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PubMed2005

Organizational characteristics and preventive service delivery in private practices: a peek inside the "black box" of private practices caring for children.

OBJECTIVE: Although privately owned practices provide the majority of primary care for children, little is known about the organizational characteristics of these practices or how these characteristics affect the quality of care for children. The purpose of this study was to describe selected organizational characteristics and preventive service delivery features that might affect the quality of primary care for children in private practices. METHODS: A cross-sectional study of 44 private pediatric and family medicine practices in 2 regions of North Carolina was performed. Preventive service performance was assessed through chart abstraction for 60 randomly selected children between 24 and 30 months of age, for evaluation of immunizations and anemia, tuberculosis, and lead screening delivery by 2 years of age. Organizational characteristics were determined through surveys of all physicians and staff members. We used descriptive statistics and scatter plots to describe variations in organizational characteristics and preventive services. RESULTS: Overall, practices demonstrated low levels of preventive service performance, with substantial variation among practices. Only 39% of children received 3 of the 4 recommended preventive services measured (practice range: 2-88%). Few practices demonstrated evidence of a systematic approach to prevention. For example, only 12 (27%) of the 44 practices used >1 of 5 recommended preventive service delivery strategies. Furthermore, practices varied greatly with respect to many of the measured organizational characteristics, which were consistent with organizational stress in some cases. For example, turnover of clinicians and staff members was remarkably high, with practices losing an average of 27% of their clinicians every 4 years (range: 0-170%) and 39% of their office staff members every 2 years (range: 0-170%). CONCLUSIONS: Private practices caring for children in North Carolina demonstrated low overall performance for the 4 recommended preventive services examined, with large variations among practices. Few practices had evidence of comprehensive systems for prevention. There was also evidence of substantial variation in many organizational characteristics. Some organizational characteristics were at levels that might impede delivery of high-quality primary care for children. These findings suggest a growing need for research that examines the impact of organizational characteristics on the quality of care in private practices.

Adolescent↗

PubMed2000

Private pharmacies and tuberculosis control: a survey of case detection skills and reported anti-tuberculosis drug dispensing in private pharmacies in Ho Chi Minh City, Vietnam.

SETTING: Ho Chi Minh City (HCMC), Vietnam. OBJECTIVES: To assess knowledge about tuberculosis, to describe self-reported dispensing practices and to estimate the magnitude of anti-tuberculosis drug dispensing in private pharmacies. DESIGN: Survey of a random sample of 147 private pharmacies out of a total of 1814 registered pharmacies. Interviews were carried out based on a structured questionnaire. RESULTS: Eighteen per cent of interviewees identified TB as a possible diagnosis for a fictitious case with fever and cough for 4 weeks. Fifty-eight per cent reported selling anti-tuberculosis drugs often or sometimes. Interviewees estimated that 1.3 persons on average (95%CI 0.6-1.9) had bought anti-tuberculosis drugs during the last 4-week period, and that 24% of them had bought anti-tuberculosis drugs without a prescription. CONCLUSION: We have estimated that between 1100 and 3400 persons buy anti-tuberculosis drugs each month in the 1814 registered private pharmacies in HCMC, that about a quarter of them do so without a prescription, and that at least 40% of all anti-tuberculosis drug dispensing in HCMC occurs in the private sector. Regulations need to be put in place urgently and collaboration strengthened between the strong National Tuberculosis Programme and the unorganised private sector in HCMC.

Adult↗

PubMed2003

Private tuberculosis care provision associated with poor treatment outcome: comparative study of a semi-private lung clinic and the NTP in two urban districts in Ho Chi Minh City, Vietnam. National Tuberculosis Programme.

