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PubMed1996

[New physician reimbursement guidelines and private health insurance. I. Changes in general liquidation regulations].

In Germany, physicians' charges for the treatment of private patients have to be based on a fee-for-service schedule that is established by law. Every few years medical progress and changes of economic and legal conditions require major amendments. The latest adjustment reduces the accounts for laboratory tests and advanced imaging techniques. Further regulations concern the better information of patients about treatment costs and a reduced upper limit of fees for in-patient procedures not performed by the head of the department himself. For private insurers it is a challenge to identify the quite frequent medical accounts which are not in accordance with the complex fee schedule.

Cost Control↗
PubMed1994

Patient Selection for Laparoscopically Assisted Vaginal Hysterectomy vs Vaginal Hysterectomy in a Private Hospital Setting

The purpose of this study is to analyze the patient selection patterns of physicians in private practice performing laparoscopically assisted vaginal hysterectomy (LAVH). Forty-nine laparoscopic hysterectomies were compared to 30 vaginal hysterectomies (VH) performed during the same time period. There was no statistical difference with respect to patient age, gravity, and parity. There were no major complications in either group and no difference in minor complications. Significantly larger percentages of LAVH patients were operated on for fibroids, endometriosis, and pelvic pain. Fifty-one percent of LAVH patients but only 23% of VH patients underwent bilateral salpingo-oophorectomy. Blood loss was greater in the LAVH group. The mean operating time was 95±36 minutes for VH vs. 164±48 minutes for LAVH. The mean uterine weights were not statistically different, 149±66 g for VH and 161±92 g for LAVH. We conclude that patients undergoing LAVH in a private hospital setting are a different population than those undergoing VH and that those differences are reflected both in the indications for surgery and in the performance of oophorectomy.

Journal Article↗
PubMedDate not supplied

The federal and private sector roles in the development of minimum data sets and core health data elements.

This article presents a picture of federal and private efforts in defining minimum data sets and core data elements for health care. For more than 25 years the Federal Government has been engaged in extensive development of minimum data sets and core health data elements. As a major collector and processor of health data, the government identifies, defines, and implements standardized data in the health care field for describing data such as mortality, morbidity, and infectious diseases of the population. This article reports on 17 minimum data sets and core health data elements that are published or in draft form in health care to date. They include regulated data elements that are needed for reimbursement from the Health Care Financing Administration and core health data elements from the Health Resources and Services Administration. They also include recommended data elements for better reporting to the government, and private sector initiatives that are under development, being researched, or in use to standardize data collection for assessing access, quality, and costs of health care. This significant framework can be used in furthering research on the development of the computer-based patient record, the acceleration of data standards, and the evaluation of vocabulary in health care.

Ambulatory Care↗
PubMed1997

Food intake and Body Mass Index in the privately institutionalized elderly in Tehran.

Food intake and Body Mass Index (BMI) of privately institutionalized elderly in Tehran was studied using a 5-day food intake survey and anthropometric measurements. Thirty-seven males and sixty-three females in private institutions were selected. The intake of many nutrients including protein, calcium, zinc, vitamins A. riboflavin, folic acid and cobalamin, were deficient. Almost half the subjects were under the 5th percentile of standard BMI for their age and sex, indicating chronic energy malnutrition. More attention needs to be paid to this group of vulnerable people.

Aged↗
PubMed1996

Ocular sports trauma: a private practice study.

BACKGROUND: Ocular sports trauma is a leading cause of permanent vision loss in the United States. Various studies have examined the nature of injury, based on retrospective emergency room data. Knowledge of the epidemiology of ocular sports trauma will help the private practitioner identify those patients who are most at risk for injury so that the appropriate eye protection can be recommended. METHODS: A prospective evaluation of ocular injuries encountered in a private ophthalmology practice was performed to identify athletes most at risk for injury and to document the long-term complications of these injuries. RESULTS: Of 125 patients, 57 suffered corneal abrasion, 48 incurred traumatic iritis, 45 received lid or orbital contusions, and 43 sustained conjunctival hemorrhages. Basketball and the racquet sports were the leading causes of trauma, while baseball/softball and football were other important sources of injury. Hyphema was the primary reason for hospital admission. Permanent sequelae were sustained in 37 patients (29 percent), while eight suffered some degree of permanent visual loss. The great majority of patients were injured while participating in unsupervised sporting activities. CONCLUSIONS: The types of injury and sports involved in this study were similar to those reported by hospital emergency rooms. The great majority of injuries could have been prevented if adequate protective eyewear had been worn. Eye care practitioners should advocate the use of protective eyewear for patients who participate in sports activities.

