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PubMed2003

[The relationships between organizations for technical cooperation in health and private consulting businesses].

In recent years, agencies that provide technical cooperation in health have increased their contractual relationships with private consulting entities. This has made it possible to respond in a timely manner to the support needs that countries have, to develop skills at the national level, and to reduce the operating costs for the cooperation agencies. However, these relationships risk moving the cooperation agencies away from generating ideas and new knowledge, which, until recently, was considered one of their essential roles. Contracting with private enterprises will almost certainly increase in the coming years. This makes it worth reviewing the tasks that correspond to the cooperation agencies in this scenario as well as mechanisms to see that these relationships result in the greatest benefit for deprived groups. Actions that can be undertaken immediately include organizing the "structural capital" (such as programs, databases, strategies, and organizational "culture," structure, systems, and procedures) of the technical cooperation agencies, precisely identifying tasks that cannot be delegated, and adequately designing and controlling terms of reference.

Contract Services↗
PubMed2000

Child behavior in a private pediatric dental practice associated with types of visits, age and socio-economic factors.

The purpose of this study was to describe child patient behavior patterns seen in a private pediatric dental practice. Patient behavior for every individual visit was recorded over a span of 3 consecutive months using the Sarnat Behavior Scale as the descriptive measurement device. Behavior during 5 categories of procedures was recorded: new patient examination/introduction to the office, periodic recare, restorative dentistry, orthodontic adjustment and quick check observation. Socio-demographic variables such as age, sex, method of payment as an indicator of socio-economic status, prior dental experience and referral source were also recorded. The results of this study showed: 1. the younger the child and the more threatening the procedure, the more often negative behavior was noted, 2. patients whose dental treatment was paid for by Medicaid and who are likely to be in a lower socio-economic strata, often exhibited more negative behavior than the fee-for service counterparts, 3. in general, there was no difference in the behavior between males and females, although males age 8 to 12 had a higher incidence of negative behavior than females when undergoing restorative dental procedures. There are trends between age, type of procedure, source of patient referral, method of payment and familiarity with the office, that may be able to used as behavioral predictors in a private pediatric dental office.

Age Factors↗
PubMed2002

The effect of restorative treatment on children's behavior at the first recall visit in a private pediatric dental practice.

Clinicians anecdotally believe that children, who have an invasive dental procedure after the initial office visit, often exhibit negative behavior at the recall examination. The purpose of this study was to document the behavior of children having the first recall visit at a private pediatric dental practice to determine if the restorative dentistry experience influenced behavior at recall. All children presenting for the first recall visit in the private practice of the author were included in the study (n = 271). Patient age, method of payment as an indicator of socio-economic status and whether or not they had restorative dental treatment subsequent to the initial visit was recorded by the author, who was also the treating dentist. Behavior was evaluated using the scale formulated by Sarnat, which rates behavior in 5 categories from completely cooperative to completely uncooperative. Behavior at the initial visit was also recorded and retrieved from retrospective examination of patient records The results showed that 3 to 6 year olds, who underwent restorative dentistry, exhibited more negative behavior than those who did not. No difference in behavior was found in those children under 3 years or over 6 years of age. Depending on the age, behavior at the first recall visit may be influenced by having undergone a restorative dental procedure after the initial examination.

Age Factors↗
PubMed1995

Compliance with supportive periodontal treatment in private periodontal practice. A 14-year retrospective study.

The purpose of this study was to determine the degree of compliance with supportive periodontal treatment (SPT) recommended in private periodontal practice and to determine if any significant differences existed in the characteristics of compliant, non-compliant, and erratically compliant patients. The study covered a period of 14 years (1977 to 1991) and included 521 patients who were classified by sex, age, socioeconomic class, disease severity, treatment rendered, and the year maintenance began. Compliance was categorized into four groups: complete compliance, erratic compliance, patients who discontinued SPT, and patients who never presented for SPT. Females began SPT more often than males (P = 0.054). Only 27.4% of the patients were in complete compliance at the end of the study. A significantly greater percentage of females (P = 0.032) and patients who had been treated by only scaling and root planing (P = 0.014) were in complete compliance. Drop-out rates from SPT tended to decrease during the first 6 years from 13.9% in the first 2 years to 9% in the sixth year. Thereafter, the percentage of patients presenting for SPT stabilized at 48.4% after 6 and 43.2% after 11 years. Younger patients (P = 0.04), those who had received only scaling and root planing (P = 0.008), and individuals in socioeconomic class I (P = 0.017) had a significantly lower tendency to drop out. The results confirm that compliance to SPT in private periodontal practice is far from ideal. Suggestions for improving compliance are discussed.

