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At least 1,261 records · Page 70Linked to original sources
PubMed2002

Private practicing endodontists: production of endodontic services and implications for workforce policy.

The methods and techniques used by private practicing endodontists to provide patient care are at the core of endodontic workforce policy. Productivity influences both the amount of care provided and the required number of practicing endodontists in the future. Data was collected from practicing endodontists in order to characterize the technical methods of producing endodontic services. This data was then used to develop a statistical model for use in assessing the national endodontic workforce conditions in the United States. A survey was mailed to a random sample of 2,075 private practicing endodontists in the United States based on membership files from the American Association of Endodontists and the American Dental Association. The overall survey consisted of three means of data collection: (1) a survey about the endodontic practice as a whole; (2) a survey about the endodontist; and (3) patient encounter forms used when collecting detailed endodontic procedure data for a single day in the practice. The model was used to obtain a projection of 4,016 endodontists in the year 2005 and 4,671 practicing endodontists in 2010 required to meet the projected demand for endodontic care. The model and survey data provide valuable information to practicing endodontists for use in identifying critical elements used to render care, how the elements are combined in the practice of endodontics, and the minimum number of endodontists required to provide a given volume of endodontic care.

Adult↗
PubMed1976

Distribution of private practice offices of physicians with specified characteristics among urban neighborhoods.

The office location of New York County physicians in private practice is determined for a verified subpopulation of the "Medical Directory of New York State" listing for the year 1970-71. Physicians are categorized by specialty status, medical schools attended, dates of graduation, and hospital affiliations. Multiple regression analysis is performed to relate numbers of physicians per Health Area (average population: 20,000) to demographic, economic, and medical care characteristics of the areas. There is considerable unevenness in the number of private physician offices among Health Areas (mean, 66; standard deviation, 173; range, 1 to 1,043). Multiple regression analysis shows a strong, positive association between practice location and median area income. The influence of population size on practice location is also found to be significant for many categories of physicians but less strong than that of income. Other independent variables are found to have a weaker to nonsignificant impact on practice location. Disaggregation of physicians into specified categories reveals differences in elasticity of location estimates that would have gone undetected had only the aggregated physician population been investigated. Itis concluded that policy decisions concerning physician distribution should be made on the basis of data on smaller areas than has been done in the past, and on specified categories of physicians rather than on aggregates.

Age Factors↗
PubMed1999

The relation of parent and provider characteristics to vaccination status of children in private practices and managed care organizations in Maryland.

OBJECTIVES: This study sought to identify provider practices and policies in private pediatric settings that relate to vaccination status, controlling for the characteristics of the children served. METHODS: Vaccination data came from the medical records of 709 randomly selected 2-year-old children at 18 private practices and managed care organizations in Maryland, family data from 466 telephone interviews with the children's parents, and provider characteristics from 18 site questionnaires and 42 individual physician and nurse practitioner questionnaires. Logistic regression and generalized estimating equations were used to estimate the relation of provider characteristics to vaccination status. Three age-appropriate (AA) and two up-to-date (UTD) vaccination status variables characterized successful vaccination. RESULTS: Approximately 70% of the study children were up-to-date by age 2 years for the full vaccination series, excluding hepatitis B vaccine. Family demographic characteristics were the strongest correlates of undervaccination. Neither parents' knowledge and attitudes about immunization nor the children's insurance coverage was statistically related to vaccination status. Site reminder or follow-up systems and provider perceptions about appointment scheduling and receipt of vaccine information from health departments were positively related to vaccination. Concern for liability was associated with a reduced odds of age-appropriate and up-to-date vaccination. CONCLUSIONS: Family demographics strongly correlate with vaccination status; however, they are generally not modifiable. This study's findings encourage providers to operate a tracking system, to remain current on immunization recommendations, to use all clinical encounters to screen and vaccinate children, and to ensure the availability and convenience of vaccination services.

