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PubMed1995

Physical morbidity in patients admitted to a private hospital for detoxification from alcohol.

A survey of patients admitted to a private hospital for detoxification from alcohol found similar levels of physical morbidity and withdrawal complications to a group admitted to a National Health Service alcohol treatment unit. Although private patients tended to be older than National Health Service patients, the two groups were similar on a number of other variables. The implications for those involved in the management of patients who abuse alcohol are discussed.

Adult↗
PubMed1995

Private dental practitioners in South Africa--a professional profile.

A questionnaire submitted to dentists in private practice was part of the first National Oral Health Survey 1988/89. The questionnaire investigated demographic and professional characteristics. Completed questionnaires were returned by 2224 dentists (69.5 per cent). Most respondents were located in the 5 main metropolitan areas. There was a paucity of Black and Coloured dentists. Male dentists dominated the profession with almost 74 per cent under 50 years of age. General practitioners made up over 90 per cent of the profession and orthodontists were the largest group of specialists. Conservation was ranked as the most frequently practised service and preventive procedures were ranked low. Medical aid systems were seen to have some disadvantages. Fees and working conditions were felt to be better in private practice than in the public sector.

Adult↗
PubMed1996

Plans to run private facility in public hospital draw some strong opposition in Alberta.

Proposals to create private wings catering mainly to American patients at some public hospitals in Alberta have attracted strong opposition. Physicians at the Leduc General Hospital near Edmonton voted unanimously against a proposal to create a private wing at their hospital. Proponents say such moves would simply provide additional funding for Canada's cash-strapped health care system.

Alberta↗
PubMed1996

Establishing a laparoscopic antireflux program: a private practice experience.

Laparoscopic antireflux surgery is an exciting new option in the treatment of gastroesophageal reflux disease. Establishing a successful antireflux program depends on obtaining proper education as well as generating a suitable flow of patients. Being outside a university-based referral center presents the surgeon in private practice with a unique challenge as to how to meet these goals effectively. A personal account of education, training, and patient recruitment methods is presented. Different modalities for stimulating interest in both the medical and lay communities, including methods for direct patient contact, such as advertising are described. This is followed by a review of a series of 57 antireflux procedures performed during the first year of this program in a private practice in a retirement community setting.

Advertising↗
PubMed1995

Is privatization the answer?

Concern is being expressed by some that Canada's publicly funded health care system can no longer be maintained and that a privately funded system will help ease the pressure on our public system. Indeed, the issue of privatizing Canada's health care system promises to be one of this fall's hottest debates.

Canada↗
PubMed1996

The alluring myth of private medicine.

Canada's medicare system has provided Canadians with high-quality health care for almost three decades. Now Canadian health care appears to be at risk of losing the single-payer system, which is the premise on which medicare is built. As medicare comes under increasing financial pressure, many are calling for the introduction of private care as a means of bolstering our health care system and maintaining its quality. Although it appears alluring to some politicians, physicians and commentators, privatization could very well lead to the demise of the principles and practices of the Canadian health care system as we know it, with little clear benefit to the public or physicians.

Canada↗
PubMedDate not supplied

Clinical similarities and demographic differences between residency and private practice patients.

BACKGROUND: This study compared the clinical and demographic mix of patients at a family practice residency site in South Carolina to those from other regions and demonstrated the effectiveness of a computerized medical record in facilitating such analysis. METHODS: Patient visits to Richland Family Practice Center (RFP), the outpatient care site for the University of South Carolina School of Medicine, were retrospectively sampled for the period July 1992-June 1993. Data analysis used descriptive statistics and contingency tables. A time test comparing manual and computerized data retrieval was also performed. RESULTS: The patients seen were predominantly female (75.2%) and African-American (68%). RFP treated proportionately more federally funded and minority patients than did community-based physicians. The top five principal diagnoses at RFP were hypertension, diabetes mellitus, general medical examination, normal pregnancy, and acute upper respiratory infection; the top 20 principal diagnoses accounted for 51.3% of all visits. When compared to the top 20 diagnoses for all family and general practice physicians in the southern United States, considerable overlap was present, confirming clinical similarity between patient populations at residency and private practice sites. Computerized data retrieval was faster and more complete than manual data retrieval. CONCLUSIONS: Diagnoses encountered at RFP and reported by other family practice residencies generally parallel those documented in family practice in various geographic regions. However, residencies differ from private practices in that they care for more economically disadvantaged patients. Computerized medical records systems facilitate research within a residency program.

Adolescent↗
PubMed1996

Private-sector share of health spending hits record level.