SETTING: Ho Chi Minh City, Vietnam. OBJECTIVE: To compare tuberculosis case management and treatment outcome between a semi-private chest clinic and a publicly run national tuberculosis programme (NTP). METHOD: Prospective, non-randomised, comparative cohort study. Case-management and treatment outcome was determined for 176 patients treated in the semi-private clinic and 326 patients treated in the NTP. RESULTS: In the semi-private clinic cohort, significantly fewer patients completed treatment and/or were cured than in the NTP cohort (48.9% vs. 85.0%, P < 0.001). Among patients with sputum-positive pulmonary TB, significantly fewer were cured in the semi-private clinic cohort compared to the NTP cohort (22.2% vs. 79.2%, P < 0.001), and treatment success was significantly lower (35.2% vs. 79.7%. P < 0.001). Adjustment for a number of potential confounders did not change these findings significantly. CONCLUSIONS: Treatment outcome was considerably better in the NTP than in the semi-private clinic. The difference is not likely to be due to differences in patient characteristics or in provider knowledge. Different financial incentives for the providers in the two settings and ways of paying for services by patients are possible reasons for the observed difference in the quality of case management and treatment outcome.

Adolescent↗

PubMed1991

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↗

PubMed2004

Comparison of private for-profit with private community-governed not-for-profit primary care services in New Zealand.

OBJECTIVE: To compare the characteristics of patients, their disease patterns, and the investigation and referral patterns in private community-governed not-for-profit and private for-profit primary care practices in New Zealand. METHODS: Observational study using a representative survey of visits to general practitioners in New Zealand. Practices were categorised according to their ownership: private for-profit or private community-governed not-for-profit. Patient socio-demographic characteristics, treated prevalence and other characteristics of presenting problems, morbidity burden, numbers of investigations and referral patterns were compared. RESULTS: Compared with for-profit practices, community-governed not-for-profit practices served a younger, largely non-European population, nearly three-quarters of whom had a means-tested benefit card (community services card), 10.5% of whom were not fluent in English, and the majority of whom lived in the 20% of areas ranked as the most deprived (by the NZDep2001 index of socio-economic deprivation). Patients visiting not-for-profit practices were diagnosed with more problems, including higher rates of asthma, diabetes and skin infections, but lower rates of chest infections. The duration of visits was also significantly longer. No differences were observed in the average number of laboratory tests ordered. The odds of specialist referral were higher in for-profit patients when confounding variables were controlled for. CONCLUSIONS: Community-governed not-for-profit practices in New Zealand serve a poor, largely non-European population who present with somewhat different rates of various problems compared with patients at for-profit practices. The study highlights for communities, policy-makers and purchasers the importance of community-governed not-for-profit practices in meeting the needs of low-income and minority population groups.

Adolescent↗

PubMed2003

Treatment results among tuberculosis patients treated by private lung specialists involved in a public-private mix project in Vietnam.

SETTING: Ho Chi Minh City, Vietnam. OBJECTIVES: To determine treatment outcome among patients treated by private lung specialists in a public-private mix (PPM) project for improved TB control. METHODS: Cohorts of patients treated by private lung specialists within the PPM project and in National Tuberculosis Programme (NTP) facilities were followed for up to 12 months. The quality of case management and treatment outcome was determined based on information in treatment cards. As a complement, questionnaire surveys of private providers (PPs) and patients and focus group discussions with PPs were conducted. RESULTS: Among 400 patients treated by PPs, 36 different treatment regimens were used. Directly observed treatment was not used at all, and treatment evaluation with sputum smear microscopy and health education was inadequate. Overall treatment success was 60% and the default rate was 37%, which was considerably worse than in NTP facilities. CONCLUSION: This PPM project, which used a combination of training, supervision, standardised referral and information system and financial incentives, did not achieve sufficiently good treatment outcome by PPs. Possible reasons for the poor outcome include absence of subsidisation of drug costs and lack of regulatory enforcement.

Adolescent↗

PubMed2004

Setting the standard for private duty home care: how the National Private Duty Association works to improve home care for providers and their patients.

This article differentiates models within the private home care industry and explains the risks involved for providers, their patients, and consumers using private hires or registry personnel. An overview of the National Private Duty Association (NPDA) and the work it performs to eliminate private duty home care industry risks and failures is presented.

Aged↗

PubMed2005

Explaining source of payment differences in U.S. cesarean rates: why do privately insured mothers receive more cesareans than mothers who are not privately insured?

The difference in the risk-adjusted cesarean rates of mothers who are and who are not privately insured is divided into components attributable to the following four factors: the practice style of the physician attending the birth, the closeness of the physician-mother relationship, individual nonclinical factors, and the direct influence of private insurance on the physician's treatment decision. Estimates from two expansive, complementary data sets indicate that the most of the differential is attributable to the first two factors, particularly the pairing of privately insured mothers with physicians who are inclined to perform cesareans. There is some evidence that these pairings are not incidental but the result of firm (and possibly consumer) choices.