Adult↗
PubMed1997

[Between liberty and control, the private docents and medical teaching in Geneva between 1876 and 1917].

The University of Geneva was founded in 1876 with two sets of teachers established as competitive entities: the salaried professors and the nonsalaried privat-docents. The ease with which physicians obtained the title of privat-docent, a series of abuses of that status and the professors' desire to manage teaching at all levels, resulted in a conflictual situation. The subsequent drive of professors to gain control over all teaching reveals tensions between the medical faculty and the political authorities, but also strains within the medical community itself. Ultimately, the result was the professors' leadership over the rest of the medical community.

Education, Medical↗
PubMed1997

[Asthma in private pneumology practice].

We assessed asthma severity in patients attending private practice chest specialists, studied the factors related to classification by physicians, and described medications prescribed. 545 chest specialists scattered throughout France, included the patients examined from 3 to 28 May 1993 (N = 14,865). Besides a classification of asthma severity in four classes (mild, moderate, moderately severe, and severe), questionnaires included 20 questions on the history and characteristics of asthma, lung function level and medications prescribed. The proportion of mild asthmatics was 55% among the 3,620 children (aged 6 to 15 years), 42% among the 6,479 young adults (aged 16 to 45 years), and 18% among the 4,766 older adults (aged 46 to 75 years). Followed-up patients were considered more severe than new patients among adults, but not among children. The factors related to asthma severity were impaired FEV1, history of hospitalization, critical care and emergency visits for asthma, limitation of physical activities, and, to a latter extent, symptoms between exacerbations, frequent asthma attacks and daily use of beta 2-agonists. Anti-inflammatory drugs were prescribed to practically all patients from grade 2 (moderate): steroids increased whereas sodium cromoglycate and nedocromil decreased with increasing severity. This study provides a valuable estimate of the classification and medications prescribed to asthmatic patients examined by 50% of private practice chest specialists in France.

Adolescent↗
PubMedDate not supplied

The role of health insurance in the growth of the private health sector in Korea.

The Korean health care system has been recognized by other countries for its rapid expansion of national health insurance. The government's policy of promoting the private sector, relying on market forces for various allocation decisions, and using the fee-for-service payment system has created a number of challenges for the Korean health system. Among these are rapid growth of health care expenditure, proliferation and duplication of medical technology, and lack of access for low-income groups due to high out-of-pocket payments for services covered by insurance. A number of recommendations are made concerning national health policy, modifying health insurance, and developing political consensus for bringing about health reform.

Developing Countries↗
PubMedDate not supplied

Private medical services in acute-care hospitals in Israel.

The objective of this study was to assess the proposed introduction of out-of-pocket funded inpatient and outpatient services (abbreviated as PMS) into government acute-care hospitals in Israel. This issue of public-private mix in not-for-profit hospitals is discussed in terms of the experience with PMS gained in selected advanced market economies. Then, the major contours of the Israeli system of health care, and the gradual evolving of patient-financed medical services within government acute-care hospitals in Israel, is described. The experience gained in the few public hospitals in Jerusalem that have been operating PMS is assessed critically. The concluding part reviews the advantages and disadvantages of these developments in public and government acute-care hospitals in Israel. It is concluded that PMS in public hospitals in Israel represents a policy aimed primarily at benefiting a select group of senior physicians in those hospitals.

Financing, Personal↗
PubMed1990

Family planning through private practitioners: characteristics of Kenyan contraceptive acceptors.

Kenya has one of the highest population growth rates in the world. Innovative programs are therefore called for to help curb the fast population growth rate. The Kenya Medical Association started a new program of involving private physicians in the active provision of family planning services. A preliminary analysis shows that the program serves generally young, better educated women of low parity. Sixty-one percent of the clients are new acceptors and the oral contraceptive pill the most popular method. The level of education of the clients had marked influence on family size. Age, parity and marital status also influenced the pattern of contraceptive use. These preliminary results are discussed against the background of the 1984 Kenya Contraceptive Prevalence Survey findings and possible areas of improvement suggested.

