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PubMed1983

A trustee with two hats: bridging the public-private gap. Interview by Emily Friedman.

John H. Stroger Jr. is a trustee of both a large, county hospital (Cook County) and a private, community hospital (South Shore) in Chicago. Here, he discusses how governance concerns differ in the two settings, evaluates the contract management experience of Cook County Hospital, and speculates on what effect financing cutbacks will have on the partnership of public-private urban hospitals serving the poor.

Chicago↗
PubMed1984

Private foundations: a need for further explorations.

Private foundations should be considered as a potential resource of funding projects initiated by recreation therapists. This article acquaints the reader with the viability of the private sector. Attention is given to exploring the various types of foundations and methods to research potential resources. Some of the procedures that would be useful in securing funds are also presented.

Financial Management↗
PubMed1986

Private association: opportunity for laity.

The Catholic Health Association recently developed two options for Catholic facilities' sponsorship: the private association of the Christian faithful (PACF) and the private juridic person (PrJP). Canonical implications of PACF collaboration in the healing ministry include the following: It is appropriate for laypersons to fulfill their obligation to spread Gospel values by owning and administering an apostolic institution such as a hospital. PACFs are subject to the vigilance of the Holy See and the diocesan bishop. These associations are distinct from other religious institutes and may comprise laity and/or clergy. PACF members guide the association according to its statutes. A PACF can become a juridic person through formal decree by the competent ecclesiastical authority. The membership of a PACF consists of the health facility's board members and other persons important to the facility. The PACF's responsibilities include sponsorship, adherence to Church laws, commitment to Catholic values, and participation in ongoing education programs. The diocesan bishop is responsible for reviewing the PACF's sponsorship according to its statutes. PACFs would benefit from cooperating with similar associations. At present, separately incorporated hospitals with autonomous boards of trustees are the target audiences for testing alternative sponsorship options.

Catholicism↗
PubMed1986

Legal limits to physician incentives: private inurement.

For a nonprofit hospital in today's competitive climate, loss of tax-exempt status may be catastrophic. Recent rulings by the Internal Revenue Service indicate that a hospital that provides physicians with overgenerous financial incentives to recruit or maintain them on its medical staff risks just such a result. This article explores the legal doctrine of "private inurement," which prohibits charitable organizations from serving private interests, and the doctrine's application to physician incentives given by exempt hospitals. The article underscores the need for great caution in structuring the incentives and recommends that nonprofit hospitals make a practice of obtaining advance letter rulings from the Service.

Employee Incentive Plans↗
PubMed1989

NAPPH (National Association of Private Psychiatric Hospitals) statement of principles of psychiatric hospital practice ethics.

A competitive and dynamic healthcare environment requires that psychiatric hospital administrators and physicians continually monitor their hospital's ability to deliver quality services to their patients. To ensure that hospitals stand for and abide by psychiatric hospital practice ethics, the National Association of Private Psychiatric Hospitals (NAPPH) Board of Trustees has formally approved and distributed to the industry a "Statement of Principles of Psychiatric Hospital Practice Ethics." Adopted at the June 22, 1989, Board meeting, the guidelines not only summarize views long held in the industry, but are a condition of NAPPH membership. Nine critical areas are identified in the NAPPH statement: admissions, advertising, marketing and referral development, resource allocation and appropriateness of care, treatment rendered, patients' rights, family rights and involvement, competition, and financial resources. Central to ethical hospital practice is a moral responsibility--shared among administrators, trustees, physicians and staff--to ensure access to care, quality of care, and fair treatment of patients. NAPPH represents more than 300 private psychiatric hospitals throughout the United States, and the NAPPH mission includes the promotion of high-quality care and treatment, efficient hospital operation, and advocacy for the patients served by its member hospitals. Each NAPPH hospital actively supports the appropriate, safe, and compassionate treatment of the mentally ill.

Ethics↗
PubMed1983

Elimination of Medicare indirect subsidy for private rooms--Health Care Financing Administration. Final rule.

