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PubMed2001

Making a public-private partnership work--an insider's view. Interview by John Maurice.

In November 1999, Dr Amadou Diarra was appointed senior director of Bristol-Myers Squibb's Secure the Future Initiative. Launched 18 months ago, this public-private partnership is seeking, together with the governments of nine African countries, innovative ways of reducing the transmission and the impact of HIV/AIDS, especially on women and children, through interventions involving medical care, research, community outreach, and education. Diarra, who was brought up in West Africa, had previously worked for about a decade with the company's Africa division. Last November Bristol-Myers Squibb joined four other major pharmaceutical manufacturers and five intergovernmental agencies in supporting the UNAIDS initiative for Accelerating Access to HIV Care, Support and Treatment. Diarra played a significant role in laying the foundations for Bristol-Myers Squibb's commitment to both of these public-private partnerships. He shares with John Maurice his views on what it takes to make a successful partnership of this kind.

Africa↗
PubMed2001

Rainwater drainage management for urban development based on public-private partnership.

The Urban Development Corporation (UDC) is one of the biggest implementation bodies for urban development in Japan. UDC has developed rainwater infiltration technology since 1975. This technology has effectively reduced runoff to a river and sewer system in the new town project areas. Recently, UDC has developed a new system which is defined as a "Rainwater Recycle Sewer System", which is supported by "Rainwater Storage and Infiltration Technology (RSIT)" applicable to new town creation and urban renewal. The new system consists of two elements: RSIT components based on Public-Private Partnership (PPP) and a stormwater drainage system. Herein, the private sector is responsible for the main part of RSIT, and the public sector is responsible for the stormwater drainage from the development area. As a result, the capacity of public facilities, such as rainwater sewers and stormwater reservoirs, can be reduced effectively. In parallel, the initial/running cost of public facilities is expected to be reduced. In conclusion, the authors would stress the importance of a co-maintenance system also based on PPP, which will be required especially in order to properly operate the whole system for the long term.

Cities↗
PubMed2001

Health sector reform agenda in the Philippines--its effect on private hospitals.

Despite the gains that Philippines posted towards improving the health of the Filipinos, more challenges need to be hurdled to further improve the country's health status i.e. high threat from infectious diseases, increasing degenerative conditions, emerging health problems due to environmental and work-related factors, etc. The development and implementation of the Health Sector Reform Agenda (HSRA) is expected to address these problems through organization/policy changes and financing structure needed to improve health care delivery, regulation and financing: 1. Provide fiscal autonomy to government hospitals; 2. Secure funding for priority public health programs; 3. Promote development of local health systems; 4. Strengthen health regulatory agencies' capacities; 5. Expand the coverage of the National Health Insurance Program. There is a need however to evaluate the implications of the HSRA implementation in the private hospital system as this sector accounts for 67.91% of the total number of hospitals, servicing 48.35% of the country's total bed requirements. Major effects are: 1. Increased competition for patient market; and consequently; 2. for funding/payments; 3. Lesser capital and financing access for service/facility improvement; versus; 4. pressure from consumers/patients to render better quality, high-technology service at a lower cost. Certainly, any adverse effect on their operation will affect the access of a large percentage of the population currently using their services. This paper will provide an in-depth analysis of the implications of the HSRA implementation on private hospitals, major initiatives being undertaken to minimize adverse effect and innovations that can be capitalized to survive/grow in the new health environment. The authors' active participation in the National Health Planning Committee convened to oversee the HSRA implementation, the dialogues and conferences held with hospital sector for the Philippine Hospital Association, and actual involvement in hospital operation will provide a unique perspective and authority for this analysis.

Delivery of Health Care↗
PubMed2001

Private pharmacy practice and regulation. A randomized trial in Lao P.D.R.

