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Longer hospitalization at Veterans Administration hospitals than private hospitals. Verification and additional insights.

Utilizing 1,297 male patients under the primary care of an identical group of house officers and under treatment between 1985 and 1987 for ten common medical diagnoses, length of hospitalization was compared between a private sector (n = 481) and Veterans Administration (VA) (n = 816) facility, both affiliated with the same medical school. All patients were rated by the Horn Severity of Illness Index. After researchers controlled for diagnosis, severity of illness, age, race, and physician, results in this study indicate that an additional 3.2 days of hospitalization were associated with the VA facility. This finding is consistent with earlier reports of inappropriate hospitalization at the VA hospital and suggests that VA facility planners need to evaluate whether longer lengths of stay (LOS) are merited.

Adult↗

Can medical school-affiliated hospitals compete with private hospitals in the age of managed care? An 11-state, population-based analysis of 351,201 patients undergoing cholecystectomy.

BACKGROUND: The purpose of this study was to use an 11-state, population-based hospital discharge database to assess the charges for care of patients undergoing cholecystectomy at both medical school affiliated hospitals (MSAHs) and private hospitals (nonMSAHs). It was our hypothesis that MSAHs could indeed provide efficient, competitively priced patient care. STUDY DESIGN: Data were obtained from the Healthcare Cost Utilization Project of the Agency for Health Care and Policy Research. The database tracks information on all hospitalized patients from 11 states for the years 1988-1992. RESULTS: Represented in the study were 849 nonMSAHs (82%) and 191 MSAHs (18%). During the 5 years of the study, 351,201 patients underwent cholecystectomy. The mean charges and the lengths of stay were similar in the two diagnosis related groups (DRGs) studied (197,198). The analysis demonstrated that during this same period, MSAHs led in both the adoption of laparoscopic cholecystectomy and decreased use of intraoperative cholangiography. CONCLUSIONS: Others have reported that MSAHs cannot compete with nonMSAHs in providing competitively priced care. The present study shows that for cholecystectomy, charges and length of hospital stay are comparable in MSAHs and nonMSAHs. This study supports the hypothesis that the leadership provided at United States medical schools may also extend to the area of cost-efficient care and hints at further areas of improvement.

Cholangiography↗

The role of private hospitals in South Africa. Part II. Towards a national policy on private hospitals.

This paper reviews some aspects of present state policy on private hospitals and sets out broad policy guidelines, as well as specific policy options, for the future role of private hospitals in South Africa. Current state policy is reviewed via an examination of the findings and recommendations of the two major Commissions of Inquiry into the role of private hospitals over the last 2 decades, and comparison of these with the present situation. The analysis confirms that existing state policy on private hospitals is inadequate, and suggests some explanations for this. Policy options analysed include the elimination of the private hospital sector through nationalization; partial integration of private hospitals into a centrally financed health care system (such as a national health insurance system); and the retention of separate, privately owned hospitals that will remain privately financed and outside the system of national health care provision. These options are explained and their merits and the associated problems debated. While it is recognised that, in the long term, public ownership of hospitals may be an effective way of attaining equity and efficiency in hospital services, the paper argues that elimination of private hospitals is not a realistic policy option for the foreseeable future. In this scenario, partial integration of private hospitals under a centrally financed system is argued to be the most effective way of improving the efficiency of the private hospital sector, and of maximising its contribution to national health care resources.

Health Policy↗

The Japanese health care system: planning the extinction of the private hospital?

The private hospital in Japan is like a patient with a very serious condition, but one that is reversible. Unless the treatment or appropriate support is given in a timely manner, the patient may have a cardiac arrest and either die or suffer permanent injury. In 1992 and 1993 there were record bankruptcies in private hospitals in Japan. These hospitals suffered permanent injuries, or ceased to exist because the proper support was not provided. More will suffer the same fate in the immediate future, because life saving measures continue to be withheld. This article attempts to provide some general and specific aspects of the Japanese health care system that have led private hospitals to the brink of extinction, and makes a plea for their survival.

Bankruptcy↗

[Nurses' perceptions of inservice training in a private hospital].