Adult↗
PubMed2004

The economic rationale of public and private sector roles in the provision of animal health services.

In the changing market environment of livestock products, the delivery of animal health services is emerging as an important priority area for enhancing the competitiveness of poor livestock producers. At the same time, governments are continuing to face serious budgetary difficulties and are finding it difficult to expand the reach of these services or improve service quality. In this context of a changing environment and dwindling public resources, this paper revisits the economic framework that has thus far guided thinking about public and private sector roles in the provision of animal health services and examines the ongoing debate on livestock service delivery for the poor. The paper highlights the importance of strong institutions and appropriate legislation for regulating behaviour and enforcing contracts and re-emphasises the idea, which is supported by economic theory, that there is a need for task sharing between the public and private sectors. The paper further emphasizes the need for: a) integrating the debate on livestock service delivery with the larger debate on political economy and institutional development, and b) ensuring service access in poor marginal areas by working through membership organisations, self-help groups and civil society organisations, and by promoting the use of para-professionals and community-based animal health delivery systems.

Animal Welfare↗
PubMed2005

Health expenditures for privately insured adults enrolled in managed care gatekeeping vs indemnity plans.

OBJECTIVES: We assessed the ability of managed care gatekeeping strategies (i.e., requiring a designated primary care provider to authorize referrals) to control health care costs in the mid-1990s. METHODS: We analyzed expenditure data from 8195 privately insured adults sampled in the nationally representative 1996 Medical Expenditure Panel Survey. Managed care gatekeeping plan enrollees included those in health maintenance organizations and other plans requiring a primary care gatekeeper. All others were considered indemnity plan enrollees. RESULTS: In 1996, total per capita annual health expenditures for adult gatekeeping enrollees were about $50 less than those of indemnity enrollees, primarily owing to lower out-of-pocket expenditures. After multivariate adjustment, mean per capita expenditures were approximately 6% lower for gatekeeping enrollees than for indemnity enrollees. CONCLUSIONS: In the private sector, gatekeeping strategies resulted in modest cost savings over indemnity plans.

Adult↗
PubMed2005

A private-sector preferred provider network model for public health screening of newly resettled refugees.

US law and regulations stipulate a process for the health screening of refugees. The responsibility of caring for refugees resettled in the United States rests, in part, with public health or welfare departments. Massachusetts has met its screening responsibilities through the innovative creation of a network of private preferred providers. We explore the Massachusetts model of public-private collaboration within the context of federal refugee health priorities and current state fiscal restraints affecting public health programs, and demonstrate the model's accomplishments.

Community Health Centers↗
PubMed1985

Restructuring health care: the social geography of public and private health care under the British Conservative Government.

The 1979 election of the Conservative Government in Britain was not followed by the demolition of the welfare state. However, a variety of policy initiatives were introduced both to restructure National Health Service (NHS) expenditure, and to facilitate private provision of health services. This article considers the effects of such policies on the existing and future distribution of health care resources. A historical introduction discusses the main thrusts of conservative welfare policy. This is followed by an examination of the current financial situation of NHS authorities, at the regional and sub-regional scales; the political response to the 1983 manpower reductions is also considered. Events in the NHS are then contrasted with the deregulation of the private sector. The emergence and distribution of commercial acute hospitals are examined, as are other initiatives designed to transfer some of the financial burden of welfare provision away from the state. A concluding section compares and contrasts these developments and considers prospects for the future form of health care provision in Britain.

Catchment Area, Health↗
PubMed2005

Colombia: in vivo test of health sector privatization in the developing world.