Age Factors↗
PubMed1997

Privatizing public mental health and substance abuse services: issues, opportunities, and challenges.

Much like the medical care system, delivery systems for mental health and substance abuse services are being transformed rapidly by managed care. Public sector systems are now facing challenges to transfer service delivery responsibilities to private managed behavioral health care organizations as a way of containing treatment costs and realizing operational efficiencies. These privatization efforts entail a range of quality management issues that are specific to mental health and substance abuse problems, treatments, and clients.

Community Participation↗
PubMed1997

Public health, privatization, and market populism: a time for reflection.

The political, social, and economic ideology fueling the movement toward privatization in health care may be characterized as "market populism." Whether or not public health agencies retain their traditional roles in personal health services delivery, these organizations must serve as the predominant external source for quality monitoring, oversight, enforcement, and advocacy for communities in an environment that regards the private market as a panacea.

Democracy↗
PubMed1998

Private sector health care organizations and essential public health services: potential effects on the practice of local public health.

This article focuses on the activities of eight private health care organizations undertaking public health and prevention activities. Few activities were motivated by or integrated into the business or operating strategy of the organizations and poor integration with the business strategy puts the long-term future of these activities in jeopardy. The lack of integrated activity can be attributed to: slow pace of managed care implementation; low penetrance of full-risk capitated reimbursement; and fragmented, competitive health care markets. Purchaser pressure, quality assurance requirements, community benefit standards, and government mandates are among the levers available to encourage such activities by the private sector.

Delivery of Health Care↗
PubMed1999

Collaborating with private sector physicians: the example of childhood lead poisoning prevention.

Collaboration between public and private health sectors to achieve public health goals can be difficult. The experience of childhood lead poisoning prevention programs in two cities where private practitioners dramatically increased blood lead screenings is used as an example of how successful collaborative relationships can be constructed. Seven action steps toward effective collaboration are offered: establish a rationale, document the problem, attend to logistics, clarify reimbursement, make known available support, build demand, and demonstrate leadership.

Child, Preschool↗
PubMed2005

Hearing aid patients in private practice and public health (Veterans Affairs) clinics: are they different?

OBJECTIVE: In hearing aid research, it is commonplace to combine data across subjects whose hearing aids were provided in different service delivery models. There is reason to question whether these types of patients are always similar enough to justify this practice. To explore this matter, this investigation evaluated similarities and differences in self-report data obtained from hearing aid patients derived from public health (Veterans Affairs, VA) and private practice (PP) settings. DESIGN: The study was a multisite, cross-sectional survey in which 230 hearing aid patients from VA and PP audiology clinic settings provided self-report data on a collection of questionnaires both before and after the hearing aid fitting. Subjects were all older adults with mild to moderately severe hearing loss. About half of them had previous experience wearing hearing aids. All subjects were fitted with wide-dynamic-range-compression instruments and received similar treatment protocols. RESULTS: Numerous statistically significant differences were observed between the VA and PP subject groups. Before the fitting, VA patients reported higher expectations from the hearing aids and more severe unaided problems compared with PP patients with similar audiograms. Three wks after the fitting, VA patients reported more satisfaction with their hearing aids. On some measures VA patients reported more benefit, but different measures of benefit did not give completely consistent results. Both groups reported using the hearing aids an average of approximately 8 hrs per day. VA patients reported age-normal physical and mental health, but PP patients tended to report better than typical health for their age group. CONCLUSIONS: These data indicate that hearing aid patients seen in the VA public health hearing services are systematically different in self-report domains from those seen in private practice services. It is therefore risky to casually combine data from these two types of subjects or to generalize research results from one group to the other. Further, compared with PP patients, VA patients consistently reported more favorable hearing aid fitting outcomes. Additional study is indicated to explore the determinants of this result and its generalizability to other public health service delivery systems such as those in other countries. Moreover, efforts should be made to assess the potential for transferring positive elements from the VA system to the PP service delivery system, if possible.