A private hospital aims at quality health care delivery with a profit making motive. Inservice education to nursing staff therefore plays an important role--it should add value to the hospital and should also be cost-effective. This research hospital has a formal inservice education programme for the professional nurses, but the question arises: what are their perceptions of the inservice education in this hospital? The aim with this research is to explore and describe the perceptions of the professional nurses on inservice education and to formulate guidelines for improvement. A qualitative research strategy was utilised, with individual focus interviews as method of data collection, followed by a content analysis of the transcribed interviews. Two main categories were identified, being the positive or facilitative perceptions and the negative perceptions/obstacles. Concluding statements were formulated to serve as basis for the description of guidelines on inservice education within this hospital. Guidelines for quality inservice education were formulated, relating to the following: scientific principles to make provision for appropriate assessment, planning, implementation and evaluation of the inservice education programme; accessibility of the inservice education sessions; establishment of a positive learning climate by the learning accompanist; credibility of the inservice education programme in the private hospital. It is recommended that these guidelines be implemented and that selected statements be converted to hypotheses and exposed to testing.

Attitude of Health Personnel↗

Prevalence of prenatal drinking assessed at an urban public hospital and a suburban private hospital.

BACKGROUND: Although the prevalence of fetal alcohol syndrome (FAS) varies within the population, few data are available concerning variation in the prevalence of prenatal drinking. METHODS: Postpartum women delivering singleton infants at two Atlanta hospitals in 1993 or 1994 were interviewed. Those delivering infants who were small for gestational age (SGA) (n = 638) were over-sampled relative to those delivering infants with birth weights that were appropriate for gestational age (AGA) (n = 247). The prevalence of prenatal drinking was estimated as a weighted average of reports from mothers of SGA and AGA infants. Estimates of the prevalence of FAS come from the Metropolitan Atlanta Congenital Defects Program (MACDP) of the Centers for Disease Control and Prevention. RESULTS: The prevalence of first-trimester drinking was half that reported for the three previous months (private hospital: 72% vs. 35%; public hospital: 52% vs. 28%). Most women (85%) reported abstaining throughout the second trimester. Fewer than 10% of women delivering at the public hospital (7.5%), but one-quarter of those delivering at the private hospital, reported third-trimester drinking. Binge, moderate and heavy drinking in pregnancy were more common among women delivering at the public hospital. Eight infants born at the public hospital during this period, but none of those born at the private hospital, were identified as possibly having FAS; four of the eight were identified as probably having FAS. CONCLUSIONS: These results have implications for health education programs. For example, obstetricians in private practice may wish to reaffirm their advice to abstain from drinking in the third trimester. They also suggest that prenatal abstinence programs be targeted at populations identified as most likely to engage in risky drinking.

Alcohol Drinking↗

Difference in the incidence of Clostridium difficile among patients infected with human immunodeficiency virus admitted to a public hospital and a private hospital.

OBJECTIVE: To compare the occurrence of Clostridium difficile among inpatients infected with human immunodeficiency virus (HIV) in two different hospitals. DESIGN: Prospective, observational study. SETTING: Specialized HIV inpatient units. PATIENTS: HIV-infected inpatients at Cook County Hospital (CCH) and Rush Presbyterian St. Luke's Medical Center (RPSLMC). INTERVENTIONS: A clinical and epidemiologic assessment of patient risk factors for C. difficile was performed. C. difficile isolates found on stool, rectal, and environmental cultures were typed by pulsed-field gel electrophoresis. RESULTS: Twenty-seven percent of patients admitted to CCH versus 4% of patients admitted to RPSLMC had positive cultures for C. difficile (P = .001). At CCH, 14.7% of environmental cultures were positive versus 2.9% at RPSLMC (P = .002). Risk factors for C. difficile acquisition included hospitalization at CCH, more severe HIV, use of acyclovir and H2-blockers, and longer hospital stay. Patients admitted to CCH were taking more antibiotics, had longer hospital stays, and more frequently had a history of C. difficile infection. During the study, two strains (CD1A and CD4) extensively contaminated the CCH environment. However, only CD1A caused an outbreak. CONCLUSIONS: The C. difficile acquisition rate at CCH was sevenfold higher than that at RPSLMC, and CCH had a more contaminated environment. Differences in patient acquisition rates likely reflect a greater prevalence of traditional C. difficile risk factors and a concurrent outbreak at CCH. Although two strains heavily contaminated the environment at CCH, only one caused an outbreak, suggesting that factors other than the environment are important in initiating C. difficile outbreaks.

Chicago↗

The funding of private hospitals in Australia.