The reform of the Colombian health sector in 1993 was founded on the internationally advocated paradigm of privatization of health care delivery. Taking into account the lack of empirical evidence for the applicability of this concept to developing countries and the documented experience of failures in other countries, Colombia tried to overcome these problems by a theoretically sound, although complicated, model. Some ten years after the implementation of "Law 100," a review of the literature shows that the proposed goals of universal coverage and equitable access to high-quality care have not been reached. Despite an explosion in costs and a considerable increase in public and private health expenditure, more than 40 percent of the population is still not covered by health insurance, and access to health care proves uncreasingly difficult. Furthermore, key health indicators and disease control programs have deteriorated. These findings confirm the results in other middle- and low-income countries. The authors suggest the explanation lies in the inefficiency of contracting-out, the weak economic, technical, and political capacity of the Colombian government for regulation and control, and the absence of real participation of the poor in decision-making on (health) policies.

Colombia↗
PubMed1989

The politics of welfare privatization: the British experience.

The 1980s Conservative government in Britain is committed to policies of welfare privatization for practical and ideological reasons--to facilitate tax cuts and to roll back the state. One problem this policy faces is that the most expensive and interventionist services are highly popular with voters from all parties. In this article, the author examines the extent to which recent privatization policies in welfare are influenced by conflict between the goals of achieving tax cuts and of maintaining electoral support, so that the outcome is a change in the form of state interventionism, rather than a rolling back of the welfare state. It also considers the impact of new policies designed to undermine the consensus across social groups and political parties of support for big-spending state services, which may facilitate reductions in the overall scope of welfare provision in future years.

Aged↗
PubMed1999

An analysis of management of private dental clinics in Japan from the survey of the current economy of medicine and dentistry.

We analyzed the current state of management of private dental offices in Japan using the 11th Survey of the Current Economy of Medicine and Dentistry conducted in September of 1997. The analysis was mainly performed by comparing the survey in 1997 with the survey conducted in 1989. The results show the medium-term tendencies in dental management. We also compared the data from dental offices with those from private medical offices without facilities for inpatients. The following are the results: the average income from dental practice for a dental office in 1997 was 4,050,000 yen, a decrease of 4.9% (about 210,000 yen) compared with the average income in 1989. The average income from treatment covered by insurance in 1997, which accounted for most of the total income, was 3,540,000 yen, a decrease of 2.8% compared with that in 1989. The average income from non-insured treatment was 490,000 yen, which was also a decrease of 17.4%. The average income from medical practice for a medical office in 1997 was 1,970,000 yen more than the average income from dental practice of the same year. The average medical practice expenses and the average balance in medicine were higher than those in dentistry by 1,360,000 yen and by 600,000 yen respectively. Although the average income from medical practice slightly increased, the average wage costs increased by as much as 42.8%, resulting in a decrease of 21.2% in the average balance. Dental offices attempted to weather the decreased income from dental practice by raising the average fee paid by an insured patient. The analysis in the present study suggested that a decreasing number of patients and increasing dental practice expenses diminished the balance.

Dental Clinics↗
PubMed2006

Hard gains through soft contracts: productive engagement of private providers in tuberculosis control.

Over the past decade, there has been a rapid increase in the number of initiatives involving "for-profit" private health care providers in national tuberculosis (TB) control efforts. We reviewed 15 such initiatives with respect to contractual arrangements, quality of care and success achieved in TB control. In seven initiatives, the National TB Programme (NTP) interacted directly with for-profit providers; while in the remaining eight, the NTP collaborated with for-profit providers through intermediary not-for-profit nongovernmental organizations. All but one of the initiatives used relational "drugs-for-performance contracts" to engage for-profit providers, i.e. drugs were provided free of charge by the NTP emphasizing that providers dispense them free of charge to patients and follow national guidelines for diagnosis and treatment. We found that 90% (range 61-96%) of new smear-positive pulmonary TB cases were successfully treated across all initiatives and TB case detection rates increased between 10% and 36%. We conclude that for-profit providers can be effectively involved in TB control through informal, but well defined drugs-for-performance contracts. The contracting party should be able to reach a common understanding concerning goals and role division with for-profit providers and monitor them for content and quality. Relational drugs-for-performance contracts minimize the need for handling the legal and financial aspects of classical contracting. We opine that further analysis is required to assess if such "soft" contracts are sufficient to scale up private for-profit provider involvement in TB control and other priority health interventions.

