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The public and private sectors will both be forced to change as they forge new relationships in order to manage the Medicaid benefit. These changes will affect both their organizational cultures and their technical capabilities.
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The private sector exerts a significant and critical influence on child health outcomes in developing countries, including the health of poor children. This article reviews the available evidence on private sector utilization and quality of care. It provides a framework for analysing the private sector's influence on child health outcomes. This influence goes beyond service provision by private providers and nongovernmental organizations (NGOs). Pharmacies, drug sellers, private suppliers, and food producers also have an impact on the health of children. Many governments are experimenting with strategies to engage the private sector to improve child health. The article analyses some of the most promising strategies, and suggests that a number of constraints make it hard for policy-makers to emulate these approaches. Few experiences are clearly described, monitored, and evaluated. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of how to engage the private sector most effectively. The starting point should include the evaluation of the presence and potential of the private sector, including actors such as professional associations, producer organizations, community groups, and patients' organizations.
Privatization has received significant attention in the popular and professional press. The notion has gained increasing political acceptance with the private sector being seen as cost-effective, innovative, and responsive. Private mental health initiatives will grow because the private sector is seen as an efficient allocator of resources and because there are profit opportunities in traditionally public services. However, a partnership between the private and public sectors will be required in planning and development, serving difficult groups, and defining and measuring quality of care.
Private-sector health care organizations increasingly tout the use of outcomes and effectiveness research in activities ranging from pharmaceutical research to insurance coverage determinations. The rapid development of this research raises important questions about the role of the Agency for Health Care Policy and Research (AHCPR) as the producer, funder, and champion of outcomes and effectiveness research. To address this issue, we reviewed the activities of pharmaceutical companies, insurers, managed care organizations, health information technology companies, and other private-sector actors in outcomes and effectiveness research. We found that it is being used in a focused way to promote business goals and other organizational objectives, particularly in the pharmaceutical, insurance, and managed care industries. We also found significant gaps in its application to important public health issues and virtually no overlap with prior federal activities in this area.
The Administration on Aging (AoA) sponsored a national information system known as the SCAN system. The SCAN bibliographic database went on-line in March 1982. Congress, however, had repealed the authority for the clearinghouse, so the Government let all of the services of SCAN expire by September 1982. The Government then tried to keep the SCAN information accessible by offering it to the private sector. The Government solicited applicants through both the Federal Register and the Commerce Business Daily. As a result, the American Association of Retired Persons (AARP) and AoA signed an agreement calling for AARP to make such of the SCAN information accessible on-line and to update it.
Private sector providers are the most commonly consulted source of care for child illnesses in many countries, offering significant opportunities to expand the reach of essential child health services and products. Yet collaboration with private providers presents major challenges - the suitability and quality of the services they provide is often questionable and governments' capacity to regulate them is limited. This article assesses the actual and potential contributions of the private sector to child health, and classifies and evaluates public sector strategies to promote and rationalize the contributions of private sector actors. Governments and international organizations can use a variety of strategies to collaborate with and influence private sector actors to improve child health - including contracting, regulating, financing and social marketing, training, coordinating and informing the public. These mutually reinforcing strategies can both improve the quality of services currently delivered in the private sector, and expand and rationalize the coverage of these services. One lesson from this review is that the private sector is very heterogeneous. At the country level, feasible strategies depend on the potential of the different components of the private sector and the capacity of governments and their partners for collaboration. To date, experience with private sector strategies offers considerable promise for children's health, but also raises many questions about the feasibility and impact of these strategies. Where possible, future interventions should be designed as experiments, with careful assessment of the intervention design and the environment in which they are implemented.
All private hospitals and clinics must now supply deidentified data, using AN-DRG classification, on all admitted patients to the Private Hospitals Data Bureau. Contracts between health funds and hospitals must also be described on the basis of AN-DRGs, which will enable funds to undertake hospital variance analysis. These data provide the foundation for nationally developed clinical pathways and utilisation reviews which could modify clinical practice, improve standards and reduce health costs. Clinicians must understand and participate in these changes, and adequate safeguards are needed to protect them against loss of their clinical integrity, and against inappropriate discretionary control by private hospitals, healthcare corporations and health insurers.
The countries of Latin America and the Caribbean are facing the gradual phase-out of international-donor support of contraceptive commodities and technical and management assistance, as well as an increased reliance on limited public sector resources and a limited private sector role in providing contraceptives to the public. Therefore, those nations must develop multisectoral strategies to achieve contraceptive security. The countries need to consider information about the market for family planning commodities and services in order to define and promote complementary roles for the public sector, the commercial sector, and the nongovernmental-organization sector, as well as to better identify which segments of the population each of those sectors should serve. While it is unable to mandate private sector participation, the public sector can create conditions that support and promote a greater role for the private sector in meeting the growing needs of family planning users. Taking steps to actively involve and expand the private sector's market share is a critical strategy for achieving a more equitable distribution of available resources, addressing unmet need, and creating a more sustainable future for family planning commodities and services. This paper also discusses in detail the experiences of two countries, Paraguay and Peru. Paraguay's family planning market illustrates a vibrant private sector, but with limited access to family planning commodities and services for those who cannot afford private sector prices. In Peru a 1995 policy change that sought to increase family planning coverage had the effect of restricting access for the poor and leaving the Ministry of Health unable to pay for the growing need for family planning commodities and services.