Adolescent↗
PubMed2002

Private medical practitioners and managed care in Malaysia: a survey of knowledge and attitudes held by Federal Territory based doctors.

This paper considers the subject of managed care in Malaysia, providing a questionnaire-based analysis of the position adopted by private medical practitioners. Managed care is now seen as the dominant health care system in the United States, with many other countries around the world including Malaysia beginning to selectively use component parts to tackle particular health care problems. In this survey it was found that three out of four respondents have concerns regarding the implementation of managed care. The survey was used to identify and categorise these concerns. At the same time, three out of four respondents held the opinion that principles of managed care were already a reality or would be in the next 5 years. This group expressed an eagerness to be trained in managed care principles and be given the opportunity to be part of managed care organisations. It is argued that clinicians' knowledge and interest perceptions are an important influence on the implementation of managed care based systems. The survey-based evidence presented in this article is intended as a measure of current understandings and beliefs, in relation to clinical micro-management process associated with managed care.

Adult↗
PubMed2026

Determinants of private health insurance uptake and its association with healthcare utilization in Gulf Cooperation Council countries: a systematic review.

All Gulf Cooperation Council (GCC) countries have a multi-payer healthcare system that comprises governmental health coverage (GHC), funded by the government, and private health insurance (PHI), mainly sponsored by employers and purchased by individuals. Both are expected to influence healthcare utilization and contribute to system efficiency and patient well-being. This systematic review explored the determinants of PHI uptake and its association with healthcare service utilization in the presence of GHC in GCC countries. We systematically searched CINAHL, PubMed, Scopus, Web of Science, and Cochrane Library for peer-reviewed studies published between January 2012 and October 2022. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) checklists for both quantitative and qualitative studies, following PRISMA guidelines. Twenty-six studies met the inclusion criteria. Determinants of PHI uptake were mapped to Andersen's Behavioral Model of Health Services Use (BMHSU) and categorized into (1) predisposing factors (sex, age, marital status, and education), (2) enabling factors (employment/income and health system-related factors such as access and perceived service quality), and (3) need factors (health status, including chronic noncommunicable diseases). PHI uptake was positively associated with being male, married, highly educated, employed with a high income, and having chronic diseases. PHI was positively associated with healthcare utilization, particularly routine check-ups, preventive services, and the use of prescribed medicines. In GCC countries, PHI uptake is influenced by sociodemographic and socioeconomic characteristics, health status, and perceived service quality. PHI is also associated with higher healthcare utilization, underlining the need for evidence-informed policies that enhance equity and expand coverage.

Humans↗
PubMed2006

Cost-effectiveness of screening strategies for Gonorrhea among females in private sector care.

OBJECTIVE: To identify the optimal screening algorithm for gonorrhea infection among females in private sector care, using cost-effectiveness analysis. METHODS: We compared 6 strategies using decision analysis for urine nucleic acid amplification testing for gonorrhea testing in a theoretical cohort of 10,000 females aged 15-35 years: 1) screen women aged younger than 25 years; 2) screen women aged younger than 30 years; 3) screen women aged younger than 25 years who report any risk (pregnant, drug use, new sexual partner < 30 days); 4) screen women aged younger than 30 years who report any risk; 5) screen women aged younger than 25 years or those who report any risk; and 6) screen women aged younger than 30 years or those who report any risk. Infection prevalence and sensitivity and specificity were by direct observation from a retrospective cohort of females attending the Baltimore City Sexually Transmitted Disease Clinics between 1999 and 2002. The main outcome measures were untreated gonorrhea cases and their sequelae in women, transmission to a male partner, congenital outcomes, and cost to prevent a case. RESULTS: Prevalence of gonorrhea was 3.0%. Not screening would result in 300 untreated cases. Not screening was cost-saving over all screening strategies. Strategy 6 resulted in the fewest cases of untreated infection (82), although Strategy 3 was the most cost-effective of the screening strategies. Univariate sensitivity analysis identified a threshold of 4.75% gonorrhea prevalence, more than which Strategy 3 became cost-saving over not screening. CONCLUSION: Screening is recommended for females aged younger than 25 years with specific risks in populations with a gonorrhea prevalence of 4.75% or greater. LEVEL OF EVIDENCE: II-2.

