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Sample records for private pay patients

  1. Private Schools and the Willingness to Pay for Public Schooling

    ERIC Educational Resources Information Center

    Brasington, David M.

    2007-01-01

    Households pay a premium to live in houses assigned to high quality public schools, and the housing market yields information about the demand for public school quality. The current study estimates a two-stage house price hedonic emphasizing the role that private schools play in the willingness to pay for public school quality. The elasticity of…

  2. Private Schools and the Willingness to Pay for Public Schooling

    ERIC Educational Resources Information Center

    Brasington, David M.

    2007-01-01

    Households pay a premium to live in houses assigned to high quality public schools, and the housing market yields information about the demand for public school quality. The current study estimates a two-stage house price hedonic emphasizing the role that private schools play in the willingness to pay for public school quality. The elasticity of…

  3. Private Pay Progression. Research Brief. Edition 6

    ERIC Educational Resources Information Center

    Anders, Jake

    2015-01-01

    While the issue of access to the professions is relatively well understood, there is limited understanding of the impact of entrants' backgrounds on success once in graduate employment. The research looks at the way social background continues to influence graduate pay and career progression once in professional employment. Key findings include:…

  4. Private Pay Progression. Research Brief. Edition 6

    ERIC Educational Resources Information Center

    Anders, Jake

    2015-01-01

    While the issue of access to the professions is relatively well understood, there is limited understanding of the impact of entrants' backgrounds on success once in graduate employment. The research looks at the way social background continues to influence graduate pay and career progression once in professional employment. Key findings include:…

  5. Beyond price: individuals' accounts of deciding to pay for private healthcare treatment in the UK

    PubMed Central

    2012-01-01

    Background Delivering appropriate and affordable healthcare is a concern across the globe. As countries grapple with the issue of delivering healthcare with finite resources and populations continue to age, more health-related care services or treatments may become an optional 'extra' to be purchased privately. It is timely to consider how, and to what extent, the individual can act as both a 'patient' and a 'consumer'. In the UK the majority of healthcare treatments are free at the point of delivery. However, increasingly some healthcare treatments are being made available via the private healthcare market. Drawing from insights from healthcare policy and social sciences, this paper uses the exemplar of private dental implant treatment provision in the UK to examine what factors people considered when deciding whether or not to pay for a costly healthcare treatment for a non-fatal condition. Methods Qualitative interviews with people (n = 27) who considered paying for dental implants treatments in the UK. Data collection and analysis processes followed the principles of the constant comparative methods, and thematic analysis was facilitated through the use of NVivo qualitative data software. Results Decisions to pay for private healthcare treatments are not simply determined by price. Decisions are mediated by: the perceived 'status' of the healthcare treatment as either functional or aesthetic; how the individual determines and values their 'need' for the treatment; and, the impact the expenditure may have on themselves and others. Choosing a private healthcare provider is sometimes determined simply by personal rapport or extant clinical relationship, or based on the recommendation of others. Conclusions As private healthcare markets expand to provide more 'non-essential' services, patients need to develop new skills and to be supported in their new role as consumers. PMID:22397733

  6. The courtship of the paying patient.

    PubMed

    Braithwaite, S S

    1993-01-01

    This article argues for a prohibition on the courtship of the paying patient by individual practitioners, groups, institutions, and corporations. Our society fails to provide universal access to health care. While we await societal resolution, the private provider retains partial responsibility for addressing issues of distributive justice. All private physicians, groups, institutions, and corporations should offer a fair share of underreimbursed, nonemergency care. If economic survival or beneficent economic commitments of a provider are at risk, the provider may explicitly limit underreimbursed services by a rational system of accepting or rejecting nonemergency, indigent patients. The system should be one that, if implemented by all providers, would meet regional societal needs. One might analyze the issue of courtship of the paying patient as a problem of distributive justice. The desire of paying patients to receive personalized care or nonmedical amenities and to have the freedom to buy the best possible medical care, and the economic interests of the providers (the desire of the already affluent provider to seek further gain and growth, the need of a threatened provider to survive, and the dependency of educational institutions on patient payments) all conflict with distributive justice. The marketing interest of providers conflicts with the greater need of the poor to receive information about health, and it conflicts with public need for protection against misleading solicitation. The possibly higher per capita cost of treating the poor, along with possibly lower success rates, create a conflict between cost-effective allocation of limited resources, on the one hand, and egalitarian distributive justice, on the other. The competitive market principle may even protect, rather than defeat, the principle of justice. The author, however, writing from the point of view of the physician, has analyzed the question in terms of a conflict between the economic

  7. One-stop shop. The houseworks experience: redefining innovations in private-pay home care.

    PubMed

    Cohen, Andrea

    2005-07-01

    For more than thirty years, forward-looking gerontologists and entrepreneurs have realized the potential market for private-pay home care services and have proposed creative approaches to meeting the projected demand. Innovative ventures ranging from "life care at home" to "virtual retirement communities" have been launched throughout the country in an attempt to meet a growing need while responding to an unprecedented business opportunity. While these ventures reflect intriguing ideas, the story of an unconventional private-pay home care company in Greater Boston suggests that innovation and creativity are most needed to transform the fundamentals of private-pay service delivery: responsiveness, reliability, customer service, and sales.

  8. Public versus Private University Presidents Pay Levels and Structure

    ERIC Educational Resources Information Center

    Monks, James

    2007-01-01

    Existing studies examine the determinants of private university presidents' compensation, but ignore recent earnings differentials between public and private university presidents. This paper estimates that public university presidents earn approximately 50 percent less than comparable private university presidents. This salary discount is robust…

  9. 32 CFR 728.14 - Pay patients.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Pay patients. 728.14 Section 728.14 National... § 728.14 Pay patients. Care is provided on a reimbursable basis to: Coast Guard active duty officers..., patient administration personnel will initiate the collection action process in subpart J in each...

  10. 32 CFR 728.36 - Pay patients.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Pay patients. 728.36 Section 728.36 National... Services § 728.36 Pay patients. Care is provided on a reimbursable basis to retired Coast Guard officers... such personnel. Accordingly, patient administration personnel will follow the provisions of subpart...

  11. Factors Related to University Presidents' Pay: An Examination of Private Colleges and Universities.

    ERIC Educational Resources Information Center

    Tang, Thomas Li-Ping; Tang, David Shin-Hsiung; Tang, Cindy Shin-Yi

    2000-01-01

    Examined institutional characteristics and market- related factors to predict university presidents' pay, benefits, and total compensation at 190 private colleges and universities. Found that presidents' pay was related to the expenditures, type of institution, existence of professional schools, and academic reputation ranking, while benefits…

  12. Gender Differences in Pay among Recent Graduates: Private Sector Employees in Ireland

    ERIC Educational Resources Information Center

    Russell, Helen; Smyth, Emer; O'Connell, Philip J.

    2010-01-01

    In this paper we seek to investigate the role of different factors in accounting for the differences in earnings among recent graduates working in the private sector in Ireland. Three years after graduation there is a pay gap of 8 per cent in hourly wages between male and female graduates in the private sector and a 4 per cent non-significant gap…

  13. Pay and Perks Creep Up for Private-College Presidents

    ERIC Educational Resources Information Center

    Stripling, Jack

    2012-01-01

    Private-college presidents often draw scrutiny for their hefty compensation packages, but most of them have a ready comeback: I could make a lot more money in the corporate world. While this statement is surely sometimes true, it is also true that some of the nation's top-paid presidents continue to receive perks that their corporate counterparts…

  14. Pay and Perks Creep Up for Private-College Presidents

    ERIC Educational Resources Information Center

    Stripling, Jack

    2012-01-01

    Private-college presidents often draw scrutiny for their hefty compensation packages, but most of them have a ready comeback: I could make a lot more money in the corporate world. While this statement is surely sometimes true, it is also true that some of the nation's top-paid presidents continue to receive perks that their corporate counterparts…

  15. Minority households’ willingness to pay for public and private wildfire risk reduction in Florida

    Treesearch

    Armando González-Cabán; José J. Sánchez

    2017-01-01

    The purpose of this work is to estimate willingness to pay (WTP) for minority (African-American and Hispanic) homeowners in Florida for private and public wildfire risk-reduction programs and also to test for differences in response between the two groups. A random parameter logit and latent class model allowed us to determine if there is a difference in wildfire...

  16. 32 CFR 728.14 - Pay patients.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 5 2012-07-01 2012-07-01 false Pay patients. 728.14 Section 728.14 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Members of the Uniformed Services on Active Duty...

  17. Willingness to pay for private and public road safety in stated preference studies: why the difference?

    PubMed

    Svensson, Mikael; Vredin Johansson, Maria

    2010-07-01

    Estimates of the willingness to pay (WTP) for a mortality risk reduction can be used to calculate the value of a statistical life, which is a major component in many economic evaluations of environmental and safety policies. Previous research on the WTP for risk reductions using stated preference methods have found that the mean WTP for public risk reductions is significantly smaller compared to the mean WTP for private risk reductions of equal magnitude. Hence, the use of a private or public scenario in stated preference studies of e.g. environmental or safety policies may strongly determine the outcome of the economic evaluation. In this paper we use a stated preference survey to show that WTP for a private risk reduction is three times higher compared to a public risk reduction and a significant part of the difference can be explained by respondents' attitudes towards privately and publicly provided goods in general.

  18. Paying pharmacists for patient care

    PubMed Central

    Houle, Sherilyn K. D.; Grindrod, Kelly A.; Chatterley, Trish; Tsuyuki, Ross T.

    2014-01-01

    Background: Expansion of scope of practice and diminishing revenues from dispensing are requiring pharmacists to increasingly adopt clinical care services into their practices. Pharmacists must be able to receive payment in order for provision of clinical care to be sustainable. The objective of this study is to update a previous systematic review by identifying remunerated pharmacist clinical care programs worldwide and reporting on uptake and patient care outcomes observed as a result. Methods: Literature searches were performed in several databases, including MEDLINE, Embase and International Pharmaceutical Abstracts, for papers referencing remuneration, pharmacy and cognitive services. Searches of the grey literature and Internet were also conducted. Papers and programs were identified up to December 2012 and were included if they were not reported in our previous review. One author performed data abstraction, which was independently reviewed by a second author. All results are presented descriptively. Results: Sixty new remunerated programs were identified across Canada, the United States, Europe, Australia and New Zealand, ranging in complexity from emergency contraception counseling to minor ailments schemes and comprehensive medication management. In North America, the average fee provided for a medication review is $68.86 (all figures are given in Canadian dollars), with $23.37 offered for a follow-up visit and $15.16 for prescription adaptations. Time-dependent fees were reimbursed at $93.60 per hour on average. Few programs evaluated uptake and outcomes of these services but, when available, indicated slow uptake but improved chronic disease markers and cost savings. Discussion: Remuneration for pharmacists’ clinical care services is highly variable, with few programs reporting program outcomes. Programs and pharmacists are encouraged to examine the time required to perform these activities and the outcomes achieved to ensure that fees are adequate to

  19. 32 CFR 728.113 - Categories of pay patients.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Categories of pay patients. 728.113 Section 728.113 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND... Pay Patients § 728.113 Categories of pay patients. The categories of patients for whom...

  20. Faculty and Administrator Perspectives of Merit Pay Compensation Systems in Private Higher Education: A Mixed Methods Analysis

    ERIC Educational Resources Information Center

    Power, Anne L.

    2013-01-01

    The purpose of this explanatory sequential mixed methods study is to explore faculty and administrator perspectives of faculty merit pay compensation systems in private, higher education institutions. The study focuses on 10 small, private, four-year institutions which are religiously affiliated. All institutions are located in Nebraska, Iowa, and…

  1. Study of patients who chose private health care for treatment.

    PubMed Central

    Higgins, J; Wiles, R

    1992-01-01

    A questionnaire survey was carried out in 1991 in Wessex regional health authority of a sample of private patients having inpatient treatment in eight independent hospitals, and in pay beds in three National Health Service hospitals. A total of 649 patients replied (response rate 60.7%). Sixty respondents to the questionnaire were also interviewed. The aim of the study was to discover which groups of people chose private care rather than using the NHS, and why. In view of the current emphasis on consumerism in health care, the study also aimed to examine how patients exercised choice in a market situation and how well informed they were when they did so. The questionnaire asked about the role and influence of the general practitioner in patients' decisions to use private health care for treatment. The largest group of respondents were in the 36-50 years age group (34.2%). Of the respondents 59.9% were women, 54.1% were in social class 2 and 77.3% were married or cohabiting. The most common reason for using private health care for treatment was to avoid NHS waiting lists (61.5% of respondents) although they did not necessarily know how long that wait would have been. Patients sought their general practitioner's opinion about whether to use private health care in 187 cases (28.8%). The majority of the 649 patients (71.2%) had decided to use private health care before consulting the general practitioner. However, patients were influenced by their general practitioner's advice on the choice of consultant and choice of hospital.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1457153

  2. Willingness to pay for private primary care services in Hong Kong: are elderly ready to move from the public sector?

    PubMed

    Liu, Su; Yam, Carrie H K; Huang, Olivia H Y; Griffiths, Sian M

    2013-10-01

    How to provide better primary care and achieve the right level of public-private balance in doing so is at the centre of many healthcare reforms around the world. In a healthcare system like Hong Kong, where inpatient services are largely funded through general taxation and ambulatory services out of pocket, the family doctor model of primary care is underdeveloped. Since 2008, the Government has taken forward various initiatives to promote primary care and encourage more use of private services. However, little is known in Hong Kong or elsewhere about consumers' willingness to pay (WTP) for private services when care is available in the public sector. This study assessed willingness of the Hong Kong elderly to pay for specific primary care and preventive services in the private sector, through a cross-sectional in-person questionnaire survey and focus group discussions among respondents. The survey revealed that the WTP for private services in general was low among the elderly; particularly, reported WTP for chronic conditions and preventive care both fell below the current market prices. Sub-group analysis showed higher WTP among healthier and more affluent elderly. Among other things, concerns over affordability and uncertainty (of price and quality) in the private sector were associated with this low level of WTP. These results suggest that most elderly, who are heavy users of public health services but with limited income, may not use more private services without seeing significant reduction in price. Financial incentives for consumers alone may not be enough to promote primary care or public-private partnership. Public education on the value of prevention and primary care, as well as supply-side interventions should both be considered. Hong Kong's policy-making process of the initiative studied here may also provide lessons for other countries with ongoing healthcare reforms.

  3. Factors affecting the willingness to pay for implants: A study of patients in Riyadh, Saudi Arabia

    PubMed Central

    Al Garni, Bishi; Pani, Sharat Chandra; AlMaaz, Adel; Al Qeshtaini, Ehsan; Abu-Haimed, Hamad; Al Sharif, Khalid

    2012-01-01

    Background: One of the factors that dissuade patients needing tooth replacement from choosing dental implants is the prohibitive cost. Willingness to pay (WTP) is a useful tool to determine the ideal cost of an expensive procedure. Aim: The aim of this study was to study the factors that influence the willingness to pay (WTP) among patients attending a private clinic and compare them to those attending a government setup. Materials and Methods: A total of 100 patients (38 male, 62 female) who had one or more missing teeth were presented with different cost-benefit scenarios and then asked if they were willing to pay the median cost of a single implant in Riyadh city. The mean WTP price was compared using the one way-ANOVA, factors which could possibly influence patients’ WTP were grouped together in a Binomial logistic regression model. Results: Of the 100 individuals surveyed 67% said they would be willing to pay the median price for the placement of an implant. A comparison of socio-demographic factors showed that significant differences were found between gender, income groups and setting of the clinic in the mean WTP price of the patients (P < 0.05). We also found that there was a significant difference in the mean WTP price between groups with regard to the area of the missing tooth, the patients’ perception of their oral health and the their desire to want an implant (P < 0.05). Conclusion: The majority of the patients surveyed were willing to pay the median price for an implant. Willingness to pay (WTP) is a multifactorial variable which is significantly influenced by the income of the patient, the setting of the clinic and the gender; the most significant factor being the acceptability of the implant to the patient. PMID:23559948

  4. Are the affluent prepared to pay for the planet? Explaining willingness to pay for public and quasi-private environmental goods in Switzerland

    PubMed Central

    Liebe, Ulf

    2010-01-01

    A large number of ‘environmental justice’ studies show that wealthier people are less affected by environmental burdens and also consume more resources than poorer people. Given this double inequity, we ask, to what extent are affluent people prepared to pay to protect the environment? The analyses are couched within the compensation/affluence hypothesis, which states that wealthier persons are able to spend more for environmental protection than their poorer counterparts. Further, we take into account various competing economic, psychological and sociological determinants of individuals’ willingness to pay (WTP) for both public environmental goods (e.g., general environmental protection) and quasi-private environmental goods (e.g., CO2-neutral cars). Such a comprehensive approach contrasts with most other studies in this field that focus on a limited number of determinants and goods. Multivariate analyses are based on a general population survey in Switzerland (N = 3,369). Although income has a positive and significant effect on WTP supporting the compensation hypothesis, determinants such as generalized interpersonal trust that is assumed to be positively associated with civic engagement and environmental concern prove to be equally important. Moreover, we demonstrate for the first time that time preferences can considerably influence survey-based WTP for environmental goods; since investments in the environment typically pay off in the distant future, persons with a high subjective discount rate are less likely to commit. PMID:20835384

  5. Paying for Quality? Associations between Private School Income, Performance and Use of Resources

    ERIC Educational Resources Information Center

    Davies, Peter; Davies, Neil M.

    2014-01-01

    Education policy in England has explicitly aimed to remodel state schools in the image of independent, private, schools. However, the body of research evidence on the operation of private schools is very small. Critics have frequently argued that, in contrast to state schools, private schools use resources efficiently because their autonomy gives…

  6. Paying for Quality? Associations between Private School Income, Performance and Use of Resources

    ERIC Educational Resources Information Center

    Davies, Peter; Davies, Neil M.

    2014-01-01

    Education policy in England has explicitly aimed to remodel state schools in the image of independent, private, schools. However, the body of research evidence on the operation of private schools is very small. Critics have frequently argued that, in contrast to state schools, private schools use resources efficiently because their autonomy gives…

  7. Two Essays in Applied Economics: Pay-As-You-Go Auto Insurance and Privatized Military Housing

    DTIC Science & Technology

    2004-06-01

    Housing Privatization Initiative Lessons Learned Program : An Analysis. p. 51. 91 Military housing is now referred to as privatized housing as of 2004...NPS. Military Housing Privatization Initiative Lessons Learned Program : An Analysis. Else, D. H. (2001, July). CRS Report for Congress

  8. Home care without Medicare: the patient-pay alternative.

    PubMed

    Jackson, J A; Schutzmann, P J

    2001-10-01

    Home care agencies can develop a robust, patient-paid service. The home care community now has an excellent opportunity to develop the largely untapped market for privately paid, home-based, long-term care management.