Cesarean Section↗

PubMed1975

Private psychiatry and accountability: a response to the APA task force report on private practice.

The authors note that the imminence of national health insurance makes it very important to determine the roles, efficiency, and effectiveness of both the private and the public sectors of mental health care. The difficulties in distinguishing public from private care are examined. The authors present estimated distributions of care by type of provider that differ from those of an APA task force report on private practice. They point out the need for objective research on the quality of care in both sectors and on the effectiveness of alternative mental health systems, suggesting that public choices should be made on the basis of correct interpretations of reliable data and accountability to those being served.

Cost-Benefit Analysis↗

PubMed1991

[Possibilities and limits for the private surgeon in Germany (private surgical practice in Germany)].

The proportion of all private doctors performing surgery in the FRG (7.7%) and breakdown of service in the areas of general surgery, accident and emergency surgery and vascular surgery in Lower Saxony, FRG. The demands are described made on the skill of the surgeon and on the private hospital are outlined, as is the legal situation with regard to the hospital owner, staff and other private doctors. Also included is information regarding anaesthesia, laboratory and roentgen. Guarantee of presence and the operation catalogue.

General Surgery↗

PubMed1987

Amniotic fluid infection syndrome in private and non-private patients.

The incidence of placental histological evidence of amniotic fluid infection syndrome (AFIS) was studied in two groups of patients delivered at term. One group received private medical care during pregnancy, while the other patients were delivered at a midwife obstetric unit. There was no significant difference in histological evidence of AFIS in the private patient (22%) and non-private patient (28%) groups.

Amniotic Fluid↗

PubMed1983

[Diabetes in private practice. Data of the INSERM national survey on private practice (1974-1975)].

Data from a national survey of private medicine in France were used to estimate the frequency of diabetes in primary care and to analyse both patient characteristics and therapeutic management. An approach was made to 2012 physicians who were requested to complete a questionnaire for each patient they saw during the course of a single day; 1103 responded and completed more than 20000 questionnaires. An additional investigation looked into the nature of the non responders. Diabetics represent 2,2% of patients in private medicine. Each year about 5,5 million consultations in private practice in France are for diabetes alone or for diabetes in association with other illnesses. 89% of diabetic patients are over 45 years of age and more than 48% older than 65. In most cases (80%), diabetes is associated with other medical problems, half of them being consequences of diabetes (cardio-vascular diseases, ocular and renal diseases). In 85% of cases, diabetics receive their basic care from a general practitioner. Therapeutic management is based mainly on drugs; diet or advice about life style are mentioned in barely one third of cases. Using linkage with social security data, it was possible to make a crude estimate of the number of diabetics in France. It was estimated at about 1 million for 52,6 million inhabitants.

Adult↗

PubMed2005

The promotion of private health insurance and its implications for the social organisation of healthcare: a case study of private sector obstetric practice in Chile.

This paper examines some of the implications of the process of privatisation of a national healthcare system for the delivery, organisation and, ultimately, the outcome of services. Through a case study of obstetric care in Chile, we illuminate the relationships between the macro-level of political decisions, the meso-level of the organisations through which government reforms were enacted, and the micro-level of clinical practice. We show that, for a significant proportion of Chilean women seeking maternity care, privatisation has led to expanded access and to ostensibly highly-personalised relationships with specialists. However, because of the fragmentation of maternity services, the altered work patterns for obstetricians occasioned by changes in healthcare financing and the relatively weak market position of most obstetricians, this personalised care is dependent on highly technologised obstetric practices. By examining the specific organisational arrangements under which private maternity care is conducted in Chile we shed light on the connection between privately-funded maternity care and high caesarean section rates in this setting.

Chile↗

PubMed2001

Public-private partnerships. Public pain, private gain.

Using private hospitals over 11 weeks this winter enabled a health authority to remove more than 1,000 patients from waiting lists. Prices were comparable to, and sometimes cheaper than, the NHS. The average cost was 1,120 Pounds per treatment. Patient satisfaction seemed high. Consultant productivity was higher in the private sector.

