency aimed at improving nursing documentation, as measured in chart review audits. Initial strategies were directed toward revising the documentation system, with implementation of a flow record, and conducting group nurse education. These efforts had a minimal effect on improving documentation compliance. A major, multifocus strategy was then implemented. The educational component stressed pre- and posttest. The chart audit tool was revised to track individual nurse behaviors. Nurses were mentored when documentation did not meet standards. Lastly, the nurse job description and corresponding performance appraisal document were revised to clarify nurse responsibility and strengthen nurse accountability; progressive discipline was initiated when warranted. Significant and sustained improvement was subsequently realized.

Documentation↗
PubMed1976

Comparison of a private family practice and a university teaching practice.

In March 1972 a private family practice in Hamilton, Canada, became a teaching practice of McMaster University. Subsequently a before-and-after study was conducted to compare characteristics of the patients and the impact of the change on the practice. There was a 34 percent reduction in practice size. There was a shift to younger patients and a substantial drop in mean patient income. Utilization rates of health services rose, particularly hospitalization, even though the average length of stay decreased. Profiles of complaints and diagnoses remained very similar. Quality of care scores were comparable with those of community controls before and after the change. Gross income from clinical earnings dropped, but the amounts per person per year were very similar in the two periods. It is concluded that the "transplanted private practice" which becomes part of a school of medicine is a realistic teaching resource in primary care.

Family Practice↗
PubMed1994

The effect of teaching medical students on private practitioners' workloads.

BACKGROUND: The costs in time and money of medical student education for family physicians in private practice is uncertain, with the literature containing conflicting reports. METHOD: Questionnaires were mailed in 1992-93 to 56 primary care physicians who had taught third- or fourth-year students during the previous academic year in fulfillment of the students' required four-week family medicine preceptorships at the University of Missouri-Columbia School of Medicine. RESULTS: Forty-six physicians responded. The physicians had been preceptors for 74 students. Most of the physicians reported increases in time spent at work (mean of 46 minutes per day, standard deviation of 32 minutes) when a student was present in their practices. Only five noted decreases in billed charges. CONCLUSION: The preceptors were consistent in their indications that having students in their offices increased their time at work. This suggests that teaching medical students places a substantial temporal burden on private practitioners.

Costs and Cost Analysis↗
PubMed1995

The outlook for clinical research: impacts of federal funding restraint and private sector reconfiguration.

Accustomed to congressional and industry support, patient-centered clinical research is at a crossroads in 1995. Forced to look into the next century by the seven-year budget cycle selected by Congress, its path seems hindered by threatened cuts in funding for the National Institutes of Health (NIH), cost pressures on private-sector organizations that support research initiatives, and market restraints on the academic health centers that traditionally have served as research bases for many clinical investigators. Assuring public and private financial support for clinical research has become an important topic on policy and industry agendas, as has the need to sort out the roles of the NIH, academic health centers, managed-care plans, and pharmaceutical firms in backing and conducting research. The very character of clinical inquiry seems to be reshaping itself amid conflicts over basic versus applied research, ongoing versus new investigations, and scientific discovery versus product development. How these issues are approached--let alone resolved--is significant not only for the future of clinical research but also for the health of the public. The author discusses these issues and concludes with a list of specific questions that must be addressed in confronting policy issues of clinical research.

Academic Medical Centers↗
PubMed1998

Comparison of the levels of quality of inpatient care delivered by pediatrics residents and by private, community pediatricians at one hospital.

PURPOSE: To compare the quality and cost of inpatient care provided by pediatrics residents with the quality and cost of that provided by private, practicing pediatricians. METHOD: Valley Children's Hospital--a 175-bed, private, nonprofit, university-affiliated pediatric hospital located in Fresno, California--has both a resident service and a community physician service. From May 1994 to March 1995 a total of 154 pediatric patients (64 from the resident service, 90 from the community service) were selected for the study using incidental sampling. In order to be included in the study, patients had discharge diagnoses of uncomplicated gastroenteritis or asthma. The parent or guardian of each patient completed a satisfaction questionnaire at discharge and agreed to a home visit one month later, when the same questionnaire and another were completed. Patients' charts were studied for treatment procedures, and follow-up data for a year were compiled. Statistical analyses were conducted with analysis of variance for continuous measures and chi-squares for dichotomous variables. RESULTS: The findings indicated no difference between the two services in terms of the parents' and guardians' satisfaction with patient care, hospital charges, and degrees of adherence to follow-up care after discharge. The community physicians were more likely than were the residents to employ non-standard laboratory and management procedures with both the asthma and gastroenteritis patients. The asthma patients cared for by community physicians had significantly more frequent asthma attacks after discharge, with a higher frequency of patients being subsequently treated in the emergency room and readmitted to the hospital, than did the asthma patients cared for by the residents. CONCLUSION: Common perceptions that physicians-in-training (1) overuse medical services and (2) fail, due to their inexperience, to provide high-quality services were not supported in this study.

Adolescent↗
PubMed1998

The challenges of governing public-private community health partnerships.

This article identifies key challenges that arise in governing public-private partnerships designed to improve community health status. Using telephone interview and focus group data, we describe how the 25 public-private community health partnerships participating in the Community Care Network (CCN) Demonstration Program grapple with three interrelated clusters of governance issues: turf, community accountability, and growth and development.

Community Health Planning↗
PubMed1992

The changing private practice environment: how to analyze opportunities.

The search by physicians for opportunities to improve the short-term performance and long-term value of their practices has resulted in the creation of a range of affiliation and group practice structures and changed the traditional private practice profile. The resulting ability to structure an environment that is optimal for each practitioner or group of practitioners can enhance the delivery of medical care and serve to attract an array of individuals to private practice. In order for this evolution to be successful, however, the entities must be developed with thoughtful and detailed analysis and should be flexible enough to adapt to the continually changing environment.

Ambulatory Care↗