  9. Patient preference and willingness to pay for knee osteoarthritis treatments

    PubMed Central

    Posnett, John; Dixit, Sanjeev; Oppenheimer, Brooks; Kili, Sven; Mehin, Nazanin

    2015-01-01

    Purpose To review treatments for osteoarthritis of the knee (OAK) received by patients across five European countries, and to obtain patients’ perceptions and willingness to pay for current treatments. Patients and methods A prospective, internet-based, double-blind survey of adults with OAK was conducted in France, Germany, Italy, Spain, and the United Kingdom. The questionnaire included questions about diagnosis, treatment history, and perceptions of OAK treatments, followed by a discrete choice-based conjoint exercise to identify preferred attributes of OAK treatments, evaluating 14 sets of four unbranded products. Results Two thousand and seventy-three patients with self-reported OAK completed the survey; 17.4% of patients rated their knee pain as drastically affecting their ability to perform normal daily activities, and 39.3% of employed patients reported that they had lost work time because of OAK. The most common treatments were exercise (69.7%), physical therapy (68.2%), and nonprescription oral pain medication (73.9%). Treatments perceived as most effective were: viscosupplement injections (74.1%), narcotics (67.8%), and steroid injection (67.6%). Patient co-pay, duration of pain relief, and type of therapy exhibited the largest impact on patient preference for OAK treatments. The average patient was willing to pay €35 and €64 more in co-pay for steroid and viscosupplement injections, respectively, over the cost of oral over-the-counter painkillers (per treatment course, per knee) (each P<0.05). Conclusion OAK is a debilitating condition that affects normal daily activities. In general, treatments most commonly offered to patients are not those perceived as being the most effective. Patients are willing to pay a premium for treatments that they perceive as being more effective and result in longer-lasting pain relief, and those that can be administered with fewer visits to a physician. PMID:26089650

  10. The Price of Admission: Who Gets into Private School, and How Much Do They Pay?

    ERIC Educational Resources Information Center

    Walton, Nina

    2010-01-01

    I analyze how elementary and secondary private schools decide which students to admit from their applicant pool using mechanism design theory. The problem for an individual private school of who to admit and how much to charge in tuition, is complicated by the existence of peer-effects: the value students place on attending school is increasing…

  11. Dealing with self-pay patients--compassionately.

    PubMed

    Mountford, Gordon J; Smith, J Cathy; Todd, John T

    2005-12-01

    Efforts to collect money should start at the beginning--in preregistration and registration. Hospitals should be firm, but compassionate, about communicating payment responsibilities to self-pay patients. Involving all revenue cycle employees in improving the collection process will gain valuable input and ensure their buy-in.

  12. New Jersey Teacher Salaries Are Comparable to Professional Pay in Private Sector. Issue Brief No. 5

    ERIC Educational Resources Information Center

    Winters, Marcus A.

    2010-01-01

    It is often said that public school teachers are poorly paid. At an average salary of about $60,000 a year, public school teachers in New Jersey take home substantially less pay than do many other college educated professionals. Teachers tend to work fewer hours in a year than do other professionals. Does the widespread assertion that New Jersey's…

  13. Robbing Public to Pay Private? Two Cases of Refinancing Education Infrastructure in Australia

    ERIC Educational Resources Information Center

    Crump, Stephen; Slee, Roger

    2005-01-01

    This paper will explore private sector participation in public sector education in the Australian context, focusing on case studies of Queensland and New South Wales, with reference to developments in other states and territories and internationally. In Australia, most states and territories have PPP policies and key projects include the Southbank…

  14. Wildfire risk management on a landscape with public and private ownership: who pays for protection?

    PubMed

    Busby, Gwenlyn; Albers, Heidi J

    2010-02-01

    Wildfire, like many natural hazards, affects large landscapes with many landowners and the risk individual owners face depends on both individual and collective protective actions. In this study, we develop a spatially explicit game theoretic model to examine the strategic interaction between landowners' hazard mitigation decisions on a landscape with public and private ownership. We find that in areas where ownership is mixed, the private landowner performs too little fuel treatment as they "free ride"-capture benefits without incurring the costs-on public protection, while areas with public land only are under-protected. Our central result is that this pattern of fuel treatment comes at a cost to society because public resources focus in areas with mixed ownership, where local residents capture the benefits, and are not available for publicly managed land areas that create benefits for society at large. We also find that policies that encourage public expenditures in areas with mixed ownership, such as the Healthy Forest Restoration Act of 2003 and public liability for private values, subsidize the residents who choose to locate in the high-risk areas at the cost of lost natural resource benefits for others.

  15. Public and/or private health care: Tuberculosis patients' perspectives in Myanmar

    PubMed Central

    Saw, Saw; Manderson, Lenore; Bandyopadhyay, Mridula; Sein, Than Tun; Mon, Myo Myo; Maung, Win

    2009-01-01

    Background Tuberculosis is a major public health problem in Myanmar as in other developing countries. About 73% of TB patients seek care at private general practitioners' clinics before presenting to the public TB centre, raising questions about how best to prevent transmission and maintain treatment regimens. Method The study was conducted in two townships in Yangon Division in Myanmar in 2004, and examined treatment seeking behaviour of TB patients and their views towards public and private health care services. This was an exploratory descriptive study. Both quantitative and qualitative research methods were employed in data collection from TB patients, health care professionals, and members of various agencies involved in TB Control Programme. Results A considerable delay was found between the onset of symptoms of TB and seeking treatment (five days – two months). General practitioners were the first point of contact in all cases. Old TB patients influenced the treatment seeking behaviour and choice of treatment clinics of new TB patients. Most patients viewed the public health sector as a place to obtain free treatment and the private sector as a fee-paying, convenient and better place to seek treatment. Conclusion The involvement of private general practitioners is crucial for effective TB control in Myanmar. The selection of GPs for partnership with the public sector is vital to the success of public-private partnership in controlling TB. PMID:19638237

  16. Natural tooth preservation versus extraction and implant placement: patient preferences and analysis of the willingness to pay.

    PubMed

    Re, D; Ceci, C; Cerutti, F; Fabbro, M Del; Corbella, S; Taschieri, S

    2017-03-24

    Objectives The aim of this study was to evaluate the patients' willingness to pay (WTP) values and preference for the treatment of a tooth with very poor prognosis, among two options: root canal therapy and crown positioning or tooth extraction, implant insertion and crown positioning.Methods A total of 103 patients were recruited from a private dental clinic and interviewed. A questionnaire measured individuals' preferences among the two alternative treatments for a tooth with poor prognosis and the maximum amount of money they would be willing to pay for their choice with a starting bid of [euro]2,000 in [euro]100 increment/decrement. Demographic data, patient choice, median values and WTP association with socio-demographic factors (Student ttest and one-way ANOVA) and correlation between variables (Pearson chi-square test) were revealed.Results Seventy-six percent of patients expressed a preference for root canal therapy, while the remaining 24% chose the dental surgery. A fair agreement between previous experience and current therapeutic choice was found (P = 0.0001). The WTP median value was [euro]2,000 and 46% of participants would pay an additional sum of money for the therapy (median: [euro]300). The preferred treatment was influenced by previous experience, but no association was found between WTP values and socio-demographic factors.Conclusion Patients tend to prefer a conservative approach for the treatment of a tooth with poor prognosis and are willing to pay an additional fee to receive their treatment choice.

  17. Private and public patients in public hospitals in Australia.

    PubMed

    Shmueli, Amir; Savage, Elizabeth

    2014-04-01

    The nature of the private-public mix in health insurance and in health care is a major issue in most health systems. To compare the hospitalization characteristics of private and public patients hospitalized in public hospitals. We focused on planned, overnight and same-day admissions, discharged during 2004-2005 from the public New South Wales hospitals, and run fixed-effects regressions in order to identify the effect of accommodation status (private/public) on the hospitalization characteristics. Private patients have one third less waiting days than public patients, and they are assigned higher urgency of admission. Length of stay and length of visit are both unrelated to the accommodation status, however, private patients tend to have more hours in ICU and more procedures performed during the hospitalization. In-hospital mortality and the number of transfers (wards) are not affected by the accommodation status. Private patients are treated differently than public patients in public hospitals, reinforcing the private health insurance-related inequity in inpatient care identified by others. Two health policy issues emerge from the findings: the role of private health insurance in the Australian socialized medicine system, and in particular, in the public hospitals; and the way public hospitals are reimbursed for private patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. San Francisco's 'pay or play' employer mandate expanded private coverage by local firms and a public care program.

    PubMed

    Colla, Carrie H; Dow, William H; Dube, Arindrajit

    2013-01-01

    In 2008 San Francisco implemented a pay-or-play employer mandate that required firms operating in the city to provide health insurance coverage for employees or contribute to the city's "public option" health access program, Healthy San Francisco. Using data from our Bay Area Employer Health Benefits Survey, we found that in the first two years after implementation, more employers offered insurance and provided employee health benefit coverage relative to employers outside San Francisco not subject to the mandate. Sixty-seven percent reported in 2009 that they had expanded benefits since 2007. Although 22 percent of firms responding to the survey reported contributing to Healthy San Francisco for some employees, we observed no crowd-out of private insurance. Premium changes between 2007 and 2009 were similar in San Francisco and surrounding areas, but more of the burden of premium contributions in San Francisco shifted from workers to employers. Overall, 64 percent of firms responding to the survey supported the employer mandate. San Francisco's experience indicates that such a mandate is feasible, increases access, and is acceptable to many employers, which bodes well for the national employer mandate that will take effect under the Affordable Care Act in 2014.

  19. High and varying prices for privately insured patients underscore hospital market power.

    PubMed

    White, Chapin; Bond, Amelia M; Reschovsky, James D

    2013-09-01

    Across 13 selected U.S. metropolitan areas, hospital prices for privately insured patients are much higher than Medicare payment rates and vary widely across and within markets, according to a study by the Center for Studying Health System Change (HSC) based on claims data for about 590,000 active and retired nonelderly autoworkers and their dependents. Across the 13 communities, aver­age hospital prices for privately insured patients are about one-and-a-half times Medicare rates for inpatient care and two times what Medicare pays for outpa­tient care. Within individual communities, prices vary widely, with the highest-priced hospital typically paid 60 percent more for inpatient services than the lowest-priced hospital. The price gap within markets is even greater for hospital outpatient care, with the highest-priced hospital typically paid nearly double the lowest-priced hospital. In contrast to the wide variation in hospital prices for pri­vately insured patients across and within markets, prices for primary care physi­cian services generally are close to Medicare rates and vary little within markets. Prices for specialist physician services, however, are higher relative to Medicare and vary more across and within markets. Of the 13 markets, five are in Michigan, which has an unusually concentrated private insurance market, with one insurer commanding a 70-percent market share. Despite the presence of a dominant insurer, almost all Michigan hospi­tals command prices that are higher than Medicare, and some hospitals com­mand prices that are twice what Medicare pays. In the eight markets outside of Michigan, private insurers generally pay even higher hospital prices, with even wider gaps between high- and low-priced hospitals. The variation in hospital and specialist physician prices within communities underscores that some hospitals and physicians have significant market power to command high prices, even in markets with a dominant insurer.

  20. Gender preferences in ObGyn clinic vs private patients.

    PubMed

    Johnson, Amy M; Schnatz, Peter F

    2009-04-01

    To determine whether clinic patients, compared to private practice patients, are more likely to prefer seeing a female physician. Connecticut women were surveyed from August through September 2001, inclusive, about the attributes they desire in an ObGyn provider. Clinic patient responses were analyzed in comparison to private patients. A total of 262 women completed the survey (32 clinic and 232 private practice patients). Demographics of the subgroups differed, as the clinic patients more likely to be younger, not married, and were primarily Hispanic. Clinic patients reported a decreased opportunity to choose the gender of their provider (33.4% vs 62.8%) and were more likely to prefer a female provider (79.3% vs 36.9%). Unlike the private patients, most clinic patients responded that female providers are more knowledgeable and understanding of women's health issues. Clinic patients have a stronger preference for female ObGyn's compared to private patients. Medical students who rotate through outpatient ObGyn clinic's are likely to have different patient encounter experiences than students who spend time in private ObGyn offices.

  1. Patients with personality disorders in private specialist practice.

    PubMed

    Wilberg, Theresa; Kvarstein, Elfrida Hartveit; Røvik, Jan Ole

    2014-12-09

    Private practitioners with contracts with the regional health authorities have an important place among the treatment options provided by the psychiatric specialist health service. Little information is available on the part such specialists in private practice should play in the treatment of patients with personality disorders. This study describes private practitioners' experiences with this patient group and the patients' satisfaction with the treatment. 46 patients were referred to specialists in private practice as part of a treatment study of patients with personality disorders. 26 private practitioners took part. The patient population had extensive problems with a high level of symptoms, interpersonal difficulties and poor work functioning. A follow-up investigation of the patient group was conducted after three years. The therapists answered questionnaires about their own practices and the patient therapy. At the time of the three-year follow-up, a third of the patients were still in therapy. The median number of therapy sessions was 43 (range 2-258 hours). On the whole, the therapists found the treatments interesting from a professional point of view, and the majority of the patients were satisfied with the therapy. Some treatments were complicated by irregular attendance, substance abuse, risk of suicide or other serious symptoms. 29 % of the patients were dissatisfied with the therapy, particularly patients with substance abuse. Psychotherapy with a specialist in private practice with a contract with regional health authorities allows for flexibility with respect to the duration of treatment for patients with a personality disorder. Substance abuse problems and acting-out behaviour present a challenge to treatment which may be difficult to handle in private practice. Treatment in private specialist practice presupposes the possibility of acute hospitalisation or access to other health services in the event of crises and complicating substance abuse.

  2. Willingness to pay as patient preference to bariatric surgery

    PubMed Central

    Khawali, Cristina; Ferraz, Marcos B.; Zanella, Maria T.; Ferreira, Sandra R. G.

    2014-01-01

    Abstract Background  An obesity epidemic is spreading worldwide. In addition to comorbidities, social and emotional problems contribute to reduce the quality of life (QoL) of obese people. Considering the heterogeneity of outcomes from clinical and surgical approaches, it is recommended that severely obese patients participate in their treatment decisions. This study evaluated preferences of severely obese patients for obesity surgical treatment using the willingness to pay (WTP) and to assess the impact of the presence of some clinical disorders, socioeconomic conditions and QoL on their decisions. Methods  The selected patients were invited to answer the WTP questionnaire using two formats of contingent valuation questions: dichotomous choice (yes/no) and a bidding game. The answers were correlated with clinical features, QoL assessed by the SF‐36 and the Moorehead‐Ardelt Quality of Life Questionnaire II, Brazilian socioeconomic classification, and family and personal incomes. Results  The group of patients who accepted the first bid was older and had higher frequency of sleep apnoea when compared to those who rejected the offer. A significant correlation between the bidding game value and family income was found (r = 0.28; P < 0.02). In the logistic regression model, socioeconomic classification and sleep apnoea were shown to be independently associated with acceptance the bid. Conclusions  Sleep apnoea was the comorbidity that most influenced the acceptance in dichotomous choice for bariatric surgery, probably due to the deleterious effects on daily activities induced by sleep disturbances. Our findings also suggest that the frequency of surgical procedures is below the preference of the obese population in Brazil. PMID:22070389

  3. The benefits, risks and costs of privacy: patient preferences and willingness to pay.

    PubMed

    Trachtenbarg, David E; Asche, Carl; Ramsahai, Shweta; Duling, Joy; Ren, Jinma

    2017-05-01

    Multiple surveys show that patients want medical privacy; however, there are costs to maintaining privacy. There are also risks if information is not shared. A review of previous surveys found that most surveys asked questions about patient's privacy concerns and willingness to share their medical information. We found only one study that asked about sharing medical information for better care and no survey that asked patients about the risk, cost or comparison between medical privacy and privacy in other areas. To fill this gap, we designed a survey to: (1) compare medical privacy preferences to privacy preferences in other areas; (2) measure willingness to pay the cost of additional privacy measures; and (3) measure willingness to accept the risks of not sharing information. A total of 834 patients attending physician offices at 14 sites completed all or part of an anonymous questionnaire. Over 95% of patients were willing to share all their medical information with their treating physicians. There was no difference in willingness to share between primary care and specialty sites including psychiatry and an HIV clinic. In our survey, there was no difference in sharing preference between standard medical information and information with additional legal protections including genetic testing, drug/alcohol treatment and HIV results. Medical privacy was ranked lower than sharing social security and credit card numbers, but was deemed more private than other information including tax returns and handgun purchases. There was no statistical difference for any questions by site except for HIV/AIDS clinic patients ranking privacy of the medical record more important than reducing high medical costs and risk of medical errors (p < .05). Most patients were willing to spend a modest amount of additional time for privacy, but few were willing to pay more for additional medical privacy. Most patients were unwilling to take on additional risks to keep medical information

  4. Patients as healthcare consumers in the public and private sectors: a qualitative study of acupuncture in the UK.

    PubMed

    Bishop, Felicity L; Barlow, Fiona; Coghlan, Beverly; Lee, Philippa; Lewith, George T

    2011-05-27

    The aim of this study was to compare patients' experiences of public and private sector healthcare, using acupuncture as an example. In the UK, acupuncture is popular with patients, is recommended in official guidelines for low back pain, and is available in both the private sector and the public sector (NHS). Consumerism was used as a theoretical framework to explore patients' experiences. Semi-structured face-to-face interviews were conducted in 2007-8 with a purposive sample of 27 patients who had recently used acupuncture for painful conditions in the private sector and/or in the NHS. Inductive thematic analysis was used to develop themes that summarised the bulk of the data and provided insights into consumerism in NHS- and private practice-based acupuncture. Five main themes were identified: value for money and willingness to pay; free and fair access; individualised holistic care: feeling cared for; consequences of choice: empowerment and vulnerability; and "just added extras": physical environment. Patients who had received acupuncture in the private sector constructed detailed accounts of the benefits of private care. Patients who had not received acupuncture in the private sector expected minimal differences from NHS care, and those differences were seen as not integral to treatment. The private sector facilitated consumerist behaviour to a greater extent than did the NHS, but private consumers appeared to base their decisions on unreliable and incomplete information. Patients used and experienced acupuncture differently in the NHS compared to the private sector. Eight different faces of consumerist behaviour were identified, but six were dominant: consumer as chooser, consumer as pragmatist, consumer as patient, consumer as earnest explorer, consumer as victim, and consumer as citizen. The decision to use acupuncture in either the private sector or the NHS was rarely well-informed: NHS and private patients both had misconceptions about acupuncture in the

  5. Patients as healthcare consumers in the public and private sectors: a qualitative study of acupuncture in the UK

    PubMed Central

    2011-01-01

    Background The aim of this study was to compare patients' experiences of public and private sector healthcare, using acupuncture as an example. In the UK, acupuncture is popular with patients, is recommended in official guidelines for low back pain, and is available in both the private sector and the public sector (NHS). Consumerism was used as a theoretical framework to explore patients' experiences. Methods Semi-structured face-to-face interviews were conducted in 2007-8 with a purposive sample of 27 patients who had recently used acupuncture for painful conditions in the private sector and/or in the NHS. Inductive thematic analysis was used to develop themes that summarised the bulk of the data and provided insights into consumerism in NHS- and private practice-based acupuncture. Results Five main themes were identified: value for money and willingness to pay; free and fair access; individualised holistic care: feeling cared for; consequences of choice: empowerment and vulnerability; and "just added extras": physical environment. Patients who had received acupuncture in the private sector constructed detailed accounts of the benefits of private care. Patients who had not received acupuncture in the private sector expected minimal differences from NHS care, and those differences were seen as not integral to treatment. The private sector facilitated consumerist behaviour to a greater extent than did the NHS, but private consumers appeared to base their decisions on unreliable and incomplete information. Conclusions Patients used and experienced acupuncture differently in the NHS compared to the private sector. Eight different faces of consumerist behaviour were identified, but six were dominant: consumer as chooser, consumer as pragmatist, consumer as patient, consumer as earnest explorer, consumer as victim, and consumer as citizen. The decision to use acupuncture in either the private sector or the NHS was rarely well-informed: NHS and private patients both had

  6. 32 CFR 728.113 - Categories of pay patients.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ....113 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Initiating Collection Action on...) Nationals and Their Dependents. (e) Secretarial designees not exempted from paying. (f) Others. (1)...

