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At least 19 recordsLinked to original sources
PubMed1989

Privatization and the mental health system. A private sector view.

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.

Community Mental Health Services↗
PubMed1991

Stress and well-being in nurses: a comparison of the public and private sectors.

Nurses in the public and private sectors were compared with regard to occupational stress and its sources and self-reported health and well-being. While both groups reported similar high levels of stress experience, most noticeably arising from high work loads and the experience of death and dying, group differences did emerge from an examination of the sources of stress. Whereas N.H.S. nurses were more troubled by high work loads, private sector nurses reported uncertainty over treatment as a more frequent source of stress than did their N.H.S. counterparts. Levels of self-reported mental and physical health symptomatology did not differ between groups. Nevertheless, overall nursing stress scores and symptomatology were significantly correlated, and workload was the best independent predictor of health and well-being status.

Burnout, Professional↗
PubMed1977

Controlling health care costs: strengthening the private sector's hand.

The council on Wage and Price Stability recently has discovered evidence suggesting "an unackonwledged potential of the private sector to exert influence and control in the area of health care cost inflation." This article examines the limitations on private-sector cost-control efforts and suggests actions which would permit and encourage private decision makers to be more effective. In particular, private health insurers' potential role in cost control is explored, and some promising insurer strategies are adumbrated. Carefully designed coverage limitations and plan-initiated reviews to exclude nonessential care from coverage are suggested, together with wider use of fixed indemnity payments or negotiated fees and charges (instead of paying unusual and customary rates or incurred costs). Among the steps needed to permit insurers to provide this added service to cost-conscious customers is enforcement of the antitrust laws to prevent doctors' organized resistance to unwanted measures. In general, it is argued that private-sector efforts are likely to be more effective than government-sponsored controls as well as more appropriate in a pluralistic society.

Cost-Benefit Analysis↗
PubMed1976

Mental health services in the public and private sectors.

Analysis of data on mental health service providers indicates that in 1971 the private sector accounted for 34% of inpatient days, 86% of outpatient visits, 44% of expenditures by source of funds, and 51% of expenditures by receipt of funds. The author believes that mental health professionals must familiarize themselves with the economic interests influencing national health insurance proposals and with public policy making processes if they are to help preserve appropriate roles for the public and private sectors in mental health service delivery.

Costs and Cost Analysis↗
PubMed1975

Quality, quantity and distribution of medical education and care: regulation by the private sector or mandate by government?

The public, the federal government and most state governments have become increasingly concerned with the lack of access to primary care as well as the specialty and geographic maldistribution problems. Currently, there is a race in progress between the private sector and the federal government to devise solutions to these problems. In the federal sector, varying pieces of legislation are under active consideration to mandate the correction of specialty and geographic maldistribution; proposals include: 1) setting up federal machinery to regulate the numbers and types of residencies; 2) make obligatory the creation of Departments of Family Practice in each medical school; 3) withdraw current education support from medical schools causing tuition levels to increase substantially--federal student loans would then provide the necessary leverage to obligate the borrower to two years of service in an under-served area in exchange for loan forgiveness. In the private sector, for the first time in the history of the United States, the five major organizations involved in medical care have organized to form the Coordinating Council on Medical Education (CCME) and the Liaison Committee on Graduate Medical Education (LCGME). One of the initial major endeavors of the CCME has been to address itself to the problem of specialty maldistribution. The LCGME has been tooling up to become the accrediting group for residency training thus providing an overview of the quality and quantity of specialty training. It will be the intent of this presentation to bring the membership of the Southern Surgical Association an up-to-date report on these parallel efforts. The author's personal hope is that the private sector can move sufficiently rapidly to set up its own regulatory mechanisms and avert another federally controlled bureaucracy that will forever change the character of the medical profession in the United States.

Allied Health Personnel↗
PubMed1989

Role of the private sector in elective surgery in England and Wales, 1986.

From a sample of 19,000 treatment episodes at 183 of the 193 independent hospitals with operating facilities in England and Wales that were open in 1986 it is estimated that 287,000 residents of England and Wales had elective surgery as inpatients in 1986 (an increase of 77% since 1981) and 72,000 as day cases. From 1985 Hospital In-Patient Enquiry data it was estimated that a further 36,000 similar elective inpatient treatments were undertaken in NHS pay beds (a decrease of 38%) and 21,000 as day cases. Overall, an estimated 16.7% of all residents of England and Wales who had non-abortion elective surgery as inpatients were treated in the private sector, as were 10.5% of all day cases. An estimated 28% of all total hip joint replacements were done privately, and in both the North West and South West Thames regions the proportion of inpatients treated privately for elective surgery was 31%. It is concluded that mainly for reasons of available manpower private sector activity may not be able to grow much more without arresting or reversing the growth of the NHS, in which case some method of calculating NHS resource allocation which takes account of the local strength of the private sector will be needed.