OBJECTIVES: The objective of this study was to assess the effectiveness of government regulation of private pharmacy practice in a low-income country. METHODS: The intervention comprised inspections of the pharmacies, information, and distribution of documents to drug sellers and sanctions. It was implemented at two different intensity levels, active and regular intervention. The methods used to assess the effect of the interventions were interviews with the district drug inspectors, drug sellers and customers, inspection of drug purchases, and indicator surveys of pharmacies. Indicators for pharmacy-specific quality as well as for dispensing quality were developed. RESULTS: The main finding was one of strong overall improvements from initially low levels. The improvements were particularly marked by increases in the availability of essential materials for dispensing by 34% and in order in the pharmacy by 19%. Information given to customers increased from 35% to 51% and the mixing of different drugs in the same package went down from 17% to 9%. The pharmacies in the active intervention districts showed greater improvements for four of the six indicators, although statistically significant compared with the regular intervention districts only for the essential materials indicator. CONCLUSIONS: It was concluded that the regulatory activities have probably been an important factor behind the service quality improvements. It appeared feasible as well as effective to regulate private pharmacy practice in this particular low-income setting.

Developing Countries↗
PubMed2001

Profile of orthodontic services provided in private practice by general practitioners and specialist orthodontists for an insured population.

In Australia, the proportion, volume and type of orthodontic care provided by general practitioners and orthodontists are largely unknown. The overall objective of this study was to create a profile of orthodontic services provided by general practitioners and orthodontists for a cohort of insured patients using private practices in New South Wales, Australia, from 1st January 1992 to 31st December 1995. Data were derived from claims records submitted by members of a health insurance fund for rebates for fees paid to private practitioners for orthodontic services they received during the study period. Distribution of the volume and type of service provided by general practitioners and orthodontists was compared using the Chi-squared test. Statistical significance was taken at the 5 per cent level. Orthodontic services were provided predominantly by orthodontists (80%). Fixed orthodontic treatment was provided almost exclusively (91%) by orthodontists. The majority of removable appliance services was provided by general practitioners. Orthodontists provided more orthodontic services in the capital city and other metropolitan areas, whereas general practitioners provided more orthodontic services in rural areas. Orthodontists provided more services to members in the highest socio-economic group, whereas general practitioners provided more services to members in the lowest socio-economic group.

Age Factors↗
PubMed2001

Infection control among dentists in private practice in Durban.

The general fear, superstition and alarm surrounding HIV/AIDS warrant that the highest standards of care be available to our patients. A survey on infection control was undertaken in Durban to assess the current state of infection control procedures among dentists in private practice. A self-administered 44-item questionnaire was hand-delivered to a random sample of 75 dentists (31.3%)--see comments in Methods--in private practice. The response rate was 90.7% (68 dentists). The routine use of gloves, masks, and protective eyewear was reported by 97.1%, 82.4% and 52.9% of dentists respectively. Although 89.7% of dentists had autoclaves in their practices, only 45.2% autoclaved their high speed handpieces and 39.7% their slow handpieces. Almost 60% of dentists did not use rubber dam at all whilst 46.3% did not disinfect impressions before sending them to the laboratory. Approximately 6% of respondents reported re-using local anaesthetic cartridges and 1.5% re-used needles. Needlestick injuries in the previous six months were reported by 13.8% of dentists but two thirds of them did not follow any specific protocol after injury. Almost 90 per cent of dentists were immunised against Hepatitis B but more than 60% of their staff were not. The results of the study showed that adherence to universally accepted guidelines for infection control remain low amid a climate of an ever-increasing HIV pandemic.

Adult↗
PubMed2002

Health promotion programme in the private workplaces in Singapore: a prevalence survey.