Adult↗
PubMed2005

Economic costs of benign prostatic hyperplasia in the private sector.

PURPOSE: Several studies document the impact of benign prostatic hyperplasia (BPH) in working, aged men. Direct medical costs related to BPH treatment are largely borne by employees through higher premiums. However, indirect costs related to lost work are primarily borne by the employer. In this study we used claims data and absentee records from large employers to estimate the costs associated with BPH in working age males. MATERIALS AND METHODS: We used 2 data sources to examine direct and indirect costs associated with BPH in a privately insured, nonelderly population. Multivariate regression models were used to predict spending for persons with and without a medical claim for BPH, controlling for relevant covariates. Data on work loss were linked to medical claims to estimate work loss related to treatment for BPH. RESULTS: Mean annual expenditures were 4,193 dollars for men without a medical claim for BPH. In contrast, annual spending was 5,729 dollars for men with a claim for BPH. Thus, the incremental cost associated with a diagnosis of BPH was 1,536 dollars yearly. Overall the average employee with the condition missed 7.3 hours of work yearly related to BPH with approximately 10% reporting some work loss related to a health care encounter for BPH. CONCLUSIONS: Treatment of men with BPH places a significant burden on employees and their employers through direct medical costs as well as through lost work time. Direct and indirect costs to the private sector related to BPH treatment are estimated to be 3.9 billion dollars.

Absenteeism↗
PubMed2003

Estimating private sector professional fees for VA providers.

OBJECTIVES: To describe new methods used to estimate inpatient and outpatient Medicare-based professional fees for Veterans Health Administration (VA) services. METHODS: National VA utilization files provided estimates of inpatient physician services, whereas local provider and utilization files gave counts of outpatient services by physicians, nurse practitioners, physician assistant, clinical psychologists, and clinical social workers. Services from ambulatory surgery, emergency room, and clinics (eg, dermatology and gastroenterology) were coded by study health information management staff (coders). VA-based billing information was edited against Medicare guidelines. Estimates for VA services without comparable Medicare fees were obtained from other commercial sources. RESULTS: Hypothetical professional fees for VA services were 17% more ($109 million vs. $93 million) than the VA budget for physicians over 1 fiscal year at six sites. Total payments of nearly $21 million were generated for VA inpatient care. In fiscal year 1999, there were 30,209 admissions (of which 4549 were psychiatric) to the study sites; 30,518 discharges; 229,783 inpatient days, including 27,235 in critical care units; and 38,348 surgical days of care. DISCUSSION: Differences between the VA and the private sector maybe overstated because VA salaries of nonphysicians were not included in the VA budgets. Conversely, the extent to which VA professional services were undercounted in VA information systems used in this study may understate the difference. Future research may consider additional data collection approaches or information systems enhancements to enumerate more accurately all provider services that are reimbursable in the private sector.

Budgets↗
PubMed2003

Using the cost distribution report in estimating private sector payments: what adjustments should researchers make?

OBJECTIVES: To reapportion Veterans Health Administration (VA) annual expenditures into benefit categories for comparison with estimated payments by private sector providers. METHODS: Total expenditures for six VA medical centers for federal fiscal year 1999 were reapportioned by benefit category using the cost distribution report (CDR). Health benefit categories were based on those of health care insurers. Cost reapportionment was based on CDR data and reviews of source accounting and payroll documents. RESULTS: Actual expenditures for many benefits can be accurately identified and reapportioned using CDR data, but other expenditures were not identifiable in the CDR and required inspection of source documents. Inpatient expenditures amounting to $75,110,094 US dollars and outpatient expenditures amounting to $73,594,284 US dollars were reapportioned into other benefit categories, primarily professional fees. Expenditures for some VA benefits could not be identified because of differences in accounting and clinical practice between the VA and the community. DISCUSSION: Revisions to bring the CDR more in line with private sector payment categories would improve effectiveness for internal VA analyses and external expenditure comparisons. CDR revisions would require changes in recording some clinical workload (eg, rehabilitation and extended care) and classifying residential and domiciliary programs separate from inpatient care. Benefits that were not assigned expenditures for comparison with payments represent a potential liability if the VA were to purchase health care services in the marketplace. Variation among hospitals on expenditures not clearly identified in the CDR was significant and raises questions about the effectiveness of capitated budget methodologies using either the CDR or the decision support system.