The private-sector share of health expenditures hit a record 28.2% in Canada in 1994, according to a recent federal report. Canadians spent $698 per person for private health-related goods and services, a 1-year increase of 3.8%. Ontarians paid the most--$790 per person--while Newfoundlanders paid the least, $538.

Canada↗
PubMed1995

[Medical economy of home care in private hospital].

In order to analyze the economics of home care, we calculated the revenue and expenditures of both hospitalization and home care in a private hospital. The home care expenses were about 44.7% of the institutional care expenses. It became clear that home care saved medical expenses. The expenses of patients were about 33.7% less with home care. In conclusion, home care may be favorable medical care if some problems are solved. The home care expenses of a cancer patient on the institutional side were about 3.4 times more that those of a patient with other diseases. If we support home care of cancer patients alone, it would be an excessive burden on them, because patients are too few at present to organize and keep a team. As a private hospital, we support home care regardless of disease. However, medical economic expenses as a total turned out to be about 17% short of the necessary expenses.

Aged↗
PubMed1996

Productivity among Australian private general dental practitioners across a ten year period.

Historical trends in Australia have shown declining levels of dentists' annual productivity from the 1960s to the 1980s. In a period of changing population demographics and oral health status appropriate levels of supply of dental services remains a key issue. Changes in practice patterns of dentists, through variables such as productivity, may influence the capacity to supply services. The aim of this study was to investigate time trends in productivity for private general practitioners at three points in time across a ten year period. A weighted, stratified random sample of Australian dentists was surveyed in 1983-84 (response rate 73 per cent), 1988 (response rate 75 per cent) and 1993-94 (response rate 74 per cent). The data were re-weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988 and 1993. Analysis of variance showed that the number of patient visits per year declined across the ten year period, related to parallel decreases in the number of patients treated per hour, while there was no significant difference during the period in the number of hours per year devoted to work.

Adult↗
PubMed1996

Privatizing Social Security: the Chilean experience.

In 1981, Chile introduced a new approach to social insurance, a system of individual capitalization accounts financed solely by the employee. This new privatized system was an improvement over Chile's failing pay-as-you-go arrangement. As many countries worldwide are facing financial problems with their social security system, they are now looking to the Chilean model in trying to find solutions. This article describes the conditions that led to the new system, the transition, and details of the new privatized system.

Chile↗
PubMed1997

Toronto centre hopes to cash in on growing demand for private health services.

When the CMA held its 1996 annual meeting, part of the debate on the future of health care involved the "appropriate balance of the roles of the public and private sectors" in delivering health care. The King's Health Centre in Toronto is now doing its own balancing act: providing publicly funded care to Canadians, and private care to non-Canadians and Canadians who can afford it. This article discusses some of the niche markets King's is attempting to develop.

Entrepreneurship↗
PubMed1977

Private practice in the public sector: a unique relationship among local government, physicians, and health care consumers in Cincinnati.

Because of health care inequities that still persist under federal and state sponsorship plans, many local government agencies are starting to consider ways of directly providing medical services to the poor. Over 100 years' experience with direct provision programs in the City of Cincinnati, however, have been ultimately counterproductive. A unique three-way contract developed by the Board of Health, a private multispecialty physicians' group and a consumer advocate organization has recently allowed Cincinnati to implement a delivery system that integrates mechanisms for prepaid public health care into a fee-for-service private group practice, all within the context of a community-based neighborhood health care facility. While it is still too early to make a full evaluation of this public health care group practice model, there are already indications that is services will be superior to those offered in Cincinnati's traditional public clinics.

Attitude of Health Personnel↗
PubMed1997

Survey of patients with sexually transmitted diseases seen by private physicians in Jamaica.