A postal survey was conducted in 4,479 private companies with at least 50 employees in 1998 to determine the prevalence and the scope of workplace health promotion programme in these companies in Singapore. The self-administered questionnaire mailed to the study population covered five areas viz, organisational details, workplace health policies, health promotion and related activities, workplace health facilities and the source of assistance for the programme. The overall response was 49.5%. Parkinson's definition of workplace health promotion was used in the analysis to determine the prevalence of the programme. The data was collated on DBase IV and analysed using SPSS computer programmes. About one third of the respondents covering an estimated 26% of the private sector workforce had a comprehensive workplace health promotion programme as defined by Parkinson. This prevalence was a function of workforce size and industry type. Workplaces with larger workforce size (p<0.001) and those from the manufacturing and human/health service sectors (p<0.001) were more likely to have such programmes compared to their smaller counterparts and other industries respectively. The management remained the main driver behind these programmes. Many of the programmes were centred around health promoting policies and facilities with emphasis on occupational healthl safety and smoking issues. A significant proportion of workplaces surveyed had in place a comprehensive workplace health promotion programme. However, more could still be done to encourage its uptake such as training for facilitators, consultation, grant provision etc. Small workplaces remained an untapped market for such programmes.

Chi-Square Distribution↗
PubMed2002

Clinical research in the private office setting--ethical issues.

A new model for performing clinical investigations has emerged in the United States which utilizes networks of physicians practicing in private office settings. This arrangement has sparked much controversy because of the potential conflicts of interest inherent in the dual roles of physician as clinician and investigator as well as the significant direct financial gains reported by some physicians which might impact on the interests of research subjects. We describe some of the ethical concerns and propose some procedural guidelines to safeguard the interests of research subjects participating in clinical trials in private physician offices. These safeguards include: requiring education of all investigators in research ethics, limiting financial incentives, disclosure to subjects of potential conflicts and financial arrangements, creation of an independent resource available to subjects to discuss concerns and answer questions, and development of educational materials to inform all potential subjects about important issues related to clinical research.

Biomedical Research↗
PubMed2002

What can be done about the private health sector in low-income countries?

A very large private health sector exists in low-income countries. It consists of a great variety of providers and is used by a wide cross-section of the population. There are substantial concerns about the quality of care given, especially at the more informal end of the range of providers. This is particularly true for diseases of public health importance such as tuberculosis, malaria, and sexually transmitted infections. How can the activities of the private sector in these countries be influenced so that they help to meet national health objectives? Although the evidence base is not good, there is a fair amount of information on the types of intervention that are most successful in directly influencing the behaviour of providers and on what might be the necessary conditions for success. There is much less evidence, however, of effective approaches to interventions on the demand side and policies that involve strengthening the purchasing and regulatory roles of governments.

Consumer Advocacy↗
PubMed2002

Comparison of orthodontic treatment outcomes in educational and private practice settings.

An accredited graduate orthodontic program provides advanced specialty education to meet standards of care mandated by the ADA, including both didactic and clinical components with defined outcome measures. To quantify these measures, the quality of care provided by graduate orthodontic students was compared to that of orthodontists in private practice. The quality of care was studied in two different delivery settings in the Columbus, Ohio, area-private practice orthodontists (PPO) and the OSU graduate orthodontic clinic (GOC). The Peer Assessment Rating (PAR) Occlusal Index was used as a measure of malocclusion severity and post-treatment occlusal outcome. Quality of care was measured using post-treatment PAR, percent PAR reduction, and treatment duration. At baseline, no differences were seen in the gender and pre-PAR scores of patients treated by the PPO and GOC, but statistically significant differences were seen in patients' pre-treatment age, race, and starting dentition. When the post-treatment occlusal results were compared, no statistically significant differences were seen in post-PAR scores and percent PAR reduction between the PPO and GOC. A statistically significant difference was seen in treatment duration (p = 0.002), which was longer in the PPO even after controlling for confounding factors such as pre-treatment age, gender, race, starting dentition, and treatment stages. Our conclusion is that there was no statistically significant difference in the occlusal outcome between the PPO and GOC, but there was a significant difference in the treatment duration.

Analysis of Variance↗
PubMed2002

Studies on acute abdominal cases in private clinic.

A cross sectional type of descriptive study was done on acute abdominal cases attending in one private clinic in Mymensingh town. The study was done in the year 2002 by collecting the secondary data of 1998-2001. Data were collected from the record book & filed documents of the clinic. The study result shows that in those four years (1998-2001) 1445 patients got admitted into the clinic with acute abdominal cases & all of them needed immediate surgical intervention. Majority of the patients of acute abdomen admitted in the clinic or private nursing home is of immediate surgical intervention.