Cooperative Behavior↗

PubMedDate not supplied

Comparison of outpatient laparoscopic cholecystectomy in a private nonteaching hospital versus a private teaching community hospital.

The development of laparoscopic cholecystectomy has allowed the introduction of outpatient surgery for biliary tract disease. However, there appears to be a wide variation of the interpretation of "outpatient surgery," ranging from discharge the same day to keeping patients for overnight observation. We prospectively reviewed the last 50 chole-cystectomies performed at Spartanburg Regional Medical Center, a private teaching institution, and Upstate Carolina Medical Center, a private nonteaching hospital. All cholecystectomies were performed by board certified surgeons or surgical residents under the supervision of board certified surgeons. Spartanburg Regional Medical Center's standard was 23-hour observation with 9 patients (18%) being discharged home the day of surgery. Upstate Carolina Medical Center's standard was discharge home (usually 4-8 hours after completion of the procedure) with 39 patients (78%) discharged the same day. No patient discharged the same day presented back with any significant complication. Comorbid disease, biliary pancreatitis, ascending cholangitis, gangrenous gallbladder, extreme age and living conditions and conversion to open were factors considered for admission. Intra-operative difficulty such as oozing, excessive adhesiolysis, postoperative nausea, vomiting or pain control were also indications for overnight admissions. The extra 15 to 19 hours for routine observation did not change any treatment for any of the 41 patients and resulted in additional cost to the hospital of approximately $15,000. We conclude that same day, outpatient laparoscopic cholecystectomy can be done safely with discharge home 4 to 8 hours postoperative without significant morbidity in selective patients.

Adolescent↗

PubMed2006

[Invested time in private care: estimated by people in need of help and care and their private caregivers].

The amount of time that ought to be invested for private care is regulated by the German Care Assurance (SGB XI). Whether this reflects the actual amount of help given to the people cornered is not certain. In our qualitative study, which was part of the project "Potentials and Limits of Independent Living in Private Households in Germany" [1] funded by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth, we had the chance to document the amount of time people themselves think they spend or vice versa receive for help and care with a timetable. Even if the amount of time alone does not yet lead to a conclusion about the quality of the given effort, it is one indicator for an adequate care that allows living at home as long as possible.

Activities of Daily Living↗

PubMed1986

Private production, collective consumption, and regional population structure: the interactions between public and private good provision as determinants of community composition.

"Theories of trade and migration explain the distribution of individuals among regions based on private good productivities. The theory of local public goods (LPG's) uses collective good consumption economies to explain the size and composition of communities. This essay combines the two theories, to explore regional population heterogeneity and stability. Assuming that individuals must consume and produce in the same jurisdiction, the paper examines the nature of efficient allocations, the tensions between the private and public incentives, the nature of the equilibrium (if any) which migration among jurisdictions will generate, and how such equilibrium will depend on tax rules for sharing the costs of the LPG."

Commerce↗

PubMedDate not supplied

[Is it possible to sustain health promotion programs in private companies? The case of four Quebec private companies of blue collar workers].

OBJECTIVE: Sustained health promotion programmes in the workplace (HPPW) continues to be a public health challenge. This article presents an evaluation of the implementation and sustainability of such programmes in private blue-collar companies in Quebec to shed light on issues specific to this type of setting. METHOD: A multiple case (4 sites), longitudinal (7 years) and interpretive study method was used. The interpretation framework considered that the implementation and sustainability of HPPW in companies are the result of organizational learning in health promotion, determined by the strategies of individuals in a position of control who shape the decisional processes related to these programmes. RESULTS: After seven years of observation, two of the four sites had continued their HPPW, although these programmes were no longer applied within these companies. The health promotion organizational learning processes in both sites were defined according to targeted organizational purposes set by the decision-makers who supported HPPW. However, these gains were largely lost when HPPW were no longer retained as a component of their organizational development strategy. DISCUSSION: The organizational conditions that are conducive to HPPW are difficult to put together and sustain in companies like those in our study. Businesses implement these programmes mainly for the organizational benefits they expect to reap in the short term, whereas improvement in the health of workers in the longer term is not a priority.

Feasibility Studies↗