Private hospitals are an essential component of Australia's complex mix of public and private health funding and provision. Private hospitals account for 34.3 per cent of all hospital separations, and over half (56.2%) of all same-day separations. The revenue (funding) of the sector approached $4 billion by 1998/99, and as a result of its recent rapid growth capital expenditure in the sector was nearly $550 million in the same year. Private casemix of private hospitals is distinctive, and characterised by a high proportion of surgical procedures in general (48.1 per cent), and more than a majority of all services in such areas as rehabilitation, orthopaedics (shoulder, knee, spinal fusion, and hand surgery), alcohol disorders, same day colonoscopy and sleep disorders. This chapter synthesizes data from a multitude of sources to produce a comprehensive picture of Australia's private hospital sector and its funding. It examines the funding (revenue) sources of private hospitals, and considers how and why private hospitals approach the issue of funding from a different perspective than their public sector colleagues. To illustrate how Australian private hospitals approach revenue (funding) strategically, a series of indicative types of hospitals is explored.

Australia↗

Results of a hospital waste survey in private hospitals in Fars province, Iran.

Hospital waste is considered dangerous because it may possess pathogenic agents and can cause undesirable effects on human health and the environment. In Iran, neither rules have been compiled nor does exact information exist regarding hospital waste management. The survey presented in this article was carried out in all 15 private hospitals of Fars province (Iran) from the total numbers of 50 governmental and private hospitals located in this province, in order to determine the amount of different kinds of waste produced and the present situation of waste management. The results indicated that the waste generation rate is 4.45 kg/bed/day, which includes 1830 kg (71.44%) of domestic waste, 712 kg (27.8%) of infectious waste, and 19.6 kg (0.76%) of sharps. Segregation of the different types of waste is not carried out perfectly. Two (13.3%) of the hospitals use containers without lids for on-site transport of wastes. Nine (60%) of the hospitals are equipped with an incinerator and six of them (40%) have operational problems with the incinerators. In all hospitals municipal workers transport waste outside the hospital premises daily or at the most on alternative days. In the hospitals under study, there aren't any training courses about hospital waste management and the hazards associated with them. The training courses that are provided are either ineffective or unsuitable. Performing extensive studies all over the country, compiling and enacting rules, establishing standards and providing effective personnel training are the main challenges for the concerned authorities and specialists in this field.

Data Collection↗

[Evolution of the hospital pharmacies in public and private hospitals in the cancer network in Lorraine: Oncolor].

With the objective of improvement of quality in oncology, an assessment of chemotherapy practice in hospital pharmacies in public and private hospitals was carried out by the regional committee of oncology in Lorraine. The 36 hospitals reporting using chemotherapy, had varied practices. The results of this survey lead to the elaboration of guideline for hospital pharmacies in the oncology regional network Oncolor. This paper describes the different aspects of the hospital pharmacies in public and private hospitals included in the network Oncolor from 1996 to 2000. In 1996, 9 hospital pharmacies had centralized preparation for chemotherapy, whereas at the end of 2000, 26 pharmacies on 28 will fulfill the guidelines.

Computer Communication Networks↗

Satisfaction with hysterectomy: low-income underinsured teaching hospital patients versus insured patients at a private hospital.

OBJECTIVE: The purpose of this study was to measure patient health-related quality of life/satisfaction with the results of hysterectomy in 2 distinct groups of women. STUDY DESIGN: A health-related outcomes questionnaire was completed 3 months after hysterectomy by 50 low-income women who underwent operation at a state-supported teaching hospital and by 50 women who underwent operation at a private hospital. RESULTS: The women at the teaching hospital had a significantly worse outcome satisfaction score than the women at a private hospital. However, 98% of the patients at the teaching hospital and 100% of patients at the private hospital noted their symptoms to be improved. Factors such as race, age, preoperative indications, route of hysterectomy, oophorectomy, and hormone replacement therapy did not affect outcome scores. CONCLUSION: Low-income women who undergo operation at a university teaching hospital experience lower satisfaction after hysterectomy than do other women.

Adult↗

Regulating the construction of hospitals or vice versa: the courts and private hospital planning in Victoria.

This paper examines the legal framework for regulating the development of new private hospitals in Victoria. It first reviews the genesis of the statutory power for private hospital regulation and outlines the two court cases which clarified the interpretation of the statute. The legislation and its interpretation by the courts emphasise a particular approach to private hospital planning which does not necessarily address the problems faced by consumers of hospital services in Victoria. It is argued that the law has constructed a particular framework for private hospital regulation which does not address the critical problems facing the hospital system in the 1990s. The legal framework for regulation is based on property rights rather than the needs of hospital users, despite the language used in the legislation.