Adolescent↗
PubMed1992

Appropriateness of cholecystectomy: the public and private sectors compared.

OBJECTIVE: To investigate the appropriateness of cholecystectomies undertaken in the public and private health sectors. DESIGN: Retrospective case note review using the findings of two consensus panels. SETTING: 35 consultant surgeons working for North West Thames Regional Health Authority and in the private sector. PATIENTS: 269 patients undergoing cholecystectomy during the study period, of whom 17 were excluded because there was insufficient information available. MAIN OUTCOME MEASURES: Appropriateness ratings as assessed by two consensus panels, one composed of surgeons and one mixed, containing doctors from different specialties. RESULTS: The mixed panel would have rated 41 per cent of cases appropriate, less than 1 per cent equivocal and 30 per cent inappropriate. The remaining 29 per cent had indications about which the panel did not reach agreement. The surgical panel would have rated 52 per cent appropriate, 3 per cent equivocal and 2 per cent inappropriate. The remaining 44 per cent had indications about which the panel did not reach agreement. Most of the patients who would have been rated inappropriate had vague symptoms only. There were no significant differences between the NHS and private patients as regards their appropriateness. NHS patients were more likely to have more than one ultrasound and to be operated on as an emergency. CONCLUSIONS: An appreciable proportion of patients undergo cholecystectomy for indications which were deemed inappropriate by a mixed panel, but not a surgical panel. Variation in clinical judgement is an important factor in the decision to operate--44 per cent of cases had indications, the appropriateness of which the surgical panel were undecided about. There were no significant differences between NHS and private patients as regards the appropriateness of their indications. These findings need to be confirmed by further studies comparing the public and private sectors.

Adult↗
PubMed1979

The public and private sector: a developing partnership in human services.

Historically, public and private providers of health and welfare services have functioned in separate, often incompatible, arenas. Drawing from the experience of a private child mental health center, the authors suggest that a more coordinated and collaborative approach would benefit both the public and private sectors, as well as their client populations.

Adult↗
PubMed1992

[Chilean hospitals: availability and productivity of the public and private sectors].

Hospital bed availability, trends in number of beds, productivity and administrative aspects in the public and private hospital sectors are analyzed. At present, there are 3.3 beds per 1000 population in Chile. This represents a decrease from previous figures, in spite of increasing demands derived from population aging and greater birth assistance needs. Overall productivity of the hospital system is reflected in 31 annual admissions per bed, an average hospital stay of 8 days and a 75% occupancy rate. The National Health Service System is responsible for 76% of admissions. However, it takes care of more than 90% of bed needs for tuberculosis patients and more than 80% for hospital birth assistance, complications of pregnancy, perinatal disease, communicable diseases, respiratory illnesses, miscarriages and skin diseases. The private sector takes care of more than 40% of rheumatic and musculo skeletal diseases and more than one third of mental health problems. The National Health Service, compared to the private sector, exhibits a greater occupancy rate with an average stay only one day longer. Complexities of hospital administration, new world trends and the relation to external economic resources are discussed.

Bed Occupancy↗
PubMed1989

Treatment outcome in a private-sector residential care program.

The treatment outcomes of 60 chronic mentally ill patients who received services at Community Care, a private-sector residential care program, were analyzed. In addition to psychiatric services, the program offers instruction in living skills and vocational preparation, helps patients find jobs and housing, and operates an outpatient support network. Forty-two percent of the patients discharged during the study period achieved independence or near independence in the program and functioned at that level during a three-year follow-up period. Patients' level of education, degree of participation in the program, levels of residential and vocational achievement at discharge, and discharge status were significantly related to outcome. Patients with good participation in the program who stayed with the outpatient support network at discharge had at least a 95 percent probability of good outcome.

Activities of Daily Living↗
PubMed1979

Private-sector services for low-income psychiatric outpatients. D.C. Institute of Mental Hygiene Washington, D.C.

A community-based, nonprofit outpatient clinic in Washington, D.C., has been successful in using the medical model to provide high-quality services to low-income patients. In 13 years it has grown from five staff members and 17 patients to a part-time staff of 74 and a patient population of 1500. Hours of direct service have increased from 1000 to more than 40,000 per year. The clinic has matched the services provided in the city's public mental health clinics at a fraction of the cost. It receives no direct federal funding and only minimal assistance from state and local governments. It exemplifies the contribution the private sector can make in creatively serving the economically disadvantaged. Fiscal reality and patient demand emphasize the need for a strong and ongoing partnership between the private and public sectors if that population is to be served.