Just as the private sector has emerged as the predominant force the greater efficiency in the delivery of health care services, so too is the private sector gaining importance as a source of quality oversight strategies. Public reliance on private sector quality assurance efforts is being fueled by such developments as the growth in the number and diversity of private health care accrediting agencies, and the increase in consumer and purchaser-driven demands for comparative information about the quality of health care providers.
OBJECTIVE: We sought to quantify Veterans Health Administration (VA) patients' utilization of coronary revascularization in the private sector and to assess the potential impact of directing this care to high-performance hospitals. METHODS: Using VA and New York State administrative and clinical databases, we conducted a retrospective cohort study examining residents of New York State who were enrolled in the VA and underwent either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) in 1999 or 2000 (n=6562) in either the VA or the private sector. We first calculated the proportion of revascularizations obtained in the VA and the private sector. We then identified the private sector hospitals in which these men obtained revascularizations and determined potential changes in mortality and travel burden associated with directing private sector care to high performance hospitals. RESULTS: VA patients in New York were much more likely to undergo revascularization in the private sector than in VA hospitals: 83% of CABGs (2341/2829) and 87% of PCIs (4054/4665) were obtained in the private sector. Private sector utilization was distributed evenly across high- and low-mortality hospitals. Directing private-sector CABG surgery to high-performance hospitals could have reduced expected mortality by 24% (from 2.3% to 1.7%) and would only increase median travel time from 21 to 30 minutes. The benefit of redirecting PCI care is minimal. CONCLUSIONS: For high-mortality procedures that veterans frequently obtain in the private sector, like CABG, directing care to high-performance hospitals may be an effective way to improve outcomes for veterans.
The rapid growth of managed care poses challenges and opportunities for the health of the public. The fundamental risk is that both mission and accountability will be defined too narrowly; the opportunity lies in broadening both. What would a socially responsible managed care system look like? Such a system would provide excellent individual care to its enrollees, yet it would also include programs and activities that address broader populations and policies. We propose 8 attributes of such a system that can be used as a guide by managed care systems and to judge whether a managed care system is a responsible, accountable, and responsive contributor to the health of its community. As the role of the public sector shrinks, the private sector must expand its responsibility. It is both prudent and reasonable for managed care systems to seize their unique opportunity to improve the health of the public.
BACKGROUND: As payers, purchasers, and providers, both the public and private sectors have a stake in developing sound methods of measuring health care quality and patient safety. However, the role of the private sector in a national quality monitoring system remains largely underdeveloped. PRIVATE SECTOR ROLE IN HEALTH CARE QUALITY MONITORING: There have been some attempts to pool private-sector data through health care industry efforts to measure and monitor the quality of health care services. Yet despite a number of public/private partnerships, no standard method exists for measuring and monitoring health care quality and safety across public and private payers. THE AHRQ WORKSHOP ON PRIVATE-SECTOR QUALITY MONITORING: The Agency for Healthcare Research and Quality (AHRQ) sponsored a workshop in fall 2000 to address the private sector's role in monitoring quality in the health care system. National experts developed a conceptual framework and recommendations on the design and scope of a private-sector data monitoring system. Ten key attributes of the monitoring system, such as timeliness of reports, flexibility, efficiency, and linkability, were identified. Barriers and gaps to the development of such a system include the cost of data collection, the diversity of the units of data collection, data privacy, and limitations of administrative data elements. SUMMARY: A comprehensive, public/private data collection system would address the multidimensional nature of quality and use data to effectively represent this complexity to the extent possible.
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The status of private home care in health care area and how to prove high quality care are discussed in this article. The clients must have a possibility to make a decision to buy services based on real facts. That is why written nursing care plan and quality assurance are the main tools.
It is generally accepted that the first recorded outbreaks of foot and mouth disease (FMD) in South America occurred around 1870. The disease emerged almost simultaneously in the province of Buenos Aires (Argentina), in the central region of Chile, in Uruguay and in southern Brazil, due to the introduction of livestock from Europe. Argentina set up an agency for the control and eradication of FMD in 1961, Brazil began disease-control activities in Rio Grande do Sul in 1965, Paraguay and Uruguay initiated similar programmes in 1967, Chile in 1970 and Colombia in 1972. A common characteristic was observed in all early national FMD programmes, namely, they were developed, financed, operated and evaluated by the public sector, without major participation from the private sector, except when buying vaccines and abiding by the regulations. In 1987, the Hemispheric Foot and Mouth Disease Eradication Plan (PHEFA: Plan Hemisférico para la Erradicación de la Fiebre Aftosa) was launched and the private sector played a prominent role in achieving the eradication and control of FMD in several countries. However, this model of co-participation between the public and private sectors has suffered setbacks and a new approach is being developed to find ways in which local structures and activities can be self-sustaining.
Recent reviews have demonstrated that a substantial proportion of cases of malaria are managed in the private sector, and international policy initiatives routinely emphasize the need for malaria control programmes to collaborate with the private sector. However, information on how to develop successful partnerships between the public and private sectors remains limited. This paper reviews the current knowledge about the management of malaria by private providers, considers the potential of different strategies for influencing the quality of care provided, and identifies processes for facilitating public-private sector collaborations. We contend that public sector-led interventions, such as training of private providers or the distribution of prepackaged antimalarials through the private sector, are unlikely to scale up to sustainable national level programmes if they do not take into account a wide range of needs and concerns, represented by private provider organizations and other interest groups, including service users. These groups should be involved at key stages including the design and piloting of interventions, through to the dissemination and implementation of findings. Research priorities are outlined for the development of tools to facilitate public-private partnerships for improving the management of malaria.