This final rule, which implements section 111 of Pub. L. 97-248 (the Tax Equity and Fiscal Responsibility Act of 1982), precludes Medicare from sharing in the added cost of private rooms in hospitals and skilled nursing facilities (SNFs) unless the rooms are used by Medicare patients, and are medically necessary. In accordance with the statute, regulations implementing this provision were published on an interim final basis on September 28, 1982. This document responds to the public comments we received on the interim final regulations, and sets forth final Medicare regulations with respect to elimination of the private room subsidy.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1982

Medicare program; elimination of Medicare indirect subsidy for private rooms--HCFA. Interim final rule with comment period.

This interim final rule changes the way Medicare determines the costs of inpatient routine services (bed and board), including costs of private rooms, furnished in hospitals and skilled nursing facilities (SNFs). This change is needed to prevent Medicare from sharing in the added costs of private rooms unless those rooms are used by Medicare beneficiaries and are medically necessary. This regulation implements section 111 of the Tax Equity and Fiscal Responsibility Act of 1982 (Pub. L. 97-248).

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1987

Privatization and bidding in the health-care sector.

Public provision of health care, as under Medicare and Medicaid, traditionally "privatized" major production decisions. Providers of care, largely private physicians and hospitals (but also public hospitals), made significant decisions about public beneficiaries' access to care, the quality and quantity of individual services, and the prices to be paid. The result was high access and quality/quantity, but also high program spending, which has prompted a reassertion of public budgetary control. Newly activist program administration is using various mechanisms to promote economizing. Unable and unwilling to specify standards of public access or quality/quantity too overtly, administration instead seeks to squeeze prices--mainly through administrative price setting but also through competitive bidding and voucherlike arrangements. Under such new incentives, major choices that in many non-American systems would be public are here "reprivatized" to be resolved out of the limelight by beneficiaries, traditional providers, or new intermediaries like Competitive Medical Plans.

Competitive Bidding↗
PubMed1999

Rates of abnormalities and infectious agents in cervical smears from female inmates in Texas: comparison with private and university clinic patients.

Inmates are generally considered a high-risk population for gynecologic neoplasia and sexually transmitted diseases. Cervical smears from prisoners of the Texas Department of Corrections (TDC) were expected initially to have higher rates of cellular abnormalities and infectious agents than do smears from the general population. The cytologic findings from 25,522 TDC gynecologic smears were compared with those of 6883 cases from The University of Texas Medical Branch (UTMB) affiliated physician private clinics, and with 56,178 from the UTMB hospital clinics. The period of study was from September 1995 to February 1998. This study revealed a 5.23% higher rate of abnormalities for TDC gynecologic smears as compared with that for the private clinic smears. However, the TDC rate of abnormalities was unexpectedly 1.08% lower than that for the UTMB clinic smears. These unexpected findings were probably the result of a more selected high-risk population referred to the UTMB clinics. The TDC smears showed also the highest incidence of trichomoniasis.

Ambulatory Care Facilities↗
PubMed1999

[Warts, swimming pools and atopy: a case control study conducted in a private dermatology practice].

OBJECTIVE: Our purpose was to study two risk factors of warts, i.e., swimming pool frequentation and atopy. PATIENTS AND METHODS: A case-control study was performed in four dermatologists' private offices. The cases were patients consulting for the first time for warts; the controls were patients consulting for the first time for acne. RESULTS: Univariate analysis performed in 153 questionnaires (including 86 cases and 67 controls) showed an association between warts with swimming pool frequentation one year before consulting and between warts and history of atopy. Multivariate analysis showed an association between warts and history of atopy (OR: 4.20; confidence interval at 95 p. 100 = (1.52-11.6). The link between warts and frequentation of swimming pool one year before is not significant (OR: 1.81; confidence interval at 95 p. 100 = (0.78-4.21)) but shows a tendency. DISCUSSION: This last point should be confirmed in further studies. Additionally, this study showed that this kind of clinical research can be carried out in dermatologist private practice.