  7. 32 CFR 728.113 - Categories of pay patients.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ....113 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Initiating Collection Action on...) Nationals and Their Dependents. (e) Secretarial designees not exempted from paying. (f) Others. (1)...

  8. 32 CFR 728.113 - Categories of pay patients.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ....113 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Initiating Collection Action on...) Nationals and Their Dependents. (e) Secretarial designees not exempted from paying. (f) Others. (1)...

  9. 32 CFR 728.113 - Categories of pay patients.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ....113 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Initiating Collection Action on...) Nationals and Their Dependents. (e) Secretarial designees not exempted from paying. (f) Others. (1)...

  10. Patient education: a potential marketing tool for the private physician.

    PubMed

    Van Doren, D C; Blank, K M

    1992-03-01

    To keep pace with increasing competition, the private physician is encouraged to consider a patient education program as a marketing tool. Meeting the educational needs of patients is presented as an opportunity to create a trusting environment in the practice, enhance the doctor-patient relationship, and increase the active role of the patient in the health care process. A management model is proposed for successfully planning, organizing, staffing, leading, and controlling the patient education program.

  11. College CFO's Outpace Other Leaders in Pay Raises: Business Leaders Got 13.8% Median Increase at Private Institutions

    ERIC Educational Resources Information Center

    June, Audrey Williams

    2007-01-01

    Chief financial officers at the nation's private colleges have bigger workloads than ever before, and in return, many are taking home much larger paychecks. A "Chronicle" survey of 103 private doctoral institutions shows that between 2003 and 2005, the median compensation package for the top financial position, which includes such titles as vice…

  12. College CFO's Outpace Other Leaders in Pay Raises: Business Leaders Got 13.8% Median Increase at Private Institutions

    ERIC Educational Resources Information Center

    June, Audrey Williams

    2007-01-01

    Chief financial officers at the nation's private colleges have bigger workloads than ever before, and in return, many are taking home much larger paychecks. A "Chronicle" survey of 103 private doctoral institutions shows that between 2003 and 2005, the median compensation package for the top financial position, which includes such titles as vice…

  13. Motivational Factors of Pay-for-Performance Plans in Educational Institutions: A Study of Select Private, Faith-Based Schools

    ERIC Educational Resources Information Center

    Wrobbel, Paul H.

    2009-01-01

    In the United States there is considerable focus on the need for continuous improvement in the quality of schools, including student achievement and teacher performance. Performance-based pay has been repeatedly suggested as a way to improve teaching in school systems. Therefore, a more thorough understanding of the differences in the perceptions…

  14. Motivational Factors of Pay-for-Performance Plans in Educational Institutions: A Study of Select Private, Faith-Based Schools

    ERIC Educational Resources Information Center

    Wrobbel, Paul H.

    2009-01-01

    In the United States there is considerable focus on the need for continuous improvement in the quality of schools, including student achievement and teacher performance. Performance-based pay has been repeatedly suggested as a way to improve teaching in school systems. Therefore, a more thorough understanding of the differences in the perceptions…

  15. Do patients' perceptions exceed their expectations in private healthcare settings?

    PubMed

    Suki, Norazah Mohd; Lian, Jennifer Chiam Chwee; Suki, Norbayah Mohd

    2011-01-01

    The purpose of this paper is to investigate whether patients' perceptions exceed expectations when seeking treatment in private healthcare settings in the Klang Valley Region of Malaysia. A survey was conducted among 191 patients in the Klang Valley Region of Malaysia to measure service quality of the private healthcare setting in Malaysia using SERVQUAL 5 dimensions model by Parasuraman et al. and three additional dimensions of the human element, when it comes to rendering good healthcare services, i.e. courtesy, communication and understanding of customers. The results revealed that the customers' perceptions did not exceed their expectations, as they were dissatisfied with the level of healthcare services rendered by private healthcare settings in that they felt that the waiting time of more than an hour to receive the service was excessive and, when there was a problem, the healthcare provider did not provide a response fast enough. Only eight service quality dimensions were studied. The sample investigated is relatively small, where three private healthcare settings were selected. It is recommended that hospital management should look into highlighted areas for which patients have high expectations. The paper adds to the existing body of research on healthcare service quality, particularly on patients' perceptions and expectations. Survey results should be useful for continuous quality improvement.

  16. Patients’ expectations of private osteopathic care in the UK: a national survey of patients

    PubMed Central

    2013-01-01

    Background Patients’ expectations of osteopathic care have been little researched. The aim of this study was to quantify the most important expectations of patients in private UK osteopathic practices, and the extent to which those expectations were met or unmet. Methods The study involved development and application of a questionnaire about patients’ expectations of osteopathic care. The questionnaire drew on an extensive review of the literature and the findings of a prior qualitative study involving focus groups exploring the expectations of osteopathic patients. A questionnaire survey of osteopathic patients in the UK was then conducted. Patients were recruited from a random sample of 800 registered osteopaths in private practice across the UK. Patients were asked to complete the questionnaire which asked about 51 aspects of expectation, and post it to the researchers for analysis. The main outcome measures were the patients-perceived level of expectation as assessed by the percentage of positive responses for each aspect of expectation, and unmet expectation as computed from the proportion responding that their expectation “did not happen”. Results 1649 sets of patient data were included in the analysis. Thirty five (69%) of the 51 aspects of expectation were prevalent, with listening, respect and information-giving ranking highest. Only 11 expectations were unmet, the most often unmet were to be made aware that there was a complaints procedure, to find it difficult to pay for osteopathic treatment, and perceiving a lack of communication between the osteopath and their GP. Conclusions The findings reflected the complexity of providing osteopathic care and meeting patients’ expectations. The results provided a generally positive message about private osteopathic practice. The study identified certain gaps between expectations and delivery of care, which can be used to improve the quality of care. The questionnaire is a resource for future research

  17. On a policy of transferring public patients to private practice.

    PubMed

    González, Paula

    2005-05-01

    We consider an economy where public hospitals are capacity-constrained, and we analyse the willingness of health authorities to reach agreements with private hospitals to have some of their patients treated there. When physicians are dual suppliers, we show that a problem of cream-skimming arises and reduces the incentives of the health authority to undertake such a policy. We argue that the more dispersed are the severities of the patients, the greater the reduction in the incentives will be. We also show that, despite the patient selection problem, when the policy is implemented it is often the case that health authorities decide a more intensive transfer of patients to private practice.

  18. The Price Professors Pay for Teaching at Public Universities: Private Institutions Offer More and the Gap Is Becoming Unbridgeable.

    ERIC Educational Resources Information Center

    Smallwood, Scott

    2001-01-01

    Describes how salaries at private colleges are growing ever greater than those at public institutions and the fears that important ideals in American higher education may be lost as a result. Includes tables on what professors earn overall and in individual institutions by state. (EV)

  19. Understanding patients' behavioral intentions: evidence from Iran's private hospitals industry.

    PubMed

    Zarei, Ehsan; Arab, Mohammad; Tabatabaei, Seyed Mahmoud Ghazi; Rashidian, Arash; Forushani, Abbas Rahimi; Khabiri, Roghayeh

    2014-01-01

    In the ever-increasing competitive market of private hospital industry, creating a strong relationship with the customers that shapes patients' loyalty has been considered a key factor in obtaining market share. The purpose of this paper is to test a model of customer loyalty among patients of private hospitals in Iran. This cross-sectional study was carried out in Tehran, the capital of the Islamic Republic of Iran in 2010. The study samples composed of 969 patients who were consecutively selected from eight private hospitals. The survey instrument was designed based on a review of the related literature and included 36 items. Data analysis was performed using structural equation modeling. For the service quality construct, three dimensions extracted: Process, interaction, and environment. Both process and interaction quality had significant effects on perceived value. Perceived value along with the process and interaction quality were the most important antecedents of patient overall satisfaction. The direct effect of the process and interaction quality on behavioral intentions was insignificant. Perceived value and patient overall satisfaction were the direct antecedents of patient behavioral intentions and the mediators between service quality and behavioral intentions. Environment quality of service delivery had no significant effect on perceived value, overall satisfaction, and behavioral intentions. Contrary to previous similar studies, the role of service quality was investigated not in a general sense, but in the form of three types of qualities including quality of environment, quality of process, and quality of interaction.

  20. Dumping HIV-infected patients from private practice.

    PubMed Central

    Isaacman, S. H.

    1991-01-01

    Physicians in private practice believe they have the freedom to accept or exclude patients. While this may be true on an individual basis, discrimination towards a patient subpopulation violates professional principles and the law. Once the doctor-patient relationship is formed, physicians may not unilaterally and arbitrarily withdraw from the relationship based solely on the patient's human immunodeficiency virus (HIV) serostatus. This article reviews civil and human rights laws along with professional position statements on excluding individuals from care because of their serostatus. PMID:1766019

  1. Service quality of private hospitals: The Iranian Patients' perspective

    PubMed Central

    2012-01-01

    Background Highly competitive market in the private hospital industry has caused increasing pressure on them to provide services with higher quality. The aim of this study was to determine the different dimensions of the service quality in the private hospitals of Iran and evaluating the service quality from the patients' perspective. Methods A cross-sectional study was conducted between October and November 2010 in Tehran, Iran. The study sample was composed of 983 patients randomly selected from 8 private general hospitals. The study questionnaire was the SERVQUAL questionnaire, consisting of 21 items in service quality dimensions. Results The result of factor analysis revealed 3 factors, explaining 69% of the total variance. The total mean score of patients' expectation and perception was 4.91(SD = 0.2) and 4.02(SD = 0.6), respectively. The highest expectation and perception related to the tangibles dimension and the lowest expectation and perception related to the empathy dimension. The differences between perception and expectation were significant (p < 0.001). There was a significant difference between the expectations scores based on gender, education level, and previous hospitalization in that same hospital. Also, there was a significant difference between the perception scores based on insurance coverage, average length of stay, and patients' health conditions on discharge. Conclusion The results showed that SERVQUAL is a valid, reliable, and flexible instrument to monitor and measure the quality of the services in private hospitals of Iran. Our findings clarified the importance of creating a strong relationship between patients and the hospital practitioners/personnel and the need for hospital staff to be responsive, credible, and empathetic when dealing with patients. PMID:22299830

  2. Service quality of private hospitals: the Iranian patients' perspective.

    PubMed

    Zarei, Asghar; Arab, Mohammad; Froushani, Abbas Rahimi; Rashidian, Arash; Ghazi Tabatabaei, S Mahmoud

    2012-02-02

    Highly competitive market in the private hospital industry has caused increasing pressure on them to provide services with higher quality. The aim of this study was to determine the different dimensions of the service quality in the private hospitals of Iran and evaluating the service quality from the patients' perspective. A cross-sectional study was conducted between October and November 2010 in Tehran, Iran. The study sample was composed of 983 patients randomly selected from 8 private general hospitals. The study questionnaire was the SERVQUAL questionnaire, consisting of 21 items in service quality dimensions. The result of factor analysis revealed 3 factors, explaining 69% of the total variance. The total mean score of patients' expectation and perception was 4.91(SD = 0.2) and 4.02(SD = 0.6), respectively. The highest expectation and perception related to the tangibles dimension and the lowest expectation and perception related to the empathy dimension. The differences between perception and expectation were significant (p < 0.001). There was a significant difference between the expectations scores based on gender, education level, and previous hospitalization in that same hospital. Also, there was a significant difference between the perception scores based on insurance coverage, average length of stay, and patients' health conditions on discharge. The results showed that SERVQUAL is a valid, reliable, and flexible instrument to monitor and measure the quality of the services in private hospitals of Iran. Our findings clarified the importance of creating a strong relationship between patients and the hospital practitioners/personnel and the need for hospital staff to be responsive, credible, and empathetic when dealing with patients.

  3. Targeting low literacy patients pays off for health system.

    PubMed

    2015-11-01

    Ochsner Health, with headquarters in New Orleans, targets patients with low health literacy, along with other readmission reduction programs. When patients are readmitted, the case managers administer the Rapid Estimate of Adult Literacy in Medicine (REALM) tool, developed by the Agency for Healthcare Research and Quality (AHRQ) to identify patients who need extra help in understanding their discharge instructions. When case managers make post-discharge follow-up calls to at-risk patients, they ask a series of questions that determine if the patient can understand written instructions. - The staff uses pictographs and videos to educate patients identified as having low literacy and make sure the caregivers understand the discharge instructions.

  4. Why do patients choose to attend a private emergency department?

    PubMed

    Shearer, Freya M; Bailey, Paul M; Hicks, Brontie L; Harvey, Brooke V; Monterosso, Leanne; Ross-Adjie, Gail; Rogers, Ian R

    2015-02-01

    Understanding the reasons patients decide to attend a particular acute care service, and their expectations of that service, is important in providing optimal patient care. The present study aimed to determine factors influencing patient decisions to attend a private Australian ED, an issue that has not been previously addressed in the literature. Semi-structured face-to-face interviews with ED patients, purposively sampled to broadly reflect the departmental caseload and casemix. The two primary questions asked were: 'Why did you choose to come to this emergency department?' and 'What are your general expectations of this emergency department visit?'. Interviews were audio recorded, transcribed verbatim, and then analysed using manifest and then latent content analysis techniques. All patients approached (n = 30) agreed to interview. Four key themes were identified: prior experience of the hospital, convenient location of the hospital, anticipated high-quality care and anticipated short wait times. Patients chose to use the private ED because of prior experience, proximity, and an expectation they would be seen promptly and be provided with competent care. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  5. Minimally-invasive dental anesthesia: Patients' preferences and analysis of the willingness-to-pay index.

    PubMed

    Re, Dino; Del Fabbro, Massimo; Karanxha, Lorena; Augusti, Gabriele; Augusti, Davide; Fessi, Sabrine; Taschieri, Silvio

    2017-05-23

    The aim of the present prospective study was to evaluate the impact of a computer-controlled anesthesia on patients' comfort and to investigate, through the willingness-to-pay (WTP) index, and patients' acceptance of this new technology. Fifty patients undergoing a class I or II restorative procedure were enrolled. A computer-controlled device for anesthetic delivery was utilized, and a questionnaire on the level of discomfort and WTP was given to all patients. A total of 86% of participants declared less discomfort than that perceived during their last traditional procedure for pain control; 58% of patients were willing to pay an additional fee for a modern anesthesia technique, with a median WTP value of 20$. Computer-controlled systems for local anesthesia represent a relevant tool for reducing patients' discomfort during dental treatment. The WTP index helps to quantify its relevance. © 2017 John Wiley & Sons Australia, Ltd.

  6. [Willingness to pay and quality of life in patients with Japanese-cedar pollinosis].

    PubMed

    Kakutani, Chieko; Ogino, Satoshi; Irifune, Morihiro; Takeda, Mariko; Baba, Kenji

    2003-01-01

    Seasonal allergic rhinitis (SAR) is one of the world's most common health problems because it's a high-cost, high-prevalence disease. In this study, we investigated patients' willingness to pay (WTP) for prevention and cure from most common SAR, Japanese-cedar pollinosis. Two hundred and forty patients with Japanese-cedar pollinosis, who visited 4 clinics in Osaka and were measured QOL by the SF-36 Questionnaire (Japanese version) during pollen season, were mailed WTP questionnaire in off-season in 1998. Completed questionnaires were sent back by 175 patients. Most patients (83.5%) were willing to pay less than 10,000 yen. Patients with longer duration of disease or severer nasal symptom tended to be more willing to pay. In contrast, no association was found between WTP and sex, age, occupation and comorbid condition. There were significant impairments in five of eight QOL dimensions in patients of Much-WTP in comparison with Less-WTP. Patients with mild symptom had significant higher medication cost than those with less mild symptom. We conclude that effective treatment, even if it costs much, can satisfy patients and may help to reduce indirect costs as well as to lessen the impact of Japanese-cedar pollinosis on QOL for both patient and society.