Awards and Prizes↗
PubMed1979

Technology evaluation roundtable discusses role of private sector.

Working from the premise that health care technology should be studied from a multiperspective approach rather than a unidirectional approach, a group of health care opinion leaders gathered to discuss how private or public-private sector efforts could lead to this broad-based approach and to more effective and efficient utilization of health technology.

Capital Expenditures↗
PubMed1992

Health service utilisation in the public and private sector by patients with diabetes mellitus aged less than 40 years.

This paper uses the Illawarra 0-39 years diabetes register to provide a data base of health service utilisation in the public and private sectors. Eligible patients from the register were divided into a 'stable group' comprising children and adults who had had diabetes for more than one year prior to review and a 'newly diagnosed' group who were followed for one year after diagnosis. The records of inpatient and selected outpatient services at public hospitals as well as visits to general practitioners, paediatricians and physicians were considered. Less than half of all 'newly diagnosed' patients were admitted to hospital for stabilisation and none required readmission in the 12 month review period. Less than one fifth of all 'stable' patients were admitted to hospital during the year. General practitioners were the most frequently used health resource being attended by 31/38 (82%) 'stable children', 122/133 (92%) 'stable adults' and 25/25 (100%) 'newly diagnosed patients'. Public hospital Accident and Emergency Services were the least used health facility being frequented by only 9/38 (24%), 23/133 (17%) and 7/25 (28%) respectively.

Adolescent↗
PubMed1990

Development of a medical-psychiatric program within the private sector. Potential problems and strategies for their resolution.

Recent reports regarding the development of combined medical-psychiatric units have primarily involved units operated under the auspices of academic medical centers. Almost no published information is available regarding the fiscal, administrative, or clinical feasibility of operating such programs within the context of the private community hospital setting. This article outlines the organization and development of such a private unit and discusses the various medical, administrative, political, and financial considerations that must be evaluated in planning for the successful operation of medical-psychiatric units within the private sector.

Cost Control↗
PubMed1989

Restructuring the Federal Employees Health Benefits Program: the private sector option.

The Federal Employees Health Benefits Program (FEHBP) needs to contain its costs. This paper recommends reforms of FEHBP that would substantially lower costs. As a first step, FEHBP should offer each employee a high and low option from a single conventional carrier, plus several HMO alternatives. FEHBP's practice of offering employees a choice of conventional carriers is virtually unheard of in the private sector. Cost control is more likely when carriers compete for employment groups rather than for individual employees. In addition, my analysis suggests that FEHBP should self-insure, competitively select third-party administrators (TPAs), one for each region of the country, aggressively manage program costs through preadmission certification and DRGs, and allow Medicare-eligible annuitants to enroll in Medicare HMOs and receive the government contribution. All of these reforms have been successfully implemented elsewhere, either by private employers or state or federal governments. These reforms would yield savings of at least $500 million annually for taxpayers and additional savings for federal employees.

Cost Control↗
PubMed1992

Testing for HIV in the public and private sectors--Oregon, 1988-1991.

Counseling and testing persons for human immunodeficiency virus (HIV) infection is a key component of the public health strategy for reducing transmission of HIV in the United States (1,2). In 1991, the federal government allocated $100 million to state and local health agencies to provide counseling and testing programs in public clinics for at-risk persons, including persons who may not otherwise use public health services. However, the relative contribution of HIV-testing in public clinics to HIV testing in the private sector is unknown. To compare HIV testing in Oregon public clinics to overall HIV testing, the Health Division (HD) of the Oregon Department of Human Resources, in cooperation with CDC, reviewed data collected from September 1, 1988, through August 31, 1991, on public and private HIV testing in Oregon. This report summarizes findings for HIV testing rates and assesses the importance of publicly funded testing in identifying HIV-seropositive persons.

Adolescent↗
PubMed1989

Private-sector care for chronically mentally ill individuals. The more things change, the more they stay the same.

Two profit-making industries, nursing homes and board-and-care homes, care for about one million chronic mental patients. This care is primarily custodial and probably not very different from the care patients received in the public sector prior to deinstitutionalization. Moreover, certain characteristics of privately owned facilities encourage poor patient care so as to maximize profit. The problem could be ameliorated if chronic mental patients were strong and informed consumers or if the public sector strongly regulated proprietary care. However, neither of these two conditions now hold. Perhaps the apparent difficulties in significantly improving care for chronically mentally ill individuals despite seemingly major changes in policy reflect a fundamental problem in overall social policy--a reluctance to care for chronically indigent individuals of all kinds.

Chronic Disease↗