Acne Vulgaris↗
PubMed1999

Hepatic resection for primary liver cancer at a private community hospital: retrospective study of 61 patients.

OBJECTIVE: To review the outcome after surgical resection for primary liver cancer. DESIGN: Retrospective study. SETTING: Private community hospital, Hong Kong. PATIENTS: Sixty-one consecutive patients who underwent liver resection for primary cancer from 1992 through 1997. MAIN OUTCOME MEASURES: Clinicopathological features, type of resection, duration of hospital stay, and actuarial overall and disease-free 5-year survival rates. RESULTS: Cirrhosis was present in 46 (75%) of the patients, and 42 (69%) were positive for hepatitis B surface antigen. The median tumour diameter was 8 cm (range, 1-16 cm). Liver resections consisted of hemihepatectomy (n=37), trisegmentectomy (n=4), segmentectomy (n=11), and wedge resection (n=9). Postoperative death and major morbidity occurred in 0% and 36% of patients, respectively; ascites was the most common complication. The median hospital stay was 11 days. The actuarial overall and disease-free 5-year survival rates were 36.0% and 22.8%, respectively. These results are similar to or better than those recently reported from local or overseas centres. Multivariate analysis showed that the Child-Pugh class significantly influenced the development of complications and the length of hospital stay, whereas a well-circumscribed tumour margin, the tumour-node-metastasis stage of the tumour, and the Child-Pugh class were independent predictors of survival. CONCLUSION: Surgical resection for primary liver cancer can be performed with acceptable safety and efficacy in a suitably staffed and equipped private community hospital.

Journal Article↗
PubMed2000

Medicaid expansions and the crowding out of private health insurance among children.

This paper re-examines the magnitude of crowd out among children. We use longitudinal data that allow us to identify and differentiate groups of children based on whether their eligibility for Medicaid was affected by the program's eligibility expansions. We investigate whether changes in insurance coverage of children affected by the expansions differed from changes in insurance coverage of children unaffected by the expansions. For example, we directly measure whether there was a greater decrease in private insurance coverage among children who became eligible for Medicaid than among children whose eligibility was unaffected. Our results suggest that there was relatively little crowd out among children. We estimate that 18.9% of the recent increase in Medicaid enrollment came from private insurance.

Adolescent↗
PubMed2000

Characteristics of a paediatric low vision population in a private eye hospital in India.

While private hospitals provide an important access point for low vision services for children in urban India, little is known about this service delivery route. A cross sectional survey was done of consecutive records of 220 children presenting at a newly opened paediatric low vision centre in a private eye hospital in Hyderabad. On presentation, 49% of the children were classified as moderately visually impaired, 31% were severely visually impaired and 20% were blind. The four major causes of visual impairment were the hereditary/genetic conditions of congenital glaucoma, hereditary macular degeneration, retinitis pigmentosa and albinism. Approach magnification was sufficient for required near tasks in all pre-school children and about 50% of school children. Provision of a distance refraction decreased the prevalence of severe visual impairment and blindness by 31%. The most commonly prescribed low vision devices were spectacles indicating a key role for optometry in the management of visual impairment in Indian children. Establishment of low vision clinics in existing Indian eye hospitals using associated optometric staff would be a cost effective method to minimise visual impairment in Indian children.

Adolescent↗
PubMed2000

[Use of safety belts by drivers and passengers in private cars in Ceské Budĕjovice].

Correct use of safety belts reduces the risk of injuries and death of the crew of private cars during traffic accidents. The objective of the investigation was to assess the prevalence of use of safety belts by drivers and companions in private cars in Ceské Budĕjovice by direct observation. A total of 996 cars were observed and it was found that safety belts were used by 46% drivers and 53% companions on the front seats. Safety belts are used more frequently on roads leading out of town than in the centre of the town.

Czech Republic↗
PubMed2000

A successful collaboration between a private nonprofit health plan and a state health department.