Adolescent↗
PubMed2003

Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study.

OBJECTIVES: To evaluate whether the projected 24% reduction in acute bed numbers in Lothian hospitals, which formed part of the private finance initiative (PFI) plans for the replacement Royal Infirmary of Edinburgh, is being compensated for by improvements in efficiency and greater use of community facilities, and to ascertain whether there is an independent PFI effect by comparing clinical activity and performance in acute specialties in Lothian hospitals with other NHS hospitals in Scotland. DESIGN: Comparison of projected and actual trends in acute bed capacity and inpatient and day case admissions in the first five years (1995-6 to 2000-1) of Lothian Health Board's integrated healthcare plan. Population study of trends in bed rate, hospital activity, length of stay, and throughput in Lothian hospitals compared with the rest of Scotland from 1990-1 to 2000-1. MAIN OUTCOME MEASURES: Staffed bed rates, admission rates, mean lengths of stay, occupancy, and throughput in four adult acute specialty groups in 1990-1, 1995-6, and 2000-1. RESULTS: By 2000-1, rates for inpatient admission in all acute, medical, surgical, and intensive therapy specialties in Lothian hospitals were respectively 20%, 6%, 28%, and 38% below those in the rest of Scotland. Day case rates in all acute and acute surgical specialties were 13% and 33% lower. The proportion of delayed discharges in staffed acute and post-acute NHS beds in Lothian hospitals exceeded the Scottish average (15% and 12% respectively; P<0.001). CONCLUSION: The planning targets and increase in clinical activity in acute specialties in Lothian hospitals associated with PFI had not been achieved by 2000-1. The effect on clinical activity has been a steeper decline in the number of acute beds and rates of admission in Lothian hospitals compared with the rest of Scotland between 1995-6 and 2000-1.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

The private duty market: operational and staffing considerations.

Wouldn't it be nice to get away from Medicare home health regulations and into a business where the provider simply needs an understanding of the difference between a revenue and an expense? Cost reports, disallowances, allocations, cost shifts, and cost limits become a thing of the past. This article will help you plan and evaluate your approach to developing a private duty business. An overview of the market, operational considerations, and a discussion of various key staff positions and their functions allows you to explore this opportunity from many vantage points.

Community Health Nursing↗
PubMed1996

Visions of our health care future: is a parallel private system the answer?

In this time of spending restraint, arguments for and against a two-tier medical system are common. Proponents say governments can no longer afford to supply all the health care we want and Canadians should have the right to purchase it, just as they purchases other services and commodities. Opponents fear that administrative costs will rise greatly if this happens, the best physicians will leave the public system and public support for medicare will erode. For this article, Charlotte Gray sought opinions on whether a parallel private system is a good option for Canadians to consider.

Canada↗
PubMed1989

Smoking counseling and preventive medicine. A survey of internists in private practices and a health maintenance organization.

Physicians could help a large number of patients quit smoking by taking time to advise them about quitting, helping them plan a date to quit, giving them self-help materials, following up, and referring some to smoking cessation programs. To determine the attitudes and practices of internists concerning smoking cessation and selected preventive medical practices, we surveyed a random sample of internists in private practice and in a large health maintenance organization (Kaiser-Permanente Medical Group) in the San Francisco Bay area. Overall, internists consider counseling about smoking to be at least as worthwhile as many other practices, such as screening for breast cancer, and more worthwhile than periodic physical examinations. Despite these beliefs, 57% to 65% of internists reported that they spend two minutes or less counseling smokers during new patient visits. Many internists never use recommended strategies for counseling about smoking: 33% to 44% never help patients plan dates to quit, 68% to 75% never make follow-up appointments with patients primarily about smoking, and 27% to 48% never give smokers self-help pamphlets about quitting. Although they believe that counseling about smoking is worthwhile, internists are not doing as much as they could to help their patients quit.

Attitude of Health Personnel↗