Cost-Benefit Analysis↗
PubMed2000

Renewing the model employer. Changing employment relations and "partnership" in the health and private sectors.

Drawing from original empirical data this paper compares the changing nature of employment relations in the health and private sectors. A key concern is to assess the extent to which the emergence of partnership-type arrangements between employers and trade unions lays the basis for the "renewal" of the traditional public sector concept of the model employer. Empirically, the paper draws on a survey of trade union representatives from 238 workplaces and a case study of a hospital trust. The data reveal that employment relations in the NHS are more collectivist when compared with the private sector. However, the development of partnership in the NHS is hamstrung by ongoing training and involvement gaps and widespread work intensification.

Employment↗
PubMed1999

Knowledge and attitudes of Malaysian private medical practitioners toward guidelines-based medicine.

This paper describes a study of the knowledge and attitudes of a sample of private medical practitioners in Malaysia in relation to questions posed on guidelines-based medicine. The study was conducted through a postal questionnaire sent to a sample of 2,000 private practitioners. Placing the research in context, a description of Malaysia and its health-care system is provided. Issues surrounding guidelines-based medicine in the Malaysian context are discussed. An analysis of the sample population's personal and professional characteristics is presented. Key research findings include identifying a substantial knowledge deficit--less than half of the respondents claimed to understand "guidelines". A majority of doctors (64 per cent) think guidelines are useful. Only 29 per cent of respondents knew where to find guidelines, with 22 per cent claiming to have used guidelines. The paper concludes with a discussion of issues in the implementation of guidelines-based medicine in Malaysia based on the study's findings.

Attitude of Health Personnel↗
PubMed2006

Public policy and private provisions: changes in residential care from 1991 to 2001.

This research examined changes in the number of care homes and their residents in the UK between the 1991 and 2001 Censuses. Local-authority-owned provision universally declined in this period, but changes in private residential and nursing homes were far more varied. Some parts of Britain experienced a growth in this market, in particular Scotland. Regions which were traditionally linked with greater numbers of retired people in their populations declined in their private residential home markets (e.g. the South West and South East). Wales experienced a regional decline that was greater than most English regions. Using additional Department of Health data, it was possible to estimate which local authority areas in England were exporting state-funded supported residents to homes out of their area. Most of these authorities were in urban areas and the highest rates of exporting were from Inner London boroughs. Political control and average property prices were explored as possible independent variables influencing the percentage rate of decline in homes in a local authority area. It appeared that Conservative authorities experienced a more rapid decline in government-owned homes than those run by Labour, but the results were not statistically significant, suggesting that local politics was a not a key influence on the trend. Average property prices did not affect all areas of the country, but were found to have a negative and significant association with percentage rates of decline in care homes in both Wales and London.

Adult↗
PubMed2005

Nurse job satisfaction and retention: comparing public to private hospitals in Jordan.

AIMS: To identify variables of Jordanian nurses' job satisfaction and retention. Comparisons were performed between three public and two private hospitals. BACKGROUND: There has been little research on nurse job satisfaction and retention in Jordan. Interest in nurse retention is renewed with each cycle of nursing shortage. METHODS: A descriptive design using surveys guided this study through convenience sample of 438 nurses. Data were analysed using descriptive and inferential statistics. RESULTS: Nurses reported that they were "moderately satisfied" in their jobs with "neutral" opinion about their retention. Nurses who work in private hospitals were more satisfied and intended to retain their jobs more than nurses in public hospitals. CONCLUSION: Nurse job satisfaction and retention are related concepts; nurses who are satisfied in their jobs are likely to retain these jobs.