Antitubercular Agents↗
PubMed1977

A point prevalence study of outpatients and inpatients in the mental health services, general hospital psychiatric units, and under private psychiatrists in Perth, Western Australia.

A one day point prevalence study of all inpatients and a one week point prevalence study of all out-patients, seen by psychiatrists in Perth, Western Australia, was conducted. On the census day in July 1971, 61 per cent of all psychiatric inpatients in Perth were long-stay patients. Of the short-stay patients 75 per cent were in Mental Health Services hospitals, 17 per cent were in general hospital psychiatric units and 8 per cent were under private psychiatrists. The bed occupancy rate was 129.7 per 100,000 population for the whole State--83.2 long-stay and 46.5 short-stay. These rates were low compared with published figures in other countries. The proportions of total outpatients seen during the census week by the Mental Health Services, general hospital units and private psychiatrists were 53.5 per cent, 16.0 per cent and 30.5 per cent respectively. There was a differential use of psychiatric services between immigrants and Australian-born outpatients.

Adult↗
PubMed1993

Inequalities in the regional distribution of private psychiatric services provided under Medicare.

An analysis was carried out on Medicare data to find out if there are inequalities in the geographical distribution of private psychiatric services in Australia. The number of psychiatric services and persons becoming patients per 100,000 population was calculated for each federal electorate for the year 1985/86 and related to social indicators derived from the 1986 census. As a comparison, services provided by consultant physicians were analyzed as well. The data were based on the electorate of the patient rather than the electorate of the practitioner. Consultant psychiatrist services were found to be received more often in high socio-economic status electorates and those with older populations, and less often in rural areas. A similar pattern was found for consultant physician services, although the relationship with socio-economic status was not as strong. Frequent psychiatric consultations of longer duration, which are an indicator of insight psychotherapy, were more common in higher socioeconomic status electorates. A limitation of the Medicare data is that they cover only private services. To overcome this limitation, a supplementary analysis was carried out on the distribution of consultations for mental disorders using data from the National Health Survey. These data confirmed that individuals of high socio-economic status with a mental disorder are more likely to receive specialist treatment.

Adolescent↗
PubMed1997

Prescriptions of antibiotics for children. Prescribing habits of district, hospital, and private physicians.

OBJECTIVE: To study how different categories of physicians prescribe antibiotics for children with respiratory tract infections. DESIGN: Prescriptions of antibiotics for children less than 15 years of age were registered at the pharmacies in the municipality of Växjö during the month of March from 1990 to 1993. SUBJECTS: Three categories of physicians were studied: district, hospital, and private. They made 3047 prescriptions for one of the following groups of antibiotics: penicillin V, ampicillin derivatives, erythromycin or other macrolides, and peroral cephalosporins. MAIN OUTCOME MEASURES: The choice and cost of drug for each physician category. The proportion of prescriptions made by district physicians in relation to distance from town centre and doctor density in local health centre. RESULTS: The district physicians used penicillin V more frequently (70% of prescriptions) than the other categories of physicians (50% and 19%), but ampicillin derivatives and cephalosporins less frequently. District physicians had a lower cost per prescription in general (SEK 92) than hospital physicians (SEK 110) and private physicians (SEK 175). The proportion of prescriptions issued by district physicians increased with increasing distance from the town centre and with higher doctor density in the local health centre. CONCLUSION: District physicians use more penicillin V, and have a lower cost per prescription, than other physicians. This might be due to differing infectious disease panoramas, but can also reflect differences in practice and attitudes.

Adolescent↗
PubMed2005

Focal aspects of co-operation between the private, public and third sectors in a sparsely populated area in northern Finland.