Health Planning Guidelines↗

[The development of private hospital in modern Korea, 1885-1960].

Modern hospital in Korea was the space of competition and comprise among different forces such as the state power and social forces, imperialism and nationalism, and the traditional and modern medicine. Hospital in the Japanese colonialism was the object of control for establishing the colonial medical system. Japanese colonialism controlled not only the public hospital but also the private hospital which had to possess more than 10 infectious beds in the isolation building by the Controlling Regulation of Private Hospital. In fact, the private hospital had to possess more than 20 beds for hospital management. As a result, its regulation prevented the independent development of the private hospital. But because the public hospital could not accommodate many graduates of medical school, most of them had to serve as practitioner. Although some practitioners had more than 20 beds in their clinics, they were not officially included in the imperial medicine. By concentrating on the trend of the number of beds in the hospital, this paper differs from most previous studies of the system of hospital, which have argued that the system of hospital was converted the public-centered hospital system under the colonial medical system into the private-centered hospital system under the U. S. medical system after the Liberation in 1945. After Liberation, medical reformers discussed arranging the public and the private hospital. Lee Yong-seol, who was a Health-Welfare minister, disagreed the introduction of the system of state medicine. Worrying about the flooding of practitioners, he did not want to intervene the construction of hospital by state power. Because the private hospital run short of the medical leadership and the fundamental basis, the state still controlled the main disease in the public health and the prevention of epidemics. This means the state also played important part in the general medical examination and treatment. The outbreak of Korean War in 1950 reinforced the role of state. The leadership of the public hospital verified the trend of the quantity of beds. The number of beds in the private hospital exceeded that of the public hospital in 1966 for the first time. Futhermore, the number of beds in the public hospital doubled that of private hospital in the new general hospital of 1950s. This means the system of hospital after the Liberation was not converted the public-centered hospital system into the private-centered hospital system, but maintained the public-centered hospital system until 1960s.

Colonialism↗

Episiotomy in NSW hospitals 1993-1996: towards understanding variations between public and private hospitals.

Episiotomy rates for women experiencing childbirth in New South Wales (NSW) hospitals are another indicator that private insurance may be a risk factor for obstetric intervention. A recent comparison of episiotomy rates in NSW public and private hospitals between 1993 and 1996 revealed that episiotomy rates were 12 to 15 percentage points higher in NSW private hospitals than in public hospitals studied. Rates also appear to be declining in NSW public hospitals, yet this trend is not evident in the NSW private hospitals studied. Although private hospital patients were almost twice as likely to experience forceps or vacuum delivery (often associated with episiotomy), this leaves a 6 to 8 percentage point difference unexplained. Given the potential health-related quality of life issues associated with perineal trauma during childbirth, further analysis of the clinical make-up of privately insured women may help determine the extent to which clinical explanations exist to support the differences in this childbirth intervention.

Adult↗

Searching for the hospital yardstick: a case study of private hospital productivity bargaining.

The decentralisation of Australia's centralised wage fixation system has been seen as providing opportunities for employers and trade unions to tailor working arrangements to suit the needs of the workplace and to provide better paid long-term jobs. This paper details the productivity bargaining between the Private Hospitals' Association of Queensland and The Australian Workers' Union in 1995-97 in Queensland that led to the introduction of a number of productivity-based enterprise agreements. The case study shows that productivity bargaining in the private hospitals studied remains focused on 'bottom line' issues where cashable savings can readily be generated. The paper concludes with an examination of the lessons drawn from the productivity bargaining process.

Collective Bargaining↗

Factors affecting the supply of private hospital beds in the UK: private insurance, NHS pay beds, or NHS waiting list?

This study attempts to isolate the determinants of private hospital growth in the United Kingdom. Thirty-six variables, representing private medicine, the socio-economic environment, the political and government conditions, and the health care systems characteristics were selected for analysis. Multiple regression analysis shows that the number of independent hospital beds in the UK can be explained almost entirely by the number of persons with private health insurance, the number of NHS pay beds, and the overall bed level. Further analysis reveals that the number of persons with private health insurance can be explained to a large extent by the length of the NHS waiting list.

Health Benefit Plans, Employee↗