This article describes the experience of a private, nonprofit health plan in establishing a collaborative relationship with a state health department. Through a federal grant project, efforts toward assuring quality care for children with special health care needs in managed care settings provided unique opportunities to form partnerships between multiple health plans, community groups, and other stakeholders. Collaborative activities included (1) formation of a pediatric asthma task force and a performance measurement and quality assurance committee; (2) planning and execution of a statewide conference; (3) development of a teaching manual for incorporating asthma education into elementary classroom curricula; and (4) publication of a parent resource manual for health plan members. Key ingredients and influencing factors for successful public-private partnerships are discussed.

Aged↗
PubMed2001

The lack of screening for diabetic nephropathy: evidence from a privately insured population.

BACKGROUND: We examined the performance of screening tests for diabetic nephropathy in a population of privately insured individuals. METHODS: Administrative data from a large private health plan were analyzed. Continuously insured persons with diabetes (ages 30-62) with > or = one office visit during the study year (July 1995 to June 1996) were included (n = 4,758). Outcome variables included a urinalysis for protein and a test for microalbuminuria. The likelihood of test performance according to age, gender, insurance plan type, total office visits, diabetes office visits, and specialty of predominant physician was examined both in bivariate analyses and a logistic regression. RESULTS: Among the 4,623 patients without evidence of nephropathy, only 16.5% had a urinalysis test conducted sometime in the year. All individuals (2.1% of sample) who received a microalbuminuria test also received a urinalysis. Individuals with indemnity or PPO plans were more likely to be screened than individuals in point-of-service plans. Patients with more visits and more diabetes visits were more likely to be screened. In the regression with family practice as the reference category, general internists were the only physician specialty more likely to have screened patients. CONCLUSIONS: The majority of patients with diabetes mellitus do not receive annual screening for microalbuminuria or urinary protein.

Adult↗
PubMed2001

An outbreak of E. coli O157 infection with evidence of spread from animals to man through contamination of a private water supply.

An outbreak of E. coli O157 infection occurred in the Highland Region of Scotland in the summer of 1999. The source of the outbreak was traced to an untreated private water supply. All six cases identified arose in visitors to the area, and most had very limited exposure to the contaminated water. Permanent residents on the same supply were unaffected. The E. coli O157 isolates from the water, sheep faeces collected from around the source and the human stool samples were indistinguishable using pulsed field gel electrophoresis. Previously reported outbreaks of E. coli O157 linked to potable water supplies have resulted from structural or treatment failures, which allowed faecal contamination of source water. Here, contamination of the water supply and subsequent human infection was due to the use of an untreated, unprotected private water source in a rural area where animals grazed freely.

Adult↗
PubMed2001

Patterns of mental health utilization and costs among children in a privately insured population.

OBJECTIVE: To examine trends in mental health service use and cost among privately insured children. DATA SOURCES: Inpatient and outpatient claims from the MarketScan database, a collection of health care claims for a national sample of over seven million privately insured individuals. Claims were analyzed for all users of mental health services 17 years of age and under from 1993 to 1996. STUDY DESIGN: The proportion of children receiving mental health services and annual costs and treatment days per treated child were compared across diagnostic groups over time. PRINCIPLE FINDINGS: The proportion of covered children receiving any mental health services fell substantially (-30.0 percent). Inpatient mental health costs per treated child fell $4,587 (-46.9 percent) during the period, driven by decreases in the number of hospital days per treated child per year (-22.9 percent) and per diem costs (-14.5 percent). Outpatient mental health costs also fell during the period due to a 5.1 percent decline in the number of treatment days and a 25.9 percent fall in costs per day. Children whose primary diagnosis was hyperactivity experienced the largest decrease in inpatient costs per treated patient, those diagnosed with schizophrenia experienced the smallest decrease, and those diagnosed with substance abuse disorders experienced large increases. CONCLUSIONS: Changes in mental health service delivery have resulted in substantially reduced access to mental health care among children and significant declines in service use and costs among those who do receive services.

Adolescent↗