OBJECTIVES: The purpose of this study was to describe and analyze the focal aspects of co-operation between the private, public and third sectors in a sparsely populated area of northern Finland. The study is part of a larger research and development project, which produced a model of co-operation between the sectors in a sparsely populated area of northern Finland. STUDY DESIGN: The study was qualitative. An expert group (n = 12), consisting of representatives from the private (n = 4), public (n = 4) and third sectors (n = 4), was recruited. METHODS: The data were collected using the focus groups method. The focus group method was feasible here because the development of co-operation between the different sectors was new, and the aim was to find novel operating models. RESULTS: The focal aspects of co-operation between the different sectors consisted of the objectives of operation, the client's perspective, the structures, the contents of operation and the operating culture. CONCLUSIONS: An expert group of representatives from the different sectors was a functional starting-point for the development of co-operation. The group also made it possible to reach representatives of the sectors more widely by means of the questionnaire survey. The operation of the expert group clearly involved elements of network management, because the group aimed to take into account the interests of all network actors. Network management at this stage of the project can be considered successful. To maintain co-operation at the concrete level, shared self-guided activities between the sectors will be needed.

Community Networks↗
PubMed2005

Comparing walk-in and call-responsive donors in a national and a private hospital in Nairobi.

BACKGROUND: The non-remunerated donors in many of Kenya's hospital blood banks are either call responsive (CR) or walk-in (WI) donors. These donors impact differently on the national blood transfusion services. OBJECTIVE: To examine the walk-in (WI) and call responsive (CR) donors' influence on the national blood transfusion services. DESIGN: A retrospective study. SETTING: A national referral and a private hospital in Nairobi, Kenya. MAIN OUTCOME MEASURES: Donor's age, sex, whether walk in or responded to a call to donate for a relative or emergency blood requirement and test results of; HIV, HBsAg, syphilis and HCV. RESULTS: Between April 1999 and April 2000, 10,295 persons donated blood either responding to a call or walked in. The national referral hospital had 8,563 (83%) and private hospital 1,732 (17%). In total, 2.5% were WI and 97.5% CR. The lowest age of donors were CR 15, and WI 18 years. Of 1,138 (11.1%) rejected were 4.6% WI and 11.2% CR donors. The infections 5.8% HIV, 4% HBSAg, 1.2% VDRL and 0.2% HCV were statistically significant in WI compared to CR (p=0.002), also in female compared to male donors (p=0.001). CONCLUSION: This study shows that walk in donors were fewer than call responsive but had less rates of transfusion associated infections.

Adolescent↗
PubMed2004

Patients who attend a private practice vs a university outpatient clinic: how do they differ?

BACKGROUND: Although interpersonal continuity is commonly assumed to be essential for care, some patients prefer to attend a university outpatient clinic where physicians change regularly and interpersonal continuity of care is not ensured. OBJECTIVES: The aim of this exploratory study was to evaluate the differences between patients attending a university outpatient clinic and patients frequenting a private practice, explore their patterns of care-seeking and their understanding of continued care. METHODS: We conducted a cross-sectional study of patients attending the university medical outpatient clinic (OC) in Lausanne, Switzerland and ten randomly selected private general practices (PP). Eligible patients were >30 years, Swiss nationals or long term residents, with one or more chronic conditions and attending the same practice for >3 years. They were asked to complete a questionnaire on sociodemographic data, use of medical resources and reasons for choosing and remaining at the same practice. Semi-structured interviews were conducted with a randomly selected subset of 26 patients to further explore their preferences. RESULTS: 329 patient questionnaires were completed, 219 by PP and 110 by OC patients. OC patients tended to be of lower socioeconomic status than PP patients. The main reason for choosing a PP were personal recommendation, while a higher percentage of patients chose the OC because they could obtain a first appointment quickly. A higher percentage of PP patients accorded importance to physician communication skills and trust, whereas a higher percentage of OC patients favoured investigation facilities. Qualitative data suggested that although OC and PP patients reported different reasons for consulting, their expectations on the medical and relationship level were similar. CONCLUSION: Our study suggests that the two groups of patients belong to different social backgrounds, have different patterns of care-seeking and attach importance to different aspects of care continuity. However, patients' expectations and perceptions of the physician-patient relationship are similar.

Adult↗