  7. The willingness of patients to pay for intravenous patient-controlled analgesia in Korea

    PubMed Central

    Lim, Hyungsun; Lee, Duck-Hyoung; Lee, Jeongwoo; Han, Young Jin; Choe, Huhn

    2012-01-01

    Background The use of intravenous patient-controlled analgesia (IV-PCA) has been increasing because it has advantages such as improved pain relief, greater patient satisfaction, and fewer postoperative complications. However, current research has not considered the patients' thoughts about IV-PCA's cost-effectiveness. The purpose of this study was to investigate the willingness to pay (WTP) for IV-PCA and the relationship between patients' characteristics and WTP in Korea. Methods We enrolled 400 adult patients who were scheduled for elective surgery. The patient was requested to indicate a series of predefined amounts of money (Korean won; 30,000/50,000/100,000/150,000/200,000/300,000/500,000). We also recorded patient characteristics, such as age, sex, type of surgery, IV-PCA history, education level, the person responsible for medical expenses, type of insurance, net annual income, and residential area. Three days after surgery, we asked about the degree of satisfaction and the WTP for IV-PCA. Results For IV-PCA, the median WTP was 100,000 won (25-75%; 50,000-200,000 won: US$1 = W1078.04; July 19, 2011) before surgery. All patients' characteristics were not related to preoperative WTP for IV-PCA, whereas the increase in WTP after surgery showed a tendency correlated to higher IV-PCA satisfaction. Conclusions The median WTP was 100,000 won. The satisfaction of IV-PCA increased patients' WTP after surgery, but the WTP may be independent of patient characteristics in Korea. PMID:22778891

  8. Patient Satisfaction with private Physiotherapy for musculoskeletal Pain

    PubMed Central

    Casserley-Feeney, Sarah N; Phelan, Martin; Duffy, Fionnuala; Roush, Susan; Cairns, Melinda C; Hurley, Deirdre A

    2008-01-01

    Background Despite emphasis on patient centred healthcare, healthcare professionals have been slow to use validated measurements of patient satisfaction in physiotherapy practice. The aim of this cross sectional survey was to measure patient satisfaction with private physiotherapy in Ireland, for patients with musculoskeletal pain, using a previously validated survey instrument. Methods A multidimensional patient satisfaction questionnaire 'PTOPS', which assesses patient satisfaction with outpatient physiotherapy treatment, was translated from American English to European English, and relevant demographic and global satisfaction items were included. This was then circulated to patients with musculoskeletal pain (n = 240) for anonymous completion and return to the research team. Data were analysed using the Statistical Package for the Social Sciences (SPSS, v.12). Results In total 55% (n = 131/240) of questionnaires were returned. Just over half of the respondents were male (53.4%, n = 70), with a mean age (SD) of 37.7 years (12.4), and had previous experience of physiotherapy (65.6%, n = 86). The most common site of musculoskeletal pain was spinal (51.5% n = 66). The mean (SD) number of treatments was 8.3 (8.3), at a mean total cost (SD) of €350.2 (€322.8). The 'PTOPS' questionnaire categorised and scored satisfaction items under four domains, Enhancer, Detractor, Location and Cost. The mean score (SD), optimum score, and scoring range for each domain were: 'Enhancer' 41.2 (3.8), 50, 10–50; 'Detractor' 19.4 (4.4), 10, 10–50; 'Location' 28.0 (4.1), 35, 7–35; 'Cost' 18.9 (2.8), 7, 7–35. "Overall satisfaction with physiotherapy experience" was scored on a five-point scale "excellent to poor", with a modal response of "Very Good" (42%; n = 55). Conclusion This study measured patient satisfaction with private physiotherapy treatment for musculoskeletal pain in Ireland using a previously validated outcome measure and provides a template for future studies of

  9. Patients in a private hospital in India leave the emergency department against medical advice for financial reasons

    PubMed Central

    2014-01-01

    Background Some reports indicate financial concerns as a factor affecting ED patients leaving the acute care setting against medical advice (AMA). In India, no person is supposed to be denied urgent care because of inability to pay. Since a large proportion of the Indian health care system is financed by out-of-pocket expenses, we investigate the role of financial constraints for ED patients at a private hospital in India in leaving AMA. Methods A prospective ED-based cross-sectional survey of patients leaving AMA was conducted at a private hospital in India from 1 October 2010 to 31 December 2010. Descriptive statistics and the chi-square test were used to identify associations between financial factors and the decision to leave the hospital AMA. Results Overall, 55 (3.84%) ED patients left AMA, of which 46 (84%) reported leaving because of financial restrictions. Thirty-nine (71%) respondents indicated the medical bill would represent more that 25% of their annual income. Females (19/19) were more likely to leave AMA for financial reasons compared to males (27/36, p = 0.017). Among females who signed out AMA, the decision was never made by the female herself. Conclusion The number of people leaving the ED AMA in a private Indian hospital is relatively high, with most leaving for financial reasons. In most cases, women did not decide to leave the ED AMA for themselves, whereas males did. This survey suggests that steps are needed to ensure that the inability to pay does not prevent emergent care from being provided. PMID:24568343

  10. Podoconiosis patients' willingness to pay for treatment services in Northwest Ethiopia: potential for cost recovery.

    PubMed

    Tamiru, Abreham; Tsegay, Girmay; Wubie, Moges; Gedefaw, Molla; Tomczyk, Sara; Tekola-Ayele, Fasil

    2014-03-19

    Podoconiosis is non-filarial elephantiasis of the lower legs. It is more commonly found in tropical Africa, Central and South America, and northwest India. In Ethiopia, a few non-governmental organizations provide free treatment to podoconiosis patients, but sustainability of free treatment and scale-up of services to reach the huge unmet need is challenged by resource limitations. We aimed to determine podoconiosis patient's willingness to pay (WTP) for a treatment package (composed of deep cleaning of limbs with diluted antiseptic solution, soap, and water, bandaging, application of emollient on the skin, and provision of shoes), and factors associated with WTP in northwestern Ethiopia. A cross-sectional study was conducted among randomly selected untreated podoconiosis patients (n=393) in Baso Liben woreda, northwestern Ethiopia. The contingent valuation method was used with a pre-tested interviewer-administered questionnaire. The majority of podoconiosis patients (72.8%) were willing to pay for treatment services. The median WTP amount was 64 Birr (US$ 3.28) per person per year. More than one-third of patients (36.7%) were willing to pay at least half of the full treatment cost and 76.2% were willing to pay at least half of the cost of shoes. A multivariate analysis showed that having a higher monthly income, being a woman, older age, being aware of the role of shoes to prevent podoconiosis, and possession of a functional radio were significantly associated with higher odds of WTP. The considerable WTP estimates showed that podoconiosis treatment could improve sustainability and service utilization. A subsidized cost recovery scheme could reduce treatment costs and more feasibility integrate podoconiosis treatment service with other NTDs and the government's primary health care system.

  11. Patients' choice between public and private hospital emergency departments: a cross-sectional survey.

    PubMed

    He, Jun; Hou, Xiang-Yu; Toloo, Ghasem Sam; FitzGerald, Gerry

    2017-09-19

    The aim of this study was to understand what factors influence patients' choice between public and private hospital ED and the relative weight of those factors among adult patients with private health insurance in Australia. A survey of 280 patients was conducted in four public and private hospitals' EDs in Brisbane between May and August 2015. The survey included information about respondent's demographics, nature of illness, decision-making, attitudes and choice. Independent t-test and Pearson's χ²-test were used to identify binary associations, and logistic regression was used to determine what factors influence patients' choice. Patients who agreed that 'long waiting time is a barrier to access public hospital ED' were twice as likely to choose private hospitals (odds ratio [OR] 2.172, P = 0.001). Alternatively patients who did not consider that 'there were long waiting times in public hospital ED' were less likely to access private hospitals (OR 0.200, P = 0.003). More public hospital patients (70.7%) than private hospital patients (56.4%) (P = 0.015) agreed that 'out-of-pocket payment is a barrier to accessing private hospital ED'. Patients attending private hospitals rated the quality of service higher than those attending public hospitals (OR 1.26, P = 0.001). Longer waiting times in public EDs is the principal issue considered by patients choosing private EDs and the out-of-pocket payment for accessing private EDs is the principal issue considered by public ED patients. The study suggests that addressing the out-of-pocket payments will attract more patients with private health insurance to access private EDs. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  12. Permitting patients to pay for participation in clinical trials: the advent of the P4 trial.

    PubMed

    Shaw, David; de Wert, Guido; Dondorp, Wybo; Townend, David; Bos, Gerard; van Gelder, Michel

    2016-10-18

    In this article we explore the ethical issues raised by permitting patients to pay for participation (P4) in clinical trials, and discuss whether there are any categorical objections to this practice. We address key considerations concerning payment for participation in trials, including patient autonomy, risk/benefit and justice, taking account of two previous critiques of the ethics of P4. We conclude that such trials could be ethical under certain strict conditions, but only if other potential sources of funding have first been explored or are unavailable.

  13. Physician and patient willingness to pay for electronic cardiovascular disease management.

    PubMed

    Deal, Ken; Keshavjee, Karim; Troyan, Sue; Kyba, Robert; Holbrook, Anne Marie

    2014-07-01

    Cardiovascular disease (CVD) is an important target for electronic decision support. We examined the potential sustainability of an electronic CVD management program using a discrete choice experiment (DCE). Our objective was to estimate physician and patient willingness-to-pay (WTP) for the current and enhanced programs. Focus groups, expert input and literature searches decided the attributes to be evaluated for the physician and patient DCEs, which were carried out using a Web-based program. Hierarchical Bayes analysis estimated preference coefficients for each respondent and latent class analysis segmented each sample. Simulations were used to estimate WTP for each of the attributes individually and for an enhanced vascular management system. 144 participants (70 physicians, 74 patients) completed the DCE. Overall, access speed to updated records and monthly payments for a nurse coordinator were the main determinants of physician choices. Two distinctly different segments of physicians were identified - one very sensitive to monthly subscription fee and speed of updating the tracker with new patient data and the other very sensitive to the monthly cost of the nurse coordinator and government billing incentives. Patient choices were most significantly influenced by the yearly subscription cost. The estimated physician WTP was slightly above the estimated threshold for sustainability while the patient WTP was below. Current willingness to pay for electronic cardiovascular disease management should encourage innovation to provide economies of scale in program development, delivery and maintenance to meet sustainability thresholds. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. What do patients value? Willingness to pay for ultrasound in normal pregnancy.

    PubMed

    Berwick, D M; Weinstein, M C

    1985-07-01

    Evaluations of diagnostic tests have focused primarily on their value in clinical decisions. Patients may attach value to 1) information that has little or no medical significance, and 2) information (medical or nonmedical) that has no bearing on decisions to be made by the doctor or the patient. Ultrasound in pregnancy, which provides a great deal of information to both doctor and patient, was chosen as the example with which to explore these hypotheses. Sixty-two women with current or recent normal pregnancies were given a structured interview to elicit their willingness to pay for ultrasound information. Among these women, 26% of the value attached to the test related to information having no decisional significance, and 37% of the value related to information of use to the patient, but not the doctor. Overall, 44% of the value of the test, from the patients' point of view, pertained to uses outside the realm of medical decisions. On the average, interviewees alleged that they would pay +706 for the information contained in an ultrasound test in an uncomplicated pregnancy. Decision analyses and cost-effectiveness analyses that take note only of the medical, decisional uses of test information may overlook a high proportion of the value patients attach to the information.

  15. Factors influencing patients' willingness to pay for new technologies in hip and knee implants.

    PubMed

    Schwarzkopf, Ran; Sagebin, Fabio M; Karia, Raj; Koenig, Karl M; Bosco, Joseph A; Slover, James D

    2013-03-01

    Rising implant prices and evolving technologies are important factors contributing to the increased cost of arthroplasty. Assessing how patients value arthroplasty, new technologies, and their perceived outcomes is critical in planning cost-effective care, as well as evaluating new-technologies. One hundred one patients undergoing arthroplasty took part in the survey. We captured demographics, spending practices, knowledge of implants, patient willingness to pay for implants, and preferences related to implant attributes. When patients were asked if they would be satisfied with "standard of care" prosthesis, 80% replied "no". When asked if they would pay for a higher than "standard of care" prosthesis, 86% replied "yes". The study demonstrated that patients, regardless of their socio-economic status, are not satisfied with standard of care implants when newer technologies are available, and they may be willing to share in the cost of their prosthesis. Patients also prefer the option to choose what they perceive to be a higher quality or innovative implant even if the "out of pocket" cost is higher.

  16. Patient acceptability of and readiness-to-pay for pharmacy-based health membership plans to improve hypertension outcomes in Lima, Peru.

    PubMed

    Vodicka, Elisabeth; Antiporta, Daniel A; Yshii, Yukimi; Zunt, Joseph R; Garcia, Patricia J

    Pharmacies have been used to improve population health in Peru and other countries globally, operating as a non-traditional health access point. A pharmacy-based model holds potential to improve patient management of hypertension, a leading risk factor for non-communicable diseases in low- and middle-income countries. The aim of this study was to evaluate patient acceptability of hypertension services and health membership plans, if offered through private pharmacies in the future. A cross-sectional study was conducted with 347 hypertensive individuals who purchased anti-hypertensive medications in a private pharmacy during the study period (July-October 2012). The study included a brief survey assessing patients' acceptability of and readiness-to-pay for pharmacy-based hypertension management services. Chi-square tests for differences in proportions were used to evaluate whether any demographic characteristics (e.g., binary variables for age, time since diagnosis, and type of medication usually purchased) could identify groups of hypertensive individuals that might be more or less likely to use pharmacy-based services. Multiple logistic regression was used to estimate associations between readiness-to-pay for pharmacy-based health membership plans and patient-level characteristics. Over 80% of individuals indicated they would be interested in pharmacy-based hypertension services, particularly discounts on anti-hypertensive medications and free blood pressure screenings. Compared to individuals 65 years of age or older, individuals under 65 years were more interested in receiving at least one pharmacy-based service. Another 80% indicated they would be interested in purchasing a monthly health plan through a pharmacy that provided access to hypertension services each month. The vast majority of individuals interested in pharmacy-based services indicated they would pay ≤$3.69 US/month to participate in a monthly health membership plan. Hypertensive patients would

  17. WILLINGNESS TO PAY FOR LUNG CANCER TREATMENT: PATIENT VERSUS GENERAL PUBLIC VALUES.

    PubMed

    Thongprasert, Sumitra; Crawford, Bruce; Sakulbumrungsil, Rungpetch; Chaiyakunapruk, Nathorn; Petcharapiruch, Sirinthip; Leartsakulpanitch, Jittrakul; Permsuwan, Unchalee

    2015-01-01

    Lung cancer has been the most common cancer since 1985, accounting for 12-13 percent of cancer cases worldwide. Newer targeted therapies with potential increased survival benefits may not be affordable to patients. Many countries use arbitrary thresholds to determine whether a medical intervention is cost-effective. As such, many effective, albeit expensive, therapies are not being reimbursed. To understand the value placed on effective therapies, this study evaluates the patient and public willingness to pay (WTP) for a quality-adjusted life-year (QALY) for lung cancer treatments using Thailand as an example. A total of 300 subjects responded to hypothetical lung cancer health states, described by three levels of severity and two levels of side effects, and provided their valuation of the level of quality of life and their WTP to improve from one state to another. The patients with the lowest income and general public were willing to pay more than twice the threshold for acceptability in Thailand (US Dollar 5,123/QALY [Thai Baht 160,000/QALY]). This increased significantly by wealth category. Patients' WTP was associated with quality of life, financial difficulties, health insurance, diarrhea, and wealth. The current study highlights the value patients and general public place on effective lung cancer therapies.

  18. Using frames to influence consumer willingness to pay for the patient health record: a randomized experiment.

    PubMed

    Vishwanath, Arun

    2009-07-01

    The American College of Medical Informatics rated the lack of willingness to pay for the patient health record (PHR) as the biggest obstacles to its rapid diffusion. Extending research propositions from the decision sciences and political communication, this study tests the influence of different types of emphasis frames on increasing consumer willingness to pay for the PHR. Using a randomized experiment embedded within a probability survey, the effects of 3 different types of emphasis frames (individual-focused, collective-focused, and joint), along with a no-frames control, are tested on a sample of early and later technology adopters. The results indicate a significant relationship between the type of frame and the type of adopter. Early adopters were more susceptible to individual-focused frames that made causal attributions at the individual level, whereas later adopters were significantly influenced by collective-focused frames that made causal attributions at the societal level. Interestingly, the framing effect continued and significantly influenced both early and later adopters' willingness to pay for the PHR. The findings demonstrate the need to carefully communicate the value of a technology to adopters and suggest the possibility of using frames to spur the diffusion of PHRs.

  19. Patient preferences and willingness to pay for different options of anticoagulant therapy.

    PubMed

    Moia, Marco; Mantovani, Lorenzo Giovanni; Carpenedo, Monica; Scalone, Luciana; Monzini, Mara Silvia; Cesana, Giancarlo; Mannucci, Pier Mannuccio

    2013-04-01

    New anticoagulant drugs alternative to vitamin K antagonists are currently under clinical evaluation. Patient's preferences should be considered in the development of new therapeutic strategies. Our study aim was to elicit patient preferences, and estimate their willingness to pay for the different treatment options. A Discrete Choice Experiment was administered to patients consecutively attending an anticoagulation clinic, either on stable oral anticoagulant therapy, or during their first visit at the time of starting therapy. Six treatment characteristics were analysed: route and number of medication administrations, frequency of monitoring, risk of some minor bleeding, the amount of attention required for drug/food interactions, requirement for dose adjustment, and out-of-pocket treatment cost. Relationships between patient's preferences and their characteristics were analysed. 255 patients participated (55 % men, with a mean age 64 years; 35.7 % on stable therapy). A statistically significant importance was attributed to all but two characteristics (the amount of attention required for interaction with other drugs/food and for dose adjustment.) Monthly patient willingness to pay was 79 for tablets versus injections; 41 for once-daily versus twice-daily tablets, 25 for drugs without risk of minor bleeding events and 20 for once-monthly versus twice-monthly monitoring. Patients on stable therapy considered more important the amount of attention required for drug/food interactions than did the starters. Younger or working patients considered the reduction of monitoring frequency more important than did the older or not working patients (retired, housewives). This study elicited preferences from patients on oral anticoagulant therapy with a simple and well established method, which allows to obtain information warranted for planning optimal healthcare.

  20. Patients' willingness to pay for electronic communication with their general practitioner.

    PubMed

    Bergmo, Trine Strand; Wangberg, Silje Camilla

    2007-06-01

    Despite the common use of electronic communication in other aspects of everyday life, its use between patients and health care providers has been slow to diffuse. Possible explanations are security issues and lack of payment mechanisms. This study investigated how patients value secure electronic access to their general practitioner (GP). One hundred and ninety-nine patients were asked an open-ended willingness-to-pay (WTP) question as part of a randomised controlled trial. We compared the WTP values between two groups of respondents; one group had had the opportunity to communicate electronically with their GP for a year and the other group had not. Fifty-two percent of the total sample was willing to pay for electronic GP contact. The group of patients with access revealed a significantly lower WTP than the group without such access. Possible explanations are that the system had fewer benefits than expected, a presence of hypothetical bias or simply a preference for face-to-face encounters.

  1. Private Prayer and Optimism in Middle-Aged and Older Patients Awaiting Cardiac Surgery

    ERIC Educational Resources Information Center

    Ai, Amy L.; Peterson, Christopher; Bolling, Steven F.; Koenig, Harold

    2002-01-01

    Purpose: This study investigated the use of private prayer among middle-aged and older patients as a way of coping with cardiac surgery and prayer's relationship to optimism. Design and Methods: The measure of prayer included three aspects: (a) belief in the importance of private prayer, (b) faith in the efficacy of prayer on the basis of previous…

  2. Private Prayer and Optimism in Middle-Aged and Older Patients Awaiting Cardiac Surgery

    ERIC Educational Resources Information Center

    Ai, Amy L.; Peterson, Christopher; Bolling, Steven F.; Koenig, Harold

    2002-01-01

    Purpose: This study investigated the use of private prayer among middle-aged and older patients as a way of coping with cardiac surgery and prayer's relationship to optimism. Design and Methods: The measure of prayer included three aspects: (a) belief in the importance of private prayer, (b) faith in the efficacy of prayer on the basis of previous…

  3. Understanding the incomprehensible: private theories of first-episode psychotic patients and their therapists.

    PubMed

    Werbart, Andrzej; Levander, Sonja

    2005-01-01

    Private theories about psychosis, its background, and cure were studied using narratives of first-time psychotic patients and their therapists. Both patients and their therapists were interviewed on three occasions over a period of 1 1/2 years. Three cases were chosen as dyads in point in order to highlight different relations between the patient's and the therapist's private theories, different patterns of recovery from psychosis, and different outcomes. The cases are contrasted by paired comparisons. The study indicates that an awareness and joint discussion of incompatibilities between the two participants' private theories might be a substantial contribution to the process of recovery from psychosis.

  4. Patients' appraisals of public and private healthcare: a qualitative study of physiotherapy and osteopathy.

    PubMed

    Bradbury, Katherine J; Bishop, Felicity L; Yardley, Lucy; Lewith, George

    2013-10-01

    Patients have previously reported differences in their experiences of treatments received in the public and private sectors; it remains unclear whether such perceived differences are particular to or shared across different interventions. This study explored whether patients' appraisals of public and private treatments are similar when appraising a complementary therapy (osteopathy) compared to a mainstream therapy (physiotherapy). Thirty-five qualitative interviews were analysed thematically. Patients' appraisals varied by health-care sector and therapy type: physiotherapy was appraised more negatively in the National Health Service than the private sector but osteopathy was appraised similarly within both health-care sectors. Potential reasons for this are discussed.