Abdomen, Acute↗
PubMed2002

What can be done about the private health sector in low-income countries?

A very large private health sector exists in low-income countries. It consists of a great variety of providers and is used by a wide cross-section of the population. There are substantial concerns about the quality of care given, especially at the more informal end of the range of providers. This is particularly true for diseases of public health importance such as tuberculosis, malaria, and sexually transmitted infections. How can the activities of the private sector in these countries be influenced so that they help to meet national health objectives? Although the evidence base is not good, there is a fair amount of information on the types of intervention that are most successful in directly influencing the behaviour of providers and on what might be the necessary conditions for success. There is much less evidence, however, of effective approaches to interventions on the demand side and policies that involve strengthening the purchasing and regulatory roles of governments.

Communicable Disease Control↗
PubMed2003

Tensions in private health insurance regulation.

This article provides an analysis of the regulatory framework of Australian private health insurance linked to four major implicit regulatory objectives: promoting access to health insurance for consumers; promoting financial solvency and industry viability of registered health benefits organisations; promoting competition between registered health benefits organisations; and promoting accountability to consumers. Through an analysis of regulatory changes, case law and policy documents on the performance of the health insurance industry, it is argued that existing health insurance regulation exhibits inevitable tensions due to shifting and often conflicting government objectives about the role of private health insurance.

Australia↗
PubMed2003

[Irritable bowel syndrome and healthcare consumption. An observational study in private gastroenterology].

AIM: Little data is available on the management of irritable bowel syndrome (IBS) in daily practice. The purpose of our study was to study the relationship between the severity of IBS and healthcare consumption. METHODS: During a cross-sectional epidemiological study undertaken by 330 private gastro-enterologists, the severity of IBS symptoms experienced by patients was quantified with Francis' score (limits 0-500) to study the relationship with the healthcare consumption. RESULTS: Data obtained from 1407 patients (mean age: 52.3 +/- 15 years, females: 68%) were analysed. Symptoms were usually long-lasting (mean duration: 134.1 +/- 128.4 months); they had required on average 5.7 +/- 4.5 medical visits in the past year including 2.3 +/- 2.1 visits to a gastroenterologist. The mean number of additional investigations performed by patient was 1.3 +/- 1.4. Ninety one percent of them took at least one medication. The mean severity score was 268.5 +/- 85.2. Patients' distribution according to severity showed that 47.3% of the patients had symptoms of moderate severity and 44.9% of high severity. There was a significant relationship between, in one hand, severity of symptoms and, in the other hand, the number of visits (P<0.001), the number of additional investigations (P<0.001) and the number of prescribed medications (P<0.001). CONCLUSION: There was a positive relationship between the severity of symptoms and the healthcare consumption in private gastroenterological practice. The data confirm the significant burden of IBS in France.

Adolescent↗
PubMed2003

[Attitudes and opinions of private practitioners towards alcoholism. A survey in the Languedoc-Roussillon region].

OBJECTIVE: Information on the position of private practitioners faced with the problem of alcoholism mainly concerns the role of the general practitioner in the follow-up of these patients and there is little information from private specialists, hence the need for new data METHOD: All the general practitioners and specialists in the Languedoc-Roussillon area were interviewed through a mailed questionnaire regarding their opinion on alcohol consumption and public health; their definition of the risks; moderate consumption and health; how they approached the question of drinking during consultations and their involvement in training and prevention. RESULTS: Six hundred sixty-five practitioners (12.4% of those interviewed) returned the questionnaire. The profile of those who replied was identical to that of the whole population surveyed. The medical corps is clearly aware of the need to fight against alcohol abuse, but this is associated with a relative ignorance of the basics of alcoholism, a non-systematic approach of the question of drinking during consultations, little involvement in its management, limited use of the specialised structures and limited training on the question. The specialists are less involved than the general practitioners, but appear more at ease when approaching the question of drinking with their patients and resort more frequently to specialised structures than the general practitioners. Continued medical training on alcoholism only concerned a minority of practitioners and its practical impact was low. CONCLUSION: With regard to alcoholism, the practitioners fulfill their role in providing medical care, within the limits of available therapeutic resources, but their role with regard to the reduction of the risks, i.e., primary or early prevention is more or less disregarded.