Adult↗
PubMed2006

Negotiating improved case management of childhood illness with formal and informal private practitioners in Uganda.

OBJECTIVE: In Uganda, formal and informal private practitioners (PPs) provide most case management for childhood illness. This paper describes the impact of negotiation sessions, an intervention to improve the quality of PPs' case management of childhood diarrhoea, acute respiratory infection and malaria in a rural district in Uganda. METHOD: Negotiation sessions targeted PPs working at private clinics and drug shops. The aim was to improve key practices extracted from the national Integrated Management of Childhood Illness Guidelines, and to measure the PPs' performance before and after the intervention. RESULTS: Post-intervention the quality of case management for childhood diarrhoea, acute respiratory infection and malaria was generally better, although certain practices appeared resistant to change. We discovered various types of PPs who were mostly unregistered by the district authorities. CONCLUSIONS: Results suggest the importance of maintaining ongoing monitoring and support to PPs to understand barriers to change and to encourage more practice improvement. Modifications to the intervention are needed to take it to scale and render it more sustainable. Getting local organizations and professional associations more involved could make it easier to establish and maintain contact with PPs. The government needs to simplify registration procedures and reduce associated fees to encourage PPs to register and thus be included in a large-scale intervention. Future interventions need to measure the impact on improving childhood case management at the community/household level.

Acute Disease↗
PubMed1996

The frequency and nature of skin conditions seen in a private dermatology practice in central Victoria, 1991-95.

A dermatology diagnostic database was established in order to determine the frequency and nature of skin conditions in a private dermatological practice in Central Victoria, Australia. Between August 1991 and June 1995, a total of 3346 dermatological diagnoses were recorded for 3000 new patient presentations. More women (58.9%) were seen than men (41.1%). Dermatitis and tumours of the skin accounted for 50% of new consultation(s), the highest attendance being for solar keratoses (11.9%). The frequency of patients seen was comparable to the previous 1970s survey of private dermatological practice in Australia, with the exception of melanocytic naevi, which was seen with twice the frequency compared to previously. The proportion of patients presenting with dermatitis was higher in the colder seasons of the year (winter and spring compared with summer and autumn). The proportion of people seen with melanocytic naevi was higher in summer and autumn compared with winter and spring. These results illustrate the usefulness of recording clinical patient data in practice as a way of recording patterns of referral as well as having a role in determining causation of disease.

Data Collection↗
PubMed2003

Having a baby in Victoria 1989-2000: women's views of public and private models of care.

OBJECTIVE: To assess and contrast women's views of antenatal, intrapartum and postnatal care based on data collected in three state-wide surveys of recent mothers conducted in 1989, 1994 and 2000. METHODS: Postal surveys were mailed to all women who gave birth in Victoria in one week in 1989, and in two weeks in 1993 and 1999, excluding those who had a stillbirth or neonatal death. Questionnaires were sent to women by hospitals and home birth practitioners 5-8 months after the birth. RESULTS: 58.6% of women participating in the 1989 survey rated their antenatal care as 'very good' compared with 62.4% in 1994 and 66.5% in 2000 (chi 2 for trend = 15.01, p < 0.001). In all three surveys, women enrolled in public models of care were significantly more likely to rate their antenatal care as less than 'very good' than women enrolled in private models of care. More than two-thirds of the women in each survey rated their intrapartum care as 'very good' (1989-67%, 1994-71%, 2000-72%). Over the time period there was an improvement in the proportion of women rating their care as 'very good' among women in private care (chi 2 for trend = 33.1, p < 0.001), but no improvement was seen in public care. Only 52% (1994) and 51% (2000) of women rated their postnatal care as 'very good'. CONCLUSIONS: The conduct of three population-based surveys of recent mothers in Victoria over the past 10 years has provided valuable information for charting the impact of organisational changes on women's views and experiences of maternity care.

Birthing Centers↗