A survey of physicians in private practice in Jamaica was conducted between March and September 1993 to provide a descriptive analysis of the occurrence of patients with sexually transmitted diseases (STDs) seen in their practices. Questionnaires were delivered to 371 physicians of whom 127 (34%) responded, completing 683 (men 353, women 330) individual patient questionnaires. Each physician collected data over a period of one week. The median ages of the men and women were 27 years and 26 years, respectively. 464 (68%) patients were being seen for the first time for symptomatic STDs, and the visit was a follow-up for 132 (19%) who had been previously diagnosed; 40 (6%) patients were asymptomatic contacts referred by a sex partner, and 12 (2%), who were asymptomatic, asked for a 'checkup'. A history of previous STD was given by 358 (52%) patients. 470 (69%) patients had a genital discharge (M, 65%; F, 73%; p = 0.017), 52 (8%) had anogenital lesions (M, 10%; F, 5%; p = 0.013) and 45 (7%), inguinal lymphadenopathy (M, 10%; F, 3%; p = 0.002). Among women, 131 (40%) had lower abdominal pain on examination and 105 (32%) had cervical excitation tenderness or pain suggesting pelvic inflammatory disease (PID). A working diagnosis of gonorrhoea was made in 273 (40%) patients, trichomoniasis in 121 (18%), nongonococcal infection in 114 (17%), syphilis in 60 (9%), herpes genitalis in 20 (3%) and chancroid in 11 (2%). PID was diagnosed in 121 (37%) women and nongonococcal urethritis in 98 (28%) men. The most frequently prescribed treatments were for chlamydia, gonorrhoea and trichomoniasis. In general, working diagnoses correlate well with clinical observations and treatment given, matched with diagnosis according to national guidelines. A comparison of the STD burden between the public and private sectors was not possible because of sample bias.

Adolescent↗
PubMed1998

Chronic depression: a case series of 203 outpatients treated at a private practice.

OBJECTIVE: To determine the prevalence of chronic depression among outpatients seen for depression. DESIGN: Case series. SETTING: Private practice. PATIENTS: Two hundred and three outpatients with mood disorders, excluding patients with comorbid substance abuse disorders and severe personality disorders. OUTCOME MEASURES: Prevalence rate and patient variables (diagnosis, age at baseline, age at onset, sex, number of previous episodes of depression, atypical features, psychiatric comorbidity, psychosis, duration of illness and baseline severity). RESULTS: The prevalence of chronic depression was 46.7%, which is higher than previously reported. The number of depressive episodes was higher, the presence of psychotic symptoms was more common and the duration of illness was longer in patients with chronic depression than in those with nonchronic depression. CONCLUSIONS: Chronic depression is more severe than nonchronic depression and is a prevalent illness in outpatients with depression seen in private practice.

Chronic Disease↗
PubMed1997

Utilization of advanced hygienist skills in the private practice.

PURPOSE: The purpose of this study was to survey dental hygiene graduates to determine utilization in the private practice setting of expanded functions taught in school. METHOD: A questionnaire was sent to 90 dental hygiene graduates from the classes of 1990-1994, of Indiana University-Purdue University, Fort Wayne. Analysis was done on utilization of specific expanded functions taught in school. Frequency tabulations of procedures performed and adequacy of preparation were done using the SAS software. The results were graphically represented in tables. RESULTS: Equal response from each class resulted in the total response rate of 74%. The expanded functions most frequently performed by dental hygienists were placing sealants followed by making cast impressions. Placing temporary and amalgam restorations were rarely performed. The majority of graduates felt adequately trained to perform these skills. CONCLUSION: Skills being required and taught in school are not being delegated in private practice. This survey shows the need for curriculum revisions and discrepancies between educational requirements and utilization.

Dental Hygienists↗
PubMed1998

Privatized managed care and forensic mental health services.

Managed care for mental health services, which began in the private, commercial sector, has spread over the past few years to the public mental health sector as well. Recently, states have begun considering whether to include the forensic population within their privatized managed care systems. This article explores some of the complexities and special challenges unique to forensic services and notes some of the problems that might be incurred if the forensic population were included in a managed care system.

Contract Services↗
PubMed1998

Ambulatory blood pressure monitoring--comparison with office blood pressure in patients on antihypertensive therapy in private practice.

INTRODUCTION: Available data on the use of 24-hour ambulatory blood pressure recordings in private practice are limited. For this purpose we studied 39 consecutive hypertensive patients on treatment in a private practice. METHOD: Office blood pressure, 24-hour ambulatory blood pressure, daytime ambulatory blood pressure and M-mode echocardiography were undertaken in 39 consecutive hypertensive patients (21 men, 18 women) on treatment. RESULTS: Mean 24-hour ambulatory blood pressure and mean daytime ambulatory blood pressure were lower than office blood pressure, similar to findings seen in academic settings. A blood pressure load of more than 50% was seen in 12 out of 39 patients (31%). Left ventricular hypertrophy, assessed by means of Framingham criteria, was seen in 33% of patients. A white-coat effect was seen in 15.4% of patients. CONCLUSIONS: A large proportion (33%) of patients on treatment for hypertension had left ventricular hypertrophy, despite normal electrocardiograms. Ambulatory blood pressure measurements identified a blood pressure load of more than 50% in 31% of patients on treatment for hypertension.

Analysis of Variance↗