Aged↗
PubMed2003

Private health care sector investment in Brazil: opportunities and obstacles.

The Brazilian health system is based upon the constitutional right formulated in 1988, according to which health is the peoples' right and duty of the State. So being, it is essentially the government's responsibility, expressed in the so-called Sistema Unico de Saúde--SUS (single health system) Since its creation, however, it admits the existence of a supplementary health system, left to the private sector. In general terms, the public system is considered unsatisfactory in the services it renders. Its resources are distributed heterogeneously, favoring centers of advanced medical practice, to the detriment of basic health care. The supplementary system is considered of better quality, however with great variations and frequent accusations of being essentially profit driven, instead of being driven to the needs of the assisted population. The growing search for health plans is a direct consequence of the image perceived by the population regarding the quality and accessibility of the public services, as well as of the peoples' growing consciousness of their needs, rights and duties as citizens. The need for continuous quality improvement and cost reduction offers numberless opportunities for actions and investments. Initiatives to identify and implement the best medical practices, medical guidelines and actions are essential regarding those illnesses which are most frequent, of higher cost and of greater risk. Health plans and healthcare providers will necessarily have to focus on their common client. Therefore, organizations must be created in order to develop initiatives aimed to the quality of patient care, as well as to the collection and dissemination of data regarding the production and results of the main service providers. Consequently, immense opportunities are being opened for investments in the area of Information Technology, collection, analysis, and data dissemination. This paper analyses the main trends in the Brazilian health sector and from the data and tendencies, draws various conclusions on the opportunities and barriers for private investment.

Brazil↗
PubMed2003

Shifting the burden: the private sector's response to the AIDS epidemic in Africa.

As the economic burden of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) increases in sub-Saharan Africa, allocation of the burden among levels and sectors of society is changing. The private sector has more scope to avoid the economic burden of AIDS than governments, households, or nongovernmental organizations, and the burden is being systematically shifted away from the private sector. Common practices that transfer the burden to households and government include pre-employment screening, reductions in employee benefits, restructured employment contracts, outsourcing of low skilled jobs, selective retrenchments, and changes in production technologies. Between 1997 and 1999 more than two-thirds of large South African employers reduced the level of health care benefits or increased employee contributions. Most firms also have replaced defined-benefit retirement funds, which expose the firm to large annual costs but provide long-term support for families, with defined-contribution funds, which eliminate risks to the firm but provide little for families of younger workers who die of AIDS. Contracting out previously permanent jobs is also shielding firms from benefit and turnover costs, effectively shifting the responsibility to care for affected workers and their families to households, nongovernmental organizations, and the government. Many of these changes are responses to globalization that would have occurred in the absence of AIDS, but they are devastating for the households of employees with HIV/AIDS. We argue that the shift in the economic burden of AIDS is a predictable response by business to which a deliberate public policy response is needed. Countries should make explicit decisions about each sector's responsibilities if a socially desirable allocation is to be achieved.

Acquired Immunodeficiency Syndrome↗
PubMed2003

[Openness in the cooperation between physicians and private corporations].

The past decades in Danish health services have been characterized by limited cooperation between health authorities, health employees, and private corporations. Today, society and legislature acknowledge the need to support this cooperation, which creates a great challenge to hospital management and its responsibility to create and secure strong research environments. This effort is often challenged by the tendency of the media to transform initial conflicts into problems of credibility. Society is also aware of the fact that increased cooperation is important to maintain the ability to develop new and better methods of treatment. It is therefore of vital importance to solve potential conflicts before the media interpret the problems, by encouraging openness in the cooperation between physicians and private corporations.

Clinical Trials as Topic↗