  5. Patients' with type 2 diabetes willingness to pay for insulin therapy and clinical outcomes

    PubMed Central

    Feher, Michael D; Brazier, John; Schaper, Nicolaas; Vega-Hernandez, Gabriela; Bøgelund, Mette

    2016-01-01

    Objectives This study assessed patient preferences, using willingness to pay as a method to measure different treatment characteristics or attributes associated with injectable insulin therapy in patients with type 2 diabetes. Research design and methods Adults with type 2 diabetes in 12 countries, diagnosed >6 months prior and receiving insulin for >3 months, were recruited through a representative online panel. Data were collected via online questionnaire and analyzed using a standard choice model for discrete choice experiment. Results A total of 3758 patients from North America (n=646), South America (n=1537), and Europe (n=1575) completed the study. Mean glycated hemoglobin (HbA1c) levels in North America, South America, and Europe were 63 mmol/mol (7.9%), 75 mmol/mol (9.0%), and 64 mmol/mol (8.0%), respectively. In the three regions, monthly willingness to pay was US$116, US$74, and US$92, respectively, for a 1%-point decrease in HbA1c; US$99, US$80, and US$104 for one less major hypoglycemic event per year; and US$64, US$37 and US$60 for a 3 kg weight decrease. To avoid preinjection preparation of insulin, the respective values were US$47, US$18, and US$37, and US$25, US$25, and US$24 for one less injection per day. Among respondents on basal-only insulin who had previously tried a more intensive regimen, reasons for switching back included difficulty in handling multiple injections and risk of hypoglycemic events. Conclusions Reducing HbA1c, frequency of major hypoglycemic events and weight decrease were the highest valued outcomes in each region. The administrative burden of injections was also considered important. PMID:27158518

  6. The role of the private sector in monitoring health care quality and patient safety.

    PubMed

    Blewett, Lynn A; Parente, Stephen T; Peterson, Eileen; Finch, Michael D

    2003-08-01

    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. 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. 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.

  7. Are clinical decisions in endodontics influenced by the patient's fee-paying status?

    PubMed

    Walker, I; Gilbert, D; Asimakopoulou, K

    2015-12-01

    We explored whether the fee status of a UK patient influences clinical decision-making in endodontics. In a randomised-controlled vignette study describing either an 'NHS-funded', 'Privately-funded' or undisclosed fee-status patient, we examined the importance vocational trainer dentists placed on a series of factors normally considered when deciding whether to offer patients endodontic treatment as opposed to extracting the tooth. N = 119 experienced (M years post qualification = 20.01) dentists participated. Having read a vignette describing a hypothetical patient who could potentially be treated either endodontically or through an extraction, dentists rated a series of factors they would normally consider (for example, poor oral hygiene, the rest of their mouth is unfilled and caries-free), before recommending either endodontic treatment or an extraction. The patient's funding status had no influence on these dentists' clinical decision-making when considering endodontic treatment as an option (p >0.05) with the exception of a single item relating to infrequent attendance where the NHS patient was more likely than the 'undisclosed-fee' patient, to be offered extractions (F (2, 116) 3.43, p <0.04). We have found no strong evidence to suggest that the fee-status of a patient influences clinical decision-making in endodontic treatment by experienced dentists.

  8. Willingness to pay and quality of life in patients with atopic dermatitis.

    PubMed

    Beikert, F C; Langenbruch, A K; Radtke, M A; Kornek, T; Purwins, S; Augustin, M

    2014-04-01

    Atopic dermatitis (AD) is a frequent and burdensome disease. The objectives of this study were (1) to assess the willingness to pay (WTP) and quality of life (Qol) in AD patients and (2) to compare the results with data on other chronic skin diseases. To collect data, a non-interventional, cross-sectional nationwide postal survey on adult patients with clinically diagnosed AD was performed; socio-demographic data, clinical features/symptoms, WTP and QoL were recorded. WTP was assessed in three different approaches, including relative and absolute figures. Data from n = 384 AD patients (mean age 42.0, range 18-92, 69.8 % female) were analyzed. WTP for complete healing was on median 1,000 (average 11,884) and exceeded WTP in rosacea (median 500) but not in vitiligo (median 3,000). Mean Dermatology Life Quality Index (DLQI) was 8.5 (vitiligo 7.0; psoriasis 6.7; rosacea 4.3) and correlated with pruritus, xerosis and disturbed sleep. WTP and DLQI correlated only marginally (r s = 0.134, p = 0.01). In conclusion, AD patients show high WTP and markedly reduced QoL compared to other chronic skin diseases.

  9. The role of disease management in pay-for-performance programs for improving the care of chronically ill patients.

    PubMed

    Beich, Jeff; Scanlon, Dennis P; Ulbrecht, Jan; Ford, Eric W; Ibrahim, Ibrahim A

    2006-02-01

    To date, pay-for-performance programs targeting the care of persons with chronic conditions have primarily been directed at physicians and provide an alternative to health plan-sponsored chronic disease management (DM) programs. Both approaches require similar infrastructure, and each has its own advantages and disadvantages for program implementation. Pay-for-performance programs use incentives based on patient outcomes; however, an alternative system might incorporate measures of structure and process. Using a conceptual framework, the authors explore the variation in 50 diabetes DM programs using data from the 2002 National Business Coalition on Health's eValue8 Request for Information (RFI). The authors raise issues relevant to the assignment of accountability for patient outcomes to either health plans or physicians. They analyze the association between RFI scores measuring structures and processes, and HEDIS diabetes intermediate outcome measures. Finally, the strengths and weaknesses of using the RFI scores as an alternative metric for pay-for-performance programs are discussed.

  10. Impact of pay-for-performance on mortality in diabetes patients in Taiwan

    PubMed Central

    Chen, Yu-Ching; Lee, Charles Tzu-Chi; Lin, Boniface J.; Chang, Yong-Yuan; Shi, Hon-Yi

    2016-01-01

    Abstract Background: The impact of pay-for-performance (P4P) programs on long-term mortality for chronic illnesses, especially diabetes mellitus, has been rarely reported. Several studies described the favorable impact of P4P for diabetes mellitus on medical utilizations or intermediate outcomes. Therefore, this study aimed to investigate the impact of a P4P program on mortality in patients with type 2 diabetes. Methods: The P4P group in this population-based cohort study was 2090 individuals with a primary diagnosis of type 2 diabetes who had been newly enrolled in the P4P program of Taiwan between January 1, 2004 and December 31, 2004. Matched by 1:1 ratio, patients in the non-P4P group were selected by propensity score matching (PSM) for sex, age, the first year of diagnosis as diabetes, and 32 other potential confounding factors. Mean (SD) age was 60.91 (12.04) years when diabetes was first diagnosed and mean (SD) duration of diabetes was 4.3 (1.9) years at baseline. The time-dependent Cox regression model was used to explore the impact of P4P on all-cause mortality. Results: During a mean of 5.13 years (SD = 1.07 years) of follow-up, 206 and 263 subjects died in the P4P group and the non-P4P group, respectively. After adjusting for the potential confounding factors at baseline, survival was significantly longer in the P4P group than in the non-P4P group (hazard ratio, 0.76 [95% confidence interval, 0.64–0.92], P = 0.004, by log-rank test). This decrease in mortality is equivalent to one less death for every 37 patients who were treated in the P4P program for 5.13 years. In this study, the P4P program significantly increased the medical utilization of physician visits and diabetes-related examinations, improved the adherence of oral hypoglycemic drugs during the first 3 years and that of insulin during the second 3 years, and was negatively associated with risk of cancer and chronic kidney disease. In annual health expense, there was no significant difference

  11. Do Hospitals Alter Patient Care Effort Allocations under Pay-for-Performance?

    PubMed Central

    Nicholas, Lauren Hersch; Dimick, Justin B; Iwashyna, Theodore J

    2011-01-01

    Objective To determine whether hospitals increase efforts on easy tasks relative to difficult tasks to improve scores under pay-for-performance (P4P) incentives. Data Source The Centers for Medicare and Medicaid Services Hospital Compare data from Fiscal Years 2003 through 2005 and 2003 American Hospital Association Annual Survey data. Study Design We classified measures of process compliance targeted by the Premier Hospital Quality Incentive Demonstration as easy or difficult to improve based on whether they introduce additional per-patient costs. We compared process compliance on easy and difficult tasks at hospitals eligible for P4P bonus payments relative to hospitals engaged in public reporting using random effects regression models. Principal Findings P4P hospitals did not preferentially increase efforts for easy tasks in patients with heart failure or pneumonia, but they did exhibit modestly greater effort on easy tasks for heart attack admissions. There is no systematic evidence that effort was allocated toward easier processes of care and away from more difficult tasks. Conclusions Despite perverse P4P incentives to change allocation of efforts across tasks to maximize performance scores at lowest cost, we find little evidence that hospitals respond to P4P incentives as hypothesized. Alternative incentive structures may motivate greater response by targeted hospitals. PMID:21029088

  12. Willingness to pay and willingness to accept in a patient-centered blood pressure control study.

    PubMed

    Gleason-Comstock, Julie; Streater, Alicia; Goodman, Allen; Janisse, James; Brody, Aaron; Mango, LynnMarie; Dawood, Rachelle; Levy, Phillip

    2017-08-07

    Elevated blood pressure is a major risk factor for cardiovascular disease and stroke but patients often discount recommended behavioral changes and prescribed medications. While effective interventions to promote adherence have been developed, cost-effectiveness from the patient's perspective, has not been well studied. The valuation of patient time and out of pocket expenses should be included while performing cost effectiveness evaluation. The Achieve BP study uses the contingent valuation method to assess willingness to accept (WTA) and willingness to pay (WTP) among patients with a history of uncontrolled blood pressure discharged from an urban emergency department and enrolled in a larger randomized controlled trial. WTA and WTP were assessed by asking patients a series of questions about time and travel costs and time value related to their study participation. A survey was conducted during the final study visit with patients to investigate the effectiveness of a kiosk-based educational intervention on blood pressure control. All study patients, regardless of study arm, received the same clinical protocol of commonly prescribed antihypertensive medication and met with research clinicians four times as part of the study procedures. Thirty-eight patients were offered the opportunity to participate in the cost-effectiveness study and all completed the survey. Statistical comparisons revealed these 38 patients were similar in representation to the entire RCT study population. All 38 (100.0%) were African-American, with an average age of 49.1 years; 55.3% were male, 21.1% were married, 78.9% had a high school or higher education, and 44.7% were working. 55.9% did not have a primary care provider and 50.0% did not have health insurance. Time price linear regression analysis was performed to estimate predictors of WTA and WTP. WTP and WTA may generate different results, and the elasticities were proportional to the estimated coefficients, with WTP about twice as

  13. Web Portals in Primary Care: An Evaluation of Patient Readiness and Willingness to Pay for Online Services

    PubMed Central

    2006-01-01

    Background Online Web communication between physician and patient has been proposed by leading primary care organizations as a way to enhance physician-patient communication, but lack of payment for this service has acted as a significant barrier to implementation. Objective This study evaluates current patient readiness and willingness to pay for online services in a fairly typical urban family medicine practice. Methods All patients that visited the author for medical care during a one-month period in the spring of 2006 were anonymously surveyed with a one-page survey instrument that inquired about demographics, willingness to pay a small annual fee for online services, the greatest fee they were willing to pay, and their most desired service. Results A total of 346 patients out of 2380 active patients in the study practice (14.5%) were surveyed. The valid survey response rate was 95.1% (329/346.) Three quarters, or 75.4%, of patients had Internet access. The group with the highest access were 18- to 29-year-olds (97%), and the group with the least access were those 70 years and up (56%) (P < .001). Categorized by employment, students and employed patients had the best access at 92% and 87%, respectively, and retirees and disabled patients had the worst access at 66% and 42%, respectively (P < .001). Of all patients with Internet access, 74.6% (n = 185) were willing to pay a small annual fee for one or more of the following online services: viewing of parts of their medical record, messaging with their physician, medication refills, appointment requests, and billing inquiries. Willingness to pay did not vary significantly by age (P = .06). Of all respondents, regardless of Internet access, 47.1% (n = 155) were willing to pay US $10 or more per year, with the median amount being US $20. Of those with Internet access (n = 248), 60.1% (n = 149) were willing to pay US $10 or more per year, and 31% were willing to pay US $50 or more per year. The three most important

  14. Web portals in primary care: an evaluation of patient readiness and willingness to pay for online services.

    PubMed

    Adler, Kenneth G

    2006-10-26

    Online Web communication between physician and patient has been proposed by leading primary care organizations as a way to enhance physician-patient communication, but lack of payment for this service has acted as a significant barrier to implementation. This study evaluates current patient readiness and willingness to pay for online services in a fairly typical urban family medicine practice. All patients that visited the author for medical care during a one-month period in the spring of 2006 were anonymously surveyed with a one-page survey instrument that inquired about demographics, willingness to pay a small annual fee for online services, the greatest fee they were willing to pay, and their most desired service. A total of 346 patients out of 2380 active patients in the study practice (14.5%) were surveyed. The valid survey response rate was 95.1% (329/346.) Three quarters, or 75.4%, of patients had Internet access. The group with the highest access were 18- to 29-year-olds (97%), and the group with the least access were those 70 years and up (56%) (P < .001). Categorized by employment, students and employed patients had the best access at 92% and 87%, respectively, and retirees and disabled patients had the worst access at 66% and 42%, respectively (P < .001). Of all patients with Internet access, 74.6% (n = 185) were willing to pay a small annual fee for one or more of the following online services: viewing of parts of their medical record, messaging with their physician, medication refills, appointment requests, and billing inquiries. Willingness to pay did not vary significantly by age (P = .06). Of all respondents, regardless of Internet access, 47.1% (n = 155) were willing to pay US $10 or more per year, with the median amount being US $20. Of those with Internet access (n = 248), 60.1% (n = 149) were willing to pay US $10 or more per year, and 31% were willing to pay US $50 or more per year. The three most important services to patients with Internet

  15. The effect of a PPO pay-for-performance program on patients with diabetes.

    PubMed

    Chen, Judy Y; Tian, Haijun; Taira Juarez, Deborah; Hodges, Krista A; Brand, Jennifer C; Chung, Richard S; Legorreta, Antonio P

    2010-01-01

    To investigate the effectiveness of a pay-for-performance program (P4P) to increase the receipt of quality care and to decrease hospitalization rates among patients with diabetes mellitus. Longitudinal study of patients with diabetes enrolled in a preferred provider organization (PPO) between January 1, 1999, and December 31, 2006. We used multivariate analyses to assess the effect of seeing P4P-participating physicians on the receipt of quality care (ie, glycosylated hemoglobin and low-density lipoprotein cholesterol testing) and on hospitalization rates, controlling for patient characteristics. Patients with diabetes who saw P4P-participating physicians were more likely to receive quality care than those who did not (odds ratio, 1.16; 95% confidence interval, 1.11-1.22; P <.001). Patients with diabetes who received quality care were less likely to be hospitalized than those who did not (incident rate ratio, 0.80; 95% confidence interval, 0.80-0.85; P <.001). During 1 year, there was no difference in hospitalization rates between patients with diabetes who saw P4P-participating physicians versus those who did not. However, patients with diabetes who saw P4P-participating physicians in 3 consecutive years were less likely to be hospitalized than those who did not (incident rate ratio, 0.75; 95% confidence interval, 0.61-0.93; P <.01). A P4P can significantly increase the receipt of quality care and decrease hospitalization rates among patients with diabetes in a PPO setting. Although it is possible that the differences observed between P4P-participating physicians and non-P4P-participating physicians were due to selection bias, we found no significant difference in the receipt of quality care between patients with diabetes who saw new P4P-participating physicians versus non-P4P-participating physicians during the baseline year. Further research should focus on defining the effect of P4Ps on intermediate outcomes such as glycosylated hemoglobin and low

  16. 42 CFR 22.1 - Duty at a station of the Service devoted to the care of Hansen's disease patients; additional pay.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... care of Hansen's disease patients; additional pay. 22.1 Section 22.1 Public Health PUBLIC HEALTH... Hansen's Disease Duty by Personnel Other Than Commissioned Officers § 22.1 Duty at a station of the Service devoted to the care of Hansen's disease patients; additional pay. (a) Non-commissioned...

  17. 42 CFR 22.1 - Duty at a station of the Service devoted to the care of Hansen's disease patients; additional pay.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... care of Hansen's disease patients; additional pay. 22.1 Section 22.1 Public Health PUBLIC HEALTH... Hansen's Disease Duty by Personnel Other Than Commissioned Officers § 22.1 Duty at a station of the Service devoted to the care of Hansen's disease patients; additional pay. (a) Non-commissioned...

  18. 42 CFR 22.1 - Duty at a station of the Service devoted to the care of Hansen's disease patients; additional pay.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... care of Hansen's disease patients; additional pay. 22.1 Section 22.1 Public Health PUBLIC HEALTH... Hansen's Disease Duty by Personnel Other Than Commissioned Officers § 22.1 Duty at a station of the Service devoted to the care of Hansen's disease patients; additional pay. (a) Non-commissioned...

  19. 42 CFR 22.1 - Duty at a station of the Service devoted to the care of Hansen's disease patients; additional pay.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... care of Hansen's disease patients; additional pay. 22.1 Section 22.1 Public Health PUBLIC HEALTH... Hansen's Disease Duty by Personnel Other Than Commissioned Officers § 22.1 Duty at a station of the Service devoted to the care of Hansen's disease patients; additional pay. (a) Non-commissioned...

  20. 42 CFR 22.1 - Duty at a station of the Service devoted to the care of Hansen's disease patients; additional pay.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... care of Hansen's disease patients; additional pay. 22.1 Section 22.1 Public Health PUBLIC HEALTH... Hansen's Disease Duty by Personnel Other Than Commissioned Officers § 22.1 Duty at a station of the Service devoted to the care of Hansen's disease patients; additional pay. (a) Non-commissioned...

  1. Tuberculosis treatment outcomes among retreatment patients registered by private practitioners in Myanmar.

    PubMed

    Win, A N; Edginton, M E; Hinderaker, S G; Minn, N N; Linn, A K

    2012-09-21

    The objectives of this retrospective cohort study were to report treatment outcomes and identify factors associated with treatment failure among all retreatment tuberculosis (TB) patients registered in the public-private mix DOTS programme of Populations Services International-Myanmar over 6 years. Among 3643 retreatment patients, 2657 (73%) were successfully treated and 309 (8.5%) failed. This study shows that retreatment patients who have failed treatment for their first TB episode are almost twice as likely to fail a second time (13.5%). We have identified some key programmatic challenges associated with retreatment TB in the private sector, and steps are being taken to address this issue.

  2. Should we pay the patient? Review of financial incentives to enhance patient compliance.

    PubMed Central

    Giuffrida, A.; Torgerson, D. J.

    1997-01-01

    OBJECTIVE: To determine whether financial incentives increase patients' compliance with healthcare treatments. DATA SOURCES: Systematic literature review of computer databases--Medline, Embase, PsychLit, EconLit, and the Cochrane Database of Clinical Trials. In addition, the reference list of each retrieved article was reviewed and relevant citations retrieved. STUDY SELECTION: Only randomised trials with quantitative data concerning the effect, of financial incentives (cash, vouchers, lottery tickets, or gifts) on compliance with medication, medical advice, or medical appointments were included in the review. Eleven papers were identified as meeting the selection criteria. DATA EXTRACTION: Data on study populations, interventions, and outcomes were extracted and analysed using odds ratios and the number of patients needed to be treated to improve compliance by one patient. RESULTS: 10 of the 11 studies showed improvements in patient compliance with the use of financial incentives. CONCLUSIONS: Financial incentives can improve patient compliance. PMID:9314754

  3. The patient's private and canons of science: Freud's case studies.

    PubMed

    Werbart, Andrzej

    2005-10-01

    Starting from Freud's classical case studies, the author highlights the tension between the psychoanalytical starting point in the subject's own meaning construction and the claims of the professional expert to objectivity, privileged knowledge and interpretative precedence. Psychoanalytic investigation of subjective phenomena came into existence parallel with Freud's magnificent project to furnish 'a psychology that shall be a natural science'. The privileged knowledge of the specialist was substituted by the explicit intention to listen to the individual's own stories and private explanatory constructions. In order to investigate the territory of the unconscious, Freud had to develop various strategies for uncovering and correcting errors, and for testing clinically anchored hypotheses. However, Freud regularly failed to follow his own intentions. The thesis the author presents here is that departures from the explicit ambition to follow the subject's own meaning construction, and departures from the scientific attitude, easy to trace in Freud's case studies, accompany each other. These departures have had far-reaching consequences for the present status of the psychoanalytic knowledge.

  4. Descriptive analysis of mycological examination of patients with onychomycosis treated in private practice*

    PubMed Central

    Veasey, John Verrinder; Nappi, Flávio; Zaitz, Clarisse; Muramatu, Laura Hitomi

    2017-01-01

    This is a retrospective study of 160 patients treated in private practice in São Paulo from March 2003 to March 2015. We analyzed 171 results of direct mycological examinations and fungal cultures from nail scrapings. The agreement between direct mycological examination results and fungal culture was satisfactory, consistent with the literature (kappa 0.603). The main agent identified was Trichophyton rubrum (51%). We observed an isolation rate of non-dermatophyte filamentous fungi superior to the literature (34%). Determining the agent is key to defining the appropriate onychomycosis treatment, and knowing the epidemiology of patients treated in private practice helps the dermatologist who works in this context. PMID:28225975

  5. The Effect of Service Quality on Patient loyalty: a Study of Private Hospitals in Tehran, Iran.

    PubMed

    Arab, M; Tabatabaei, Sm Ghazi; Rashidian, A; Forushani, A Rahimi; Zarei, E

    2012-01-01

    Service quality is perceived as an important factor for developing patient's loyalty. The aim of this study was to determine the hospital service quality from the patients' viewpoints and the relative importance of quality dimensions in predicting the patient's loyalty. A cross-sectional study was conducted in 2010. The study sample was composed of 943 patients selected from eight private general hospitals in Tehran. The survey instrument was a questionnaire included 24 items about the service quality and 3 items about the patient's loyalty. Exploratory factor analysis was employed to extracting the dimensions of service quality. Also, regression analysis was performed to determining the relative importance of the service quality dimensions in predicting the patient's loyalty. The mean score of service quality and patient's loyalty was 3.99 and 4.16 out of 5, respectively. About 29% of the loyalty variance was explained by the service quality dimensions. Four quality dimensions (Costing, Process Quality, Interaction Quality and Environment Quality) were found to be key determinants of the patient's loyalty in the private hospitals of Tehran. The patients' experience in relation to the private hospitals' services has strong impact on the outcome variables like willingness to return to the same hospital and reuse its services or recommend them to others. The relationship between the service quality and patient's loyalty proves the strategic importance of improving the service quality for dragging and retaining patients and expanding the market share.

  6. Willingness-to-pay for a rapid malaria diagnostic test and artemisinin-based combination therapy from private drug shops in Mukono district, Uganda

    PubMed Central

    Hansen, Kristian Schultz; Pedrazzoli, Debora; Mbonye, Anthony; Clarke, Sian; Cundill, Bonnie; Magnussen, Pascal; Yeung, Shunmay

    2013-01-01

    In Uganda, as in many parts of Africa, the majority of the population seek treatment for malaria in drug shops as their first point of care; however, parasitological diagnosis is not usually offered in these outlets. Rapid diagnostic tests (RDTs) for malaria have attracted interest in recent years as a tool to improve malaria diagnosis, since they have proved accurate and easy to perform with minimal training. Although RDTs could feasibly be performed by drug shop vendors, it is not known how much customers would be willing to pay for an RDT if offered in these settings. We conducted a contingent valuation survey among drug shop customers in Mukono District, Uganda. Exit interviews were undertaken with customers aged 15 years and above after leaving a drug shop having purchased an antimalarial and/or paracetamol. The bidding game technique was used to elicit the willingness-to-pay (WTP) for an RDT and a course of artemisinin-based combination therapy (ACT) with and without RDT confirmation. Factors associated with WTP were investigated using linear regression. The geometric mean WTP for an RDT was US$0.53, US$1.82 for a course of ACT and US$2.05 for a course of ACT after a positive RDT. Factors strongly associated with a higher WTP for these commodities included having a higher socio-economic status, no fever/malaria in the household in the past 2 weeks and if a malaria diagnosis had been obtained from a qualified health worker prior to visiting the drug shop. The findings further suggest that the WTP for an RDT and a course of ACT among drug shop customers is considerably lower than prevailing and estimated end-user prices for these commodities. Increasing the uptake of ACTs in drug shops and restricting the sale of ACTs to parasitologically confirmed malaria will therefore require additional measures. PMID:22589226

  7. [Difficulties in access to treatment for patients undergoing cataract surgery in public and private health systems].

    PubMed

    Kara-Júnior, Newton; Dellapi Jr, Roberto; Espíndola, Rodrigo França de

    2011-01-01

    To identify the difficulties in access to diagnosis and treatment of cataract in patients attended during a cataract campaign. A questionnaire was administered to patients selected for cataract surgery. We evaluated, among others, the following variables: prior access to ophthalmologists (public or private), reason(s) for not having surgery early in the initial service, the average cost charged by cataract surgery and intraocular lens (IOL) (private services and agreements). A total of 627 patients was evaluated. Most of them - 595 (95%) had previously attended an ophthalmologist, and in 63% of cases (375 patients) the consultation had been held for less than a year. The last evaluation was performed by the Brazilian Public Health System (SUS) in 52% of the cases (307 patients). Regarding the reason for not having surgery in the initial service, the high cost of the surgery (R$ 2.000 - R$ 4.000) and the cost of IOLs (R$ 1.000 - R$ 1.500) was the main obstacle for most attended services and private covenants. The results of this study suggest that the routine of ophthalmologic care in SUS at São Paulo is not prepared to answer the demand for cataract surgeries and private healthcare system still excludes a portion of the population. It is important to continue the implementation of community campaigns to serve the population that would be unable to access the surgery through conventional ways.

  8. Patients of internists in hospital outpatient departments and in private practice.

    PubMed Central

    Rudd, P.; Carrier, A. C.

    1978-01-01

    To test the contention that patients in outpatient departments and private practices differ, variables were assessed that might affect both the process and the outcome of medical care. Two groups of 60 patients consulting nine Montreal internists who worked in both private practice and in an outpatient department of a university teaching hospital were surveyed. The internists served as their own controls. The two groups of patients were compared for 57 demographic, socioeconomic, access, utilization, attitudinal and current medical status variables. Financial factors were minimized by the existence of universal health insurance. The outpatient group was found to be older, less fluent in English, less likely to be employed, less educated, less wealthy, more dependent on public transportation, more disabled, more likely to use ambulatory services, more anxious about health, and more sceptical about physicians, yet more dependent on them than the private practice group. The outpatient group tended to have more active, significant medical conditions and to receive more prescriptions for medication than the private practice group, in contrast to the national patterns in the practice of internal medicine in the United States. Medical educators, researchers, administrators and providers of health care who have assumed that these two groups of patients are comparable must re-evaluate their practices. PMID:737639

  9. Patient satisfaction and loyalty to the private hospitals in Sana'a, Yemen.

    PubMed

    Anbori, Ali; Ghani, Sirajoon Noor; Yadav, Hematram; Daher, Aqil Mohammad; Su, Tin Tin

    2010-08-01

    To evaluate patients' satisfaction and loyalty to private hospitals and to identify factors influencing patient loyalty. A cross-sectional, population-based study was conducted between May and September of 2005. Sana'a, the capital city of the Republic of Yemen. Eight hundred and nineteen respondents who were admitted for at least 1 day in a private hospital within last 6 months from the date of interview. The scores on the modified SERVQUAL market research instrument including six domains (tangibility, reliability, responsiveness, assurance, empathy and cost) that identify perceptions of service quality. In addition, the respondents were asked whether or not they would return to the same facility when they need future medical care (loyalty). Loyalty was higher among females [odds ratio (OR) = 1.44; P < 0.05], among those reporting higher reliability scores (OR = 1.24; P < 0.01), higher assurance scores (OR = 1.2; P < 0.01) and higher empathy scores (OR = 1.13; P < 0.05) and also among those reporting higher cost (OR = 1.15; P<0.05). No significant association was found between patient loyalty and, tangibility and responsiveness score. Improvements are required to achieve high-quality healthcare services in the private hospitals in Yemen and increase loyalty among patients. Findings from this study could inform private sector healthcare development in low- and middle-income countries.

  10. An empirical study of the impact of service quality on patient satisfaction in private hospitals, Iran.

    PubMed

    Zarei, Ehsan; Daneshkohan, Abbas; Pouragha, Behrouz; Marzban, Sima; Arab, Mohammad

    2014-07-29

    Perceived service quality is the most important predictor of patient satisfaction. The purpose of this study was to investigate the impact of the service quality on the overall satisfaction of patients in private hospitals of Tehran, Iran. This cross-sectional study was conducted in the year 2010. The study's sample consisted of 969 patients who were recruited from eight private general hospitals in Tehran, Iran using consecutive sampling. A questionnaire was used for data collection; contacting 21 items (17 items about service quality and 4 items about overall satisfaction) and its validity and reliability were confirmed. Data analysis was performed using t-test, ANOVA and multivariate regression. this study found a strong relationship between service quality and patient satisfaction. About 45% of the variance in overall satisfaction was explained by four dimensions of perceived service quality. The cost of services, the quality of the process and the quality of interaction had the greatest effects on the overall satisfaction of patients, but not found a significant effect on the quality of the physical environment on patient satisfaction. Constructs related to costs, delivery of service and interpersonal aspect of care had the most positive impact on overall satisfaction of patients. Managers and owners of private hospitals should set reasonable prices compared to the quality of service. In terms of process quality, waiting time for visits, admissions, and surgeries must be declined and services provided at the fastest possible time. It should be emphasized to strengthen of interpersonal aspects of care and communication skills of care providers.

  11. Prevalence of systemic diseases among patients requesting dental consultation in the public and private systems

    PubMed Central

    Garea-Gorís, Rafael; Fernández-Varela, Marta; Tomás-Carmona, Inmaculada; Diniz-Freitas, Marcio; Limeres-Posse, Jacobo

    2012-01-01

    Objectives: To determine the prevalence and aetiology of systemic disease among patients requesting dental treatment in public and private practice. Study Design: A retrospective analysis was performed of the medical histories of 2000 patients requesting dental treatment during the year 2009. One thousand patients came from the Fontiñas Primary Care Oral and Dental Health Unit of the Galician Health Service (SERGAS), Spain, and the other thousand from a private clinic; both clinics were situated in Santiago de Compostela, La Coruña, Spain. The data collected were the following: demographic data (age and sex), presence or absence of systemic diseases and the nosologic categories, and drug history (type and number of drugs). Results: The prevalence of systemic disease was significantly higher among patients seen in the public system (35.2% in the public system versus 28.1% in the private system; p= 0.003). The differences between the two systems were more marked when considering patients aged under 65 years, particularly with respect to rheumatic and endocrine-metabolic (diabetes) disorders. The prevalence of patients receiving polypharmacy (>4 drugs/day) was significantly higher among patients seen in the public system (5.7% in the public system versus 2.7% in the private system; p= 0.009). Conclusions: There is a high prevalence of medical disorders and of patients receiving polypharmacy among individuals requesting dental care, particularly in the public health system. Dentists must have adequate training in medical disease and must be fully integrated into primary care health teams in order to prevent or adequately resolve complications. Key words: Dentistry, medical history, systemic disease, polypharmacy. PMID:22157672

  12. Private physicians or walk-in clinics: do the patients differ?

    PubMed

    Dant, R P; Lumpkin, J R; Bush, R P

    1990-06-01

    The authors use a consumer-oriented framework to compare patients of private physicians with those of walk-in clinics in terms of factors that influence selection of health care providers. Data suggest few differences in the way the two types of providers are perceived by their patients. Instead, a fairly strong income effect suggests that segmentation strategies for health care delivery systems should be reevaluated. The results provide insights for applying strategic marketing concepts within health care delivery systems.

  13. Effect of pill burden on dosing preferences, willingness to pay, and likely adherence among patients with type 2 diabetes

    PubMed Central

    Hauber, A Brett; Han, Steven; Yang, Jui-Chen; Gantz, Ira; Tunceli, Kaan; Gonzalez, Juan Marcos; Brodovicz, Kimberly; Alexander, Charles M; Davies, Michael; Iglay, Kristy; Zhang, Qiaoyi; Radican, Larry

    2013-01-01

    Purpose To quantify willingness-to-pay (WTP) for reducing pill burden and dosing frequency among patients with type 2 diabetes mellitus (T2DM), and to examine the effect of dosing frequency and pill burden on likely medication adherence. Patients and methods Participants were US adults with T2DM on oral antihyperglycemic therapy. Each patient completed an online discrete-choice experiment (DCE) with eight choice questions, each including a pair of hypothetical medication profiles. Each profile was defined by reduction in average glucose (AG), daily dosing, chance of mild-to-moderate stomach problems, frequency of hypoglycemia, weight change, incremental risk of congestive heart failure (CHF), and cost. Patients were asked to rate their likely adherence to the profiles presented in each question. Choice questions were based on a predetermined experimental design. Choice data were analyzed using random-parameters logit. Likely treatment adherence was analyzed using a Heckman two-stage model. Results Of the 1,114 patients who completed the survey, 90 had lower dosing burden (<5 pills/day taken once/day or as needed) for all medications, and 1,024 had higher dosing burden (≥5 pills/day or more than once/day). Reduction in AG was valued most highly by patients. Hypoglycemia, chance of mild-to-moderate stomach problems, weight change, incremental risk of CHF, and daily dosing were less valued. Patients with higher current dosing burden had lower WTP for more convenient dosing schedules than patients with lower current dosing burden. Changes in dosing and cost impacted likely adherence. The magnitude of the impact of dosing on likely adherence was higher for patients with lower current dosing burden than for patients with higher current dosing burden. Conclusion Patients with T2DM were willing to pay for improvements in efficacy, side effects, and dosing. Patients’ WTP for more convenient dosing depended on current dosing burden, as did the effect of these attributes

  14. When should managed care firms terminate private benefits for chronically mentally ill patients?

    PubMed

    Gerson, S N

    1994-01-01

    Corporate America's healthcare cost crisis and the country's budget deficit are forcing limits on the resources used to finance healthcare, including mental healthcare. At the same time, the 1990 Americans with Disabilities Act bars discrimination against patients with chronic illnesses, including chronic mental illness. Therefore, corporate benefits managers need guidance on how to ethically and rationally allocate scarce clinical resources to those high-morbidity insureds who utilize disproportionate amounts of these resources. In particular, how should we define the public/private interface: When do patients who repeatedly fail to respond to treatment fall out of the private sector's responsibility? The author, medical director for a leading behavioral healthcare utilization management company, offers the following guidelines recommending reasonable and practical limitations on trials of treatment for seven common categories of difficult psychiatric patients.

  15. Public versus Private Drug Insurance and Outcomes of Patients Requiring Biologic Therapies for Inflammatory Bowel Disease

    PubMed Central

    Rumman, Amir; Candia, Roberto; Sam, Justina J.; Croitoru, Kenneth; Silverberg, Mark S.; Steinhart, A. Hillary

    2017-01-01

    Background. Antitumor necrosis factor (anti-TNF) therapy is a highly effective but costly treatment for inflammatory bowel disease (IBD). Methods. We conducted a retrospective cohort study of IBD patients who were prescribed anti-TNF therapy (2007–2014) in Ontario. We assessed if the insurance type was a predictor of timely access to anti-TNF therapy and nonroutine health utilization (emergency department visits and hospitalizations). Results. There were 268 patients with IBD who were prescribed anti-TNF therapy. Public drug coverage was associated with longer median wait times to first dose than private one (56 versus 35 days, P = 0.002). After adjusting for confounders, publicly insured patients were less likely to receive timely access to anti-TNF therapy compared with those privately insured (adjusted hazard ratio, 0.66; 95% CI: 0.45–0.95). After adjustment for demographic and clinical characteristics, publicly funded subjects were more than 2-fold more likely to require hospitalization (incidence rate ratio [IRR], 2.30; 95% CI: 1.19–4.43) and ED visits (IRR 2.42; 95% CI: 1.44–4.08) related to IBD. Conclusions. IBD patients in Ontario with public drug coverage experienced greater delays in access to anti-TNF therapy than privately insured patients and have a higher rate of hospitalizations and ED visits related to IBD. PMID:28239601

  16. Evidence-based perspectives on pay for performance and quality of patient care and outcomes in emergency medicine.

    PubMed

    Glickman, Seth W; Schulman, Kevin A; Peterson, Eric D; Hocker, Michael B; Cairns, Charles B

    2008-05-01

    Pay for performance is gaining momentum as a means to improve the quality of clinical care. Recently, the Centers for Medicare & Medicaid Services has expanded pay for performance initiatives to incorporate 9 emergency care metrics, including indicators for cardiac, pneumonia, and stroke care. The American College of Cardiology and American Heart Association (ACC/AHA) have published methodology for the selection and creation of performance measures for quantifying the quality of cardiovascular care. The purpose of this study is to grade each of the 9 Physician Quality Reporting Initiative emergency medicine process measures according to the ACC/AHA criteria related to clinical evidence (yes, no, indeterminate). Five of the 9 recently selected metrics in emergency medicine do not appear to meet all of the ACC/AHA criteria for measurement selection. Several of the metrics, including aspirin for acute myocardial infarction (mean hospital adherence 94.7%; SD 6.7%) and pulse oximetry for community-acquired pneumonia (mean 99.4%; SD 2.0%), already have high levels of performance nationally, which raises uncertainty about the overall cost-effectiveness of quality improvement interventions for these measures. Formal methodology needs to be established for future selection of performance measures for quality improvement programs in emergency care. These performance measures should focus on unique aspects of emergency and acute care, including recognition and treatment of time-sensitive life-threatening conditions, assessment of patients with undifferentiated signs and symptoms, and care of all-inclusive geographically based patient populations. In key emergency therapeutic areas, the evidence linking treatment and improved patient outcomes will require additional study before inclusion in pay for performance programs. New research initiatives are needed to assess the effect of timely administration of emergency department interventions on patient outcomes.

  17. Pay-for-performance: toxic to quality? Insights from behavioral economics.

    PubMed

    Himmelstein, David U; Ariely, Dan; Woolhandler, Steffie

    2014-01-01

    Pay-for-performance programs aim to upgrade health care quality by tailoring financial incentives for desirable behaviors. While Medicare and many private insurers are charging ahead with pay-for-performance, researchers have been unable to show that it benefits patients. Findings from the new field of behavioral economics challenge the traditional economic view that monetary reward either is the only motivator or is simply additive to intrinsic motivators such as purpose or altruism. Studies have shown that monetary rewards can undermine motivation and worsen performance on cognitively complex and intrinsically rewarding work, suggesting that pay-for-performance may backfire.

  18. Comparing the probability of stroke by the Framingham risk score in hypertensive Korean patients visiting private clinics and tertiary hospitals.

    PubMed

    Choi, Cheol Ung; Park, Chang Gyu

    2010-09-08

    The purpose of this study was to investigate the pattern of distribution of risk factors for stroke and the 10-year probability of stroke by the Framingham risk score in hypertensive patients visiting private clinics vs. tertiary hospitals. A total of 2,490 hypertensive patients who attended 61 private clinics (1088 patients) and 37 tertiary hospitals (1402 patients) were enrolled. The risk factors for stroke were evaluated using a series of laboratory tests and physical examinations, and the 10-year probability of stroke was determined by applying the Framingham stroke risk equation. The proportion of patients who had uncontrolled hypertension despite the use of antihypertensive agents was 49% (66 and 36% of patients cared for at private clinics and tertiary hospitals, respectively; p < 0.001). The average 10-year probability of stroke by the Framingham risk score in hypertensive patients was 21% (approximately 2.2 times higher than of the risk of stroke in the Korean Cancer Prevention Study [KCPS] cohort) and was higher in patients attending tertiary hospitals compared to private clinics (16 and 24% of patients attending private clinics and tertiary hospitals, respectively; p < 0.001). Since the 10-year probability of stroke by the Framingham risk score in hypertensive patients attending tertiary hospitals was higher than the risk for patients attending private clinics. We suggest that the more aggressive interventions are needed to prevent and early detect an attack of stroke in hypertensive patients attending tertiary hospitals.

  19. Intrauterine contraceptive devices: a comparison between their use in indigent and private patients.

    PubMed

    Willson, J R; Ledger, W J; Lowell, J

    1967-01-01

    Use of intrauterine contraception for an aggregate 8291 months in a group of 706 private patients (mean age 27.5 years, mean number of pregnancies 2.75, 9 nulligravidas) was analyzed and compared briefly with use in a group of 623 women from a lower socioeconomic level. Considering private patients only, 195 (27.6%) had intermenstrual bleeding after IUD insertion and 27 (3.8%) experienced an increase in the amount or duration of menstrual flow. All women had cramping after insertion of the Lippes loop (or Permaspiral in 2 patients); 43 (6.1%) expelled the device. Infection developed in 9 (1.3%), and perforation of the uterus during insertion of the loop occurred in 2 patients. The pregnancy rate for all users was 2.6 pregnancies per 100 years of use. Termination of intrauterine contraception in 216 (30.6%) was because of intermenstrual bleeding (89 women), increased menstrual flow (7), cramping (19), infection (8), spontaneous ejection (22), a sterilizing operation on either spouse (8), pregnancy when IUD inserted (2), pregnancy desired (37), and other personal reasons (6). The IUD continued to be acceptable to 535 (75.8%, including those sterilized or desiring pregnancy) of 706 upper and middle class women an aggregate of 6655 months of use. Private patients compared to clinic ones had a lower incidence of irregular bleeding (195 of 706 vs. 391 of 623), but more of them discontinued intrauterine contraception because of irregular or excessive bleeding (96 or 13.6% of private patients vs. 28 or 4.5% of clinic patients). The infection rate, total expulsion rate, and final rate for discontinuation due to expulsion were lower for private vs. clinic patients (1.3% vs. 8%, 6.1% vs. 15%, and 3% vs. 5.7%, respectively). It was found that the main advantage of the IUD, constant unburdensome protection against pregnancy, was important to both groups and that couples of any social class could effectively use intrauterine contraception. Differences in use are due to lesser

  20. Changing characteristics of psychiatric patients: private and public care in Chicago.

    PubMed

    Greenley, J R; Kepecs, J G; Henry, W E

    1982-01-01

    There is increasing evidence that the social and cultural characteristics of psychiatric patients have been changing over time. It is important from a professional and public policy point of view to understand better the nature of these changes, and to what they are related. This paper presents data showing that: 1) psychiatric care is increasingly reaching patients of lower socio-economic status, and 2) changes in patient characteristics are related to the growth in the proportion of psychiatric care given in organisationally based non-private practice settings.

  1. [Potential for intervention of private health insurers in discharge management using the example of stroke patients].

    PubMed

    Sterl, E; Böhme, J

    2016-06-01

    The study reveals that stroke patients today can still experience gaps in the provision of healthcare and fragmented therapy. This is often the case on transferral from the inpatient to outpatient sector, causing complications that could be avoided by means of good discharge management across all sectors. Private health insurance can actively support and positively influence the treatment process in the form of case management. Individual contact with stroke patients and their relatives allows for early planning and organisation of the next steps, and offers patients the support they need during a difficult phase of life.

  2. Insurance coverage and socioeconomic differences in patient choice between private and public health care providers in China.

    PubMed

    Wang, Qing; Zhang, Donglan; Hou, Zhiyuan

    2016-12-01

    The private health care sector has become an increasingly important complement to China's health care system. During the health care reform in 2009, China's central government established multiple initiatives to relax constraints on the growth of the private health care sector. However, private health services have not been growing as rapidly as private health care facilities. Using data from the China Health and Retirement Longitudinal Study collected between 2011 and 2013, this study investigated patient choice between private and public providers for outpatient care and estimated its relationship with health insurance and socioeconomic status (SES). The Heckman sample selection model was applied to address the problem of selection bias caused by a lack of awareness of provider ownership. We found that 82.1% of the outpatient care users were aware of their provider's ownership, and 23.8% chose private health care providers. Although patients with health insurance and higher SES were more likely to be aware of their provider's ownership, they preferred public providers over private providers. For example, having Urban Employee Basic Medical Insurance was associated with a 16.5% lower probability of choosing private providers than no health insurance. Respondents with the highest level of household expenditure had a 7.5% lower probability of choosing private providers than those with the lowest level of expenditure. The probability of choosing private providers were significantly lower by 4.0% among respondents with an education level of junior high school and above than those with no formal education. For private providers to play an effective role in the health care system, policies that have constrained the growth of the private sector should be changed, and more effort should be directed toward equalizing health insurance coverage for both types of providers.

  3. Measuring patient preferences by willingness to pay to avoid: the case of acute otitis media.

    PubMed

    Sorum, P C

    1999-01-01

    The aim of this study was to evaluate willingness to pay (WTP) to avoid as a method of eliciting relative values for use in expected-value (EV) decision making. Parents' preferences for the events and outcomes associated with acute otitis media (AOM) and its treatment were quantified by means of a questionnaire asking how much they would be willing to pay to avoid them. Their responses were then used to calculate the EVs of treating or not treating presumed AOM with antibiotics. The advantages of the WTP method were its simplicity, its analogy with everyday financial transactions, its explicit recognition of illness and its management as involving decreases in value, and its face validity. The disadvantages included the need to use another method (the standard gamble) to derive a value for death and the wide ranges and the poor test-retest reliability of individual parents' responses. Nonetheless, median WTP values and their ranges may prove useful in defining for physicians and policymakers the parameters of their practical management decisions. In the case of AOM, the EV of treating with antibiotics was, for the aggregate sample and for most individual parents, robustly superior because of parents' desire to avoid any increased risk of their children's death.

  4. An Empirical Study of the Impact of Service Quality on Patient Satisfaction in Private Hospitals, Iran

    PubMed Central

    Zarei, Ehsan; Daneshkohan, Abbas; Pouragha, Behrouz; Marzban, Sima; Arab, Mohammad

    2015-01-01

    Objective: Perceived service quality is the most important predictor of patient satisfaction. The purpose of this study was to investigate the impact of the service quality on the overall satisfaction of patients in private hospitals of Tehran, Iran. Method: This cross-sectional study was conducted in the year 2010. The study’s sample consisted of 969 patients who were recruited from eight private general hospitals in Tehran, Iran using consecutive sampling. A questionnaire was used for data collection; contacting 21 items (17 items about service quality and 4 items about overall satisfaction) and its validity and reliability were confirmed. Data analysis was performed using t-test, ANOVA and multivariate regression. Result: this study found a strong relationship between service quality and patient satisfaction. About 45% of the variance in overall satisfaction was explained by four dimensions of perceived service quality. The cost of services, the quality of the process and the quality of interaction had the greatest effects on the overall satisfaction of patients, but not found a significant effect on the quality of the physical environment on patient satisfaction. Conclusions: Constructs related to costs, delivery of service and interpersonal aspect of care had the most positive impact on overall satisfaction of patients. Managers and owners of private hospitals should set reasonable prices compared to the quality of service. In terms of process quality, waiting time for visits, admissions, and surgeries must be declined and services provided at the fastest possible time. It should be emphasized to strengthen of interpersonal aspects of care and communication skills of care providers. PMID:25560338

  5. Hemodialysis system privatization and patient survival: a report from a large registry Eastern Europe cohort.

    PubMed

    Ştefan, Gabriel; Podgoreanu, Eugen; Mircescu, Gabriel

    2015-01-01

    There has been a rapid increase in incident and prevalent rates of hemodialysis (HD) patients in Romania following the 2004 system privatization, but little is known about the impact of privatization on patient outcomes. We retrospectively examined the outcome during 1 year of 8161 prevalent HD patients registered in the Romanian Renal Registry at 31 December 2011. Standardized mortality ratio (SMR) was calculated for each for-profit (FP) and non-profit (NP) HD provider. The 12-month SMR across all HD chain providers was 1.27. FP Chain 1 and the "other" group had SMR similar to the reference level. The mortality rate was two times higher in public NP dialysis centers than the national reference. A stepwise Cox regression analysis identified older age, male gender, DN as primary renal disease and the HD chain provider to be independently associated with a higher mortality. Excepting patients treated by FP Chain 4, patients treated by all the other dialysis providers had a better outcome than those treated in NP facilities. In conclusion, the increase in number of patients treated was not doubled by an increase in their survival. In the context of an expanding dialysis marketplace that tends to consolidate around large for-profit (FP) providers, further exploration of indicators associated with mortality may guide future healthcare policy to improve patient outcomes.

  6. Private ownership of primary care providers associated with patient perceived quality of care

    PubMed Central

    Wei, Xiaolin; Yin, Jia; Wong, Samuel Y.S.; Griffiths, Sian M.; Zou, Guanyang; Shi, Leiyu

    2017-01-01

    Abstract Ownership of primary care providers varies in different cities in China. Shanghai represented the full public ownership model of primary providers; Shenzhen had public-owned but private-operated providers; and Hong Kong represented the full private ownership. The study aims to assess the association of primary care ownership and patient perceived quality of care in 3 Chinese megacities. We conducted multistage stratified random surveys in 2013 in the 3 cities. Quality scores of primary care were measured using the validated primary care assessment tools. Multivariate linear regression models were used to compare quality scores after controlling potential confounders of patient demographic, socioeconomic, and healthcare utilization factors. Overall, 797 primary care users in Shanghai, 802 in Shenzhen, and 1325 in Hong Kong participated in the study. The mean total quality scores were reported the highest in Shanghai (28.39), followed by Shenzhen (25.82) and then Hong Kong (25.21) (P < 0.001). Shanghai participants reported the highest scores for 1st contact accessibility, coordination of information, comprehensiveness of service availability, and culture competence, while Hong Kong participants reported the lowest for these domains (P < 0.001). Hong Kong participants from rich households reported higher total scores than those from poor households (P < 0.05); however, this was not found in Shanghai and Shenzhen. The study suggests that private primary care ownership may be associated with lower quality and less equitable care distribution. In China, it suggests that it may be beneficial to promote public-owned and nonprofit providers. Promoting privatization in primary care may be at the cost of quality and equity of primary care. PMID:28072718

  7. Doctor-Patient Relationship Between Individuals With Fibromyalgia and Rheumatologists in Public and Private Health Care in Mexico.

    PubMed

    Colmenares-Roa, Tirsa; Huerta-Sil, Gabriela; Infante-Castañeda, Claudia; Lino-Pérez, Leticia; Alvarez-Hernández, Everardo; Peláez-Ballestas, Ingris

    2016-10-01

    The aim of this article was to describe and analyze the doctor-patient relationship between fibromyalgia patients and rheumatologists in public and private health care contexts within the Mexican health care system. This medical anthropological study drew on hospital ethnography and patients' illness narratives, as well as the experiences of rheumatologists from both types of health care services. The findings show how each type of medical care subsystem shape different relationships between patients and doctors. Patient stigmatization, overt rejection, and denial of the disease's existence were identified. In this doctor-patient-with-fibromyalgia relationship, there are difficult encounters, rather than difficult patients. These encounters are more fluid in private consultations compared with public hospitals. The doctor-centered health care model is prevalent in public institutions. In the private sector, we find the characteristics of the patient-centered model coexisting with the traditional physician-centered approach.

  8. Evaluation of a structured educational programme for type 2 diabetes patients seen in private practice.

    PubMed

    Boegner, C; Fontbonne, A; Gras Vidal, M-F; Mouls, P; Monnier, L

    2008-06-01

    Structured education is necessary in the management of a chronic disease such as diabetes and should be readily offered to patients in different settings. Our aim was to demonstrate the feasibility and advantages of a group education programme for type 2 diabetic patients in a private setting in France. A programme of group education for patients with type 2 diabetes was initiated by a multidisciplinary group of volunteer healthcare providers, including general practitioners, specialists in diabetology and non-medical members. All volunteers received one day of training, and physicians were instructed to organize several sessions of group education for the type 2 diabetic patients who regularly attended their practice. The first 427 patients entering the programme were included in the study, and asked to fill in a questionnaire to assess their knowledge, beliefs and behaviours with regard to diabetes. Their physician filled in a medical form. Six months later, the same questionnaire and form were sent for follow-up information. At six months versus baseline, patients exhibited small, but consistent, improvements: (i) fasting glucose 142+/-42 mg/dL (P<0.04) vs 146+/-44 mg/dL (P<0.04); (ii) HbA(1c) 7.41+/-1.26% vs 7.57+/-1.33% (P<0.01); and (iii) all of the main parameters of diabetes self-management recorded in the study. The percentage of patients who inspected their feet at least once a week increased from 67 to 77% (P<0.001). Patients improved their knowledge of the disease and developed a more positive attitude towards their diabetes. Our study demonstrates that it is possible to organize educational sessions for diabetic patients in a private-practice setting. At six months, patients receiving these sessions showed benefits in terms of blood glucose control and other important markers of self-management of their disease.

  9. Do Professional Practices among Malaysian Private Healthcare Providers Differ? A Comparative Study using Simulated Patients.

    PubMed

    Alabid, Alamin Hassan M A; Ibrahim, Mohamed Izham Mohamed; Hassali, Mohamed Azmi

    2013-12-01

    Malaysia, a South East Asian country, legally permits general medical practitioners in private clinics to dispense medicines. This possibly can dilute the pharmacist role in the provision of healthcare and pharmaceutical care and deprive patients to benefit from these services. This study explored, assessed and compared the current status of medicines labeling, patient's counseling, and symptomatic diagnosis by general practitioners and community pharmacists. This study used trained Simulated Patients (SP), who participated in a scenario of common cold symptoms at private clinics and community pharmacies. SPs explored medication labeling, patients counseling and symptomatic diagnosis undertaken by general practitioners and community pharmacists. Later, study authors assessed and compared these practices. The study was conducted during June 2011 in Penang, Malaysia. The study used descriptive statistics and Fisher-exact test to analyze data. Regarding patients counseling standard, among 100 visits by simulated patients, 64 (64%) from community pharmacists provided information about the medicine name, its indication, dosage and route of administration versus 17 (42.5%) general practitioners during 40 visits (p=0.024). Concerning adherence to labeling standard, for instance, only in one pharmacy visit, (1%) the pharmacist wrote the name of the patient on the medication label versus in 32 (80%) of doctors' visits, the doctors adhered to this labeling standard (p<0.001). In all doctors' visits (n=40, 100%), SPs were asked about symptoms, whereas in 87 (87%) CPs' visits, pharmacists fulfilled this counseling standard (p=0.02). Although pharmacists showed less compliance to medicine labeling and symptomatic diagnosis compared to doctors, their counseling of patients was better. Separation will definitely contribute to more concentration of each provider on his/her roles and improve and direct the experiences and skills towards being more patient oriented.

  10. 'Waiting for' and 'waiting in' public and private hospitals: a qualitative study of patient trust in South Australia.

    PubMed

    Ward, Paul R; Rokkas, Philippa; Cenko, Clinton; Pulvirenti, Mariastella; Dean, Nicola; Carney, A Simon; Meyer, Samantha

    2017-05-05

    Waiting times for hospital appointments, treatment and/or surgery have become a major political and health service problem, leading to national maximum waiting times and policies to reduce waiting times. Quantitative studies have documented waiting times for various types of surgery and longer waiting times in public vs private hospitals. However, very little qualitative research has explored patient experiences of waiting, how this compares between public and private hospitals, and the implications for trust in hospitals and healthcare professionals. The aim of this paper is to provide a deep understanding of the impact of waiting times on patient trust in public and private hospitals. A qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals). Data collection occurred in 2012-13, and data were analysed using pre-coding, followed by conceptual and theoretical categorisation. Participants differentiated between experiences of 'waiting for' (e.g. for specialist appointments and surgery) and 'waiting in' (e.g. in emergency departments and outpatient clinics) public and private hospitals. Whilst 'waiting for' public hospitals was longer than private hospitals, this was often justified and accepted by public patients (e.g. due to reduced government funding), therefore it did not lead to distrust of public hospitals. Private patients had shorter 'waiting for' hospital services, increasing their trust in private hospitals and distrust of public hospitals. Public patients also recounted many experiences of longer 'waiting in' public hospitals, leading to frustration and anxiety, although they rarely blamed or distrusted the doctors or nurses, instead blaming an underfunded system and over-worked staff. Doctors and nurses were seen to be doing their best, and therefore trustworthy. Although public patients experienced longer 'waiting for' and 'waiting in' public hospitals, it did not lead to widespread distrust

  11. Who pays? How reimbursement impacts the emergency department.

    PubMed

    Downey, Lavonne; Zun, Leslie S; Burke, Trena; Jefferson, Tangula

    2014-01-01

    Nationwide from 1996 to 2004, the overall proportion of Emergency Department (ED) reimbursement ratios for outpatient ED visits decreased from 57% to 42%. The continued falling of ED reimbursement ratios, which is the share of ED charges that are ultimately paid, is an indicator of the financial pressures facing the ED. Once the healthcare reforms are put in place what will the impact be on reimbursement rates of overburdened and underfunded emergency departments. The purpose of this study is to examine if there is a declining disparity in payment rates for ED care based on payment sources in a safety net ED provider. Findings of this study could indicate how the healthcare reforms might impact these types of ED reimbursement ratios in the upcoming years. This was a retrospective study that examined randomly selected charts of all ED visits charts from May 2002 to May 2008 at a level one adult and pediatric emergency trauma center with 45,000 annual visits. This study was IRB approved. A regression model was used to predict if there was a relationship between amount received and types of insurance payers within the ED. A significant relationship was found between types of insurance (payers) as the independent variable, and the dependent variables of charges (p = .00), payments (p = .00), amount of adjustments (p= .00), and balance remaining after 90 days (p = .00). Who pays for the ED services does impact the ED's bottom line. The privately funded patients will provide an ED with a higher reimbursement ratio per year as compared to those patients who are publicly or self pay. This explains why EDs that provide care for 40% or more publicly or self pay patients have seen a decline in reimbursement ratios. Healthcare reform has the potential to change and possibly improve safety net ED rate of reimbursement depending on how private, public and self pay patients pay for ED services.

  12. Potential unintended financial consequences of pay-for-performance on the quality of care for minority patients.

    PubMed

    Karve, Amrita M; Ou, Fang-Shu; Lytle, Barbara L; Peterson, Eric D

    2008-03-01

    The purpose of this study was to determine whether pay-for-performance (PFP) increases existing racial care disparities. Medicare's PFP program provides financial rewards to hospitals whose care performance ranks in the highest quintile relative to peers and reduces funding to hospitals that rank in the lowest quintile. Pay-for-performance is designed to improve care but may disproportionately penalize hospitals caring for large minority populations. Using Medicare data, 3449 US hospitals were ranked by performance on PFP process measures for acute myocardial infarction (AMI), community-acquired pneumonia (CAP), and heart failure (HF). These rankings were compared with the percentage of African American (AA) patients in a center. We determined the eligibility for financial bonus (highest quintile ranking) or penalty (lowest quintile) among centers treating large AA populations (> or = 20%) versus not after adjusting for hospital facility (catheterization, percutaneous coronary intervention, surgery), academic status, number of hospital beds, location, patient volume, and region. The percentage of AA patients treated by a center was inversely associated with performance for AMI and CAP (P < .01) but not HF (P = .06). Relative to hospitals with < 20% AA, those with > or = 20% AA were less likely eligible for financial bonuses and more likely to face penalties: for AMI, adjusted odds ratio (OR) 0.7 (95% CI 0.5-1.0) and 1.8 (1.4-2.4), respectively; for CAP, OR 0.5 (95% CI 0.3-0.6) and 2.3 (1.8-2.9), respectively; for HF, OR 1.0 (95% CI 0.7-1.2) and 1.2 (0.9-1.5), respectively. Hospitals with large minority populations may be at financial risk under PFP. Thus, PFP may worsen existing racial care disparities.

  13. The value of private patient information in the physician-patient relationship: a game-theoretic account.

    PubMed

    De Jaegher, Kris

    2012-01-01

    This paper presents a game-theoretical model of the physician-patient relationship. There is a conflict of interests between physician and patient, in that the physician prefers the patient to always obtain a particular treatment, even if the patient would not consider this treatment in his interest. The patient obtains imperfect cues of whether or not he needs the treatment. The effect of an increase in the quality of the patient's private information is studied, in the form of an improvement in the quality of his cues. It is shown that when the patient's information improves in this sense, he may either become better off or worse off. The precise circumstances under which either result is obtained are derived.

  14. Excess costs associated with patients with pulmonary arterial hypertension in a US privately insured population.

    PubMed

    Kirson, Noam Y; Birnbaum, Howard G; Ivanova, Jasmina I; Waldman, Tracy; Joish, Vijay; Williamson, Todd

    2011-09-01

    Pulmonary arterial hypertension (PAH) is a rare but fatal disease. Little is known about the economic burden associated with PAH patients in the US. The objective of this study was to estimate excess direct costs associated with privately insured PAH patients in the US. From a privately insured claims database (>8 million beneficiaries, 2002-7), 471 patients with PAH were identified using the criteria: two or more claims for primary pulmonary hypertension (PH), International Classification of Diseases, ninth edition, clinical modification (ICD-9-CM) code 416.0; no left heart disease, lung diseases, chronic thromboembolic PH or miscellaneous PH diagnoses within 12 months prior or 1 month after the initial PH claim (index date); one or more claim for right heart catheterization (RHC) within 6 months prior to any PH claim or one or more claim for echocardiogram within 6 months prior to a specialist-diagnosed PH claim; aged 18-64 years. Patients with PAH were matched demographically to controls without PH. Patients were followed as long as continuously eligible; mean follow-up of PAH patients was 24.8 months. Chi-squared tests were used to compare baseline co-morbidities. Wilcoxon rank-sum tests were used to compare direct (medical and pharmaceutical) patient-month costs to insurers. The average age for PAH patients was 52.2 years, and 55.8% were women. Compared with controls, PAH patients had significantly higher baseline rates of co-morbidities (e.g. essential hypertension, diabetes mellitus and congestive heart failure) and a higher mean Charlson Co-morbidity Index score. Mean direct patient-month costs (year 2007 values) were $US2023 for PAH patients and $US498 for controls (p < 0.0001), yielding excess costs of $US1525. Sensitivity analysis restricting the sample to patients diagnosed following RHC yielded a 64% increase in excess costs relative to the original sample. Regarding cost drivers, inpatient services accounted for 45%, outpatient and other services

  15. Excess costs associated with patients with chronic thromboembolic pulmonary hypertension in a US privately insured population.

    PubMed

    Kirson, Noam Y; Birnbaum, Howard G; Ivanova, Jasmina I; Waldman, Tracy; Joish, Vijay; Williamson, Todd

    2011-11-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and potentially fatal disease. Little is known about the economic burden associated with CTEPH patients in the US. The objective of this study was to estimate excess direct costs associated with privately insured patients with CTEPH in the US. From a privately insured claims database (>8 million beneficiaries, 2002-7), 289 CTEPH patients were identified using the criteria: two or more claims for pulmonary hypertension (PH), International Classification of Diseases, ninth edition, clinical modification (ICD-9-CM) code 416.0 or 416.8; one or more claim for pulmonary embolism (ICD-9-CM: 415.1, V12.51; ICD-9 procedure: 38.7; Current Procedural Terminology [CPT]-4 code: 36010, 37620, 75825, 75940; Healthcare Common Procedure Coding System [HCPCS] code: C1880) within 12 months prior or 1 month after the initial PH claim (index date); one or more claim for right heart catheterization (RHC) within 6 months prior to any PH claim or one or more claim for echocardiogram within 6 months prior to a specialist-diagnosed PH claim; aged 18-64 years. Patients with CTEPH were matched demographically to controls without PH. Patients were followed as long as continuously eligible; mean follow-up in CTEPH patients was 21.5 months. Chi-squared tests were used to compare baseline co-morbidities. Wilcoxon rank-sum tests were used to compare direct (medical and pharmaceutical) patient-month costs to insurers. The average age for CTEPH patients was 52.2 years, and 57.1% were women. Compared with controls, CTEPH patients had significantly higher baseline rates of co-morbidities (e.g. essential hypertension, congestive heart failure and chronic pulmonary disease) and a higher mean Charlson Co-morbidity Index score. Mean direct patient-month costs (year 2007 values) were $US4782 for CTEPH patients and $US511 for controls (p < 0.0001). Sensitivity analysis restricting the sample to patients diagnosed following RHC yielded a 15

  16. Do Professional Practices among Malaysian Private Healthcare Providers Differ? A Comparative Study using Simulated Patients

    PubMed Central

    Alabid, Alamin Hassan M. A.; Ibrahim, Mohamed Izham Mohamed; Hassali, Mohamed Azmi

    2013-01-01

    Background: Malaysia, a South East Asian country, legally permits general medical practitioners in private clinics to dispense medicines. This possibly can dilute the pharmacist role in the provision of healthcare and pharmaceutical care and deprive patients to benefit from these services. Objective: This study explored, assessed and compared the current status of medicines labeling, patient’s counseling, and symptomatic diagnosis by general practitioners and community pharmacists. Material and Methods: This study used trained Simulated Patients (SP), who participated in a scenario of common cold symptoms at private clinics and community pharmacies. SPs explored medication labeling, patients counseling and symptomatic diagnosis undertaken by general practitioners and community pharmacists. Later, study authors assessed and compared these practices. The study was conducted during June 2011 in Penang, Malaysia. Results: The study used descriptive statistics and Fisher-exact test to analyze data. Regarding patients counseling standard, among 100 visits by simulated patients, 64 (64%) from community pharmacists provided information about the medicine name, its indication, dosage and route of administration versus 17 (42.5%) general practitioners during 40 visits (p=0.024). Concerning adherence to labeling standard, for instance, only in one pharmacy visit, (1%) the pharmacist wrote the name of the patient on the medication label versus in 32 (80%) of doctors’ visits, the doctors adhered to this labeling standard (p<0.001). In all doctors’ visits (n=40, 100%), SPs were asked about symptoms, whereas in 87 (87%) CPs’ visits, pharmacists fulfilled this counseling standard (p=0.02). Conclusion: Although pharmacists showed less compliance to medicine labeling and symptomatic diagnosis compared to doctors, their counseling of patients was better. Separation will definitely contribute to more concentration of each provider on his/her roles and improve and direct the

  17. SOEMPI: A Secure Open Enterprise Master Patient Index Software Toolkit for Private Record Linkage

    PubMed Central

    Toth, Csaba; Durham, Elizabeth; Kantarcioglu, Murat; Xue, Yuan; Malin, Bradley

    2014-01-01

    To mitigate bias in multi-institutional research studies, healthcare organizations need to integrate patient records. However, this process must be accomplished without disclosing the identities of the corresponding patients. Various private record linkage (PRL) techniques have been proposed, but there is a lack of translation into practice because no software suite supports the entire PRL lifecycle. This paper addresses this issue with the introduction of the Secure Open Enterprise Master Patient Index (SOEMPI). We show how SOEMPI covers the PRL lifecycle, illustrate the implementation of several PRL protocols, and provide a runtime analysis for the integration of two datasets consisting of 10,000 records. While the PRL process is slower than a non-secure setting, our analysis shows the majority of processes in a PRL protocol require several seconds or less and that SOEMPI completes the process in approximately two minutes, which is a practical amount of time for integration. PMID:25954421

  18. A listening perspective in psychotherapy with suicidal patients: Establishing convergence in therapists and patients private theories on suicidality and cure.

    PubMed

    Østlie, Kristin; Stänicke, Erik; Haavind, Hanne

    2016-05-30

    To explore ways that psychotherapists and suicidal patients handle suicidality as a topic, and how it impacts the bond between them. Nineteen suicidal patients and their therapists participated in a naturalistic study. Patients were interviewed before they started in therapy, and both patients and therapists were interviewed after three sessions and after one year. Whether suicidality was frequently or seldomly addressed during the sessions did not bear any direct influence on the establishment of a working alliance. Rather, the sense of being engaged in a process of change followed from the therapist's capacity to establish a wide listening perspective, with sensitivity towards their own uncertainties, as well as to implicit and explicit messages about the patient's state of mind. The "private theories" of suicidality and cure that were held by the two parties tended to converge as a result of their work together. If convergence was not established early on, what mattered was their capacity to detect and work on their divergences. Unaddressed divergences led to vicissitudes and eventually resignation. Listening and exploring divergences in private theories of cure mattered for the creation of a viable working alliance directed at the patient's efforts to live their life.

  19. The Effect of Service Quality on Patient loyalty: a Study of Private Hospitals in Tehran, Iran

    PubMed Central

    Arab, M; Tabatabaei, SM Ghazi; Rashidian, A; Forushani, A Rahimi; Zarei, E

    2012-01-01

    Background: Service quality is perceived as an important factor for developing patient’s loyalty. The aim of this study was to determine the hospital service quality from the patients’ viewpoints and the relative importance of quality dimensions in predicting the patient’s loyalty. Methods: A cross-sectional study was conducted in 2010. The study sample was composed of 943 patients selected from eight private general hospitals in Tehran. The survey instrument was a questionnaire included 24 items about the service quality and 3 items about the patient’s loyalty. Exploratory factor analysis was employed to extracting the dimensions of service quality. Also, regression analysis was performed to determining the relative importance of the service quality dimensions in predicting the patient’s loyalty. Result: The mean score of service quality and patient’s loyalty was 3.99 and 4.16 out of 5, respectively. About 29% of the loyalty variance was explained by the service quality dimensions. Four quality dimensions (Costing, Process Quality, Interaction Quality and Environment Quality) were found to be key determinants of the patient’s loyalty in the private hospitals of Tehran. Conclusion: The patients’ experience in relation to the private hospitals’ services has strong impact on the outcome variables like willingness to return to the same hospital and reuse its services or recommend them to others. The relationship between the service quality and patient’s loyalty proves the strategic importance of improving the service quality for dragging and retaining patients and expanding the market share. PMID:23193509

  20. Treatment of breast cancer patients from a public healthcare system in a private center: costs of care for a pilot public-private partnership in oncology

    PubMed Central

    Kaliks, Rafael Aliosha; Pontes, Lucíola de Barros; Bognar, Cinthia Leite Frizzera Borges; Santos, Kelly Cristine Carvalho; Bromberg, Sílvio Eduardo; do Amaral, Paulo Gustavo Tenório; Karnakis, Theodora; Chen, Michael; de Andrade, Cláudia Toledo; Dantas, Joacira; Escobosa, Daísa de Mesquita; Giglio, Auro Del

    2013-01-01

    ABSTRACT Objective: To describe the flow and costs associated with the diagnosis and treatment of patients with breast cancer who come from the public healthcare system and were treated at Hospital Israelita Albert Einstein. Methods: Between August 2009, and December 2011, 51 patients referred by the Unified Public Healthcare System (SUS) had access to Hospital Israelita Albert Einstein for diagnostic radiology, medical oncology, radiotherapy, and oncologic/ breast reconstruction surgery. The data were collected retrospectively from the hospital records, patient charts, pharmacy records, and from the hospital billing system. Results: The total sum spent for diagnosis and treatment of these 51 patients was US$ 1,457,500.00. This value encompassed expenses with a total of 85 hospitalizations, 2,875 outpatient visits, 16 emergency room visits, and all expenses associated with these stays at the hospital. The expenditure for treatment of each patient submitted to biopsy, breast conserving surgery, adjuvant chemotherapy without trastuzumab (a regime with taxane followed by anthracycline), radiotherapy, and 5 years of tamoxifen was approximately US$ 25,500.00. Conclusion: Strategies for cost-reduction of treatment in the private setting are necessary to enable future large-scale public-private partnerships in oncology. PMID:23843064

  1. Nordic privatization and private healthcare.

    PubMed

    Ovretveit, John

    2003-01-01

    The role of the private sector in public healthcare systems is much debated, but there is little research to inform the debate. In the Nordic countries the extent and type of private sector involvement is largely unknown and the changes and the consequences have not been studied. This paper presents a conceptual framework and some limited data about the changing private-public mix and privatization in the Nordic countries between 1985 and 2000. The data suggest a small increase in both private financing and provision which has accelerated in recent years, especially in specific healthcare fields such as diagnostic centres, dentistry, primary medical care and care for older people. The overall increase is small, but large in certain sectors. Differences between the countries can only be understood in relation to their historical, financial, economic and political context, even though there are many commonalities. Impact also is context dependent, but the findings do show a cross-country pattern of a willingness to experiment and a change in underlying assumptions. The findings show a more extensive interpenetration of private and public than previously recognized but more research is required, especially about changes in recent years about which data are scarce. The paper considers the factors driving these trends, the likely larger changes in the next 10 years and the possible consequences for patients, professionals, managers and governments. It notes the different ways governments can control or influence finance and provision. It proposes that the Nordic and other governments improve regulation and data collection about the private sector and consider influencing private providers through partnership arrangements, rather than leaving the developments to be shaped by growing consumer demands or market logic alone.

  2. Who's that sleeping in my bed? Potential and actual utilization of public and private in-patient beds in Irish acute public hospitals.

    PubMed

    O'Reilly, Jacqueline; Wiley, Miriam

    2010-10-01

    To examine the impact of the unusual public/private mix on public and private in-patient bed utilization within Irish acute public hospitals. Data from the Department of Health and Children and the Hospital In-Patient Enquiry were used to estimate and compare potential and actual utilization of public and private designated in-patient beds in 54 acute public hospitals from 2000 to 2004. Private in-patients used more bed days than were potentially available to them in 14.1% of hospital-year observations. The equivalent figure for public in-patients was 12.6%. Although the prevalence of excess utilization of private beds was relatively small, it did increase over the study period. Hospitals with excess private utilization were characterized by a relatively low proportion of private- or non-designated beds despite their patient profile being broadly similar to that of hospitals where there was no excess private utilization. Despite policies designed to limit private practice in Irish acute public hospitals, some hospitals have apparently been able to overcome these restrictions. In a system where financial incentives to treat private patients exist both for consultants and hospitals, it is not clear whether this excess private practice in public hospitals reflects a more efficient utilization of resources (when demand from public patients is low) or the displacement of public patients in favour of private patients. However, that a smaller number on hospital waiting lists possess private health insurance provides some support for the displacement hypothesis. Thus, it appears that policy-makers may need to reconsider attempts to ensure an appropriate division of acute public hospital resources between public and private patients.

  3. Differences between patients' expectations and satisfaction with nursing care in a private hospital in Jordan.

    PubMed

    Abdel Maqsood, Amal Samir; Oweis, Arwa I; Hasna, Fadia Shawqi

    2012-04-01

    A descriptive correlation study was conducted to describe the differences between patient expectations and satisfaction with nursing care, and to determine the relationships among patient's satisfaction with nursing care and selected sociodemographic variables. A convenience sample of 250 patients with different medical, surgical and gynaecologic diagnoses was recruited to participate in the study, which was carried out at a private hospital in Amman. Two research instruments and a sociodemographic data form were used for data collection: The Patient Expectations Questionnaire and Patient Satisfaction with Nursing Care Quality Questionnaire. The results indicated that patients were more satisfied with technical and ethical aspects of nursing care whereas they were less satisfied with nursing care during the night shift as well as with professional information provided by the nurses. The difference between patients' expectations and satisfaction was statistically significant. Patients' opinions regarding their expectations and their satisfaction with nursing care can be considered as an important opportunity for nurses to plan and implement appropriate strategies that improve the quality of nursing care.

  4. Cost-Effectiveness of a Diabetes Pay-For-Performance Program in Diabetes Patients with Multiple Chronic Conditions.

    PubMed

    Hsieh, Hui-Min; Gu, Song-Mao; Shin, Shyi-Jang; Kao, Hao-Yun; Lin, Yi-Chieh; Chiu, Herng-Chia

    2015-01-01

    Pay for performance (P4P) has been used as a strategy to improve quality for patients with chronic illness. Little was known whether care provided to individuals with multiple chronic conditions in a P4P program were cost-effective. This study investigated cost effectiveness of a diabetes P4P program for caring patients with diabetes alone (DM alone) and diabetes with comorbid hypertension and hyperlipidemia (DMHH) from a single payer perspective in Taiwan. Analyzing data using population-based longitudinal databases, we compared costs and effectiveness between P4P and non-P4P diabetes patient groups in two cohorts. Propensity score matching (PSM) was used to match comparable control groups for intervention groups. Outcomes included life-years, quality-adjusted life-years (QALYs), program intervention costs, cost-savings and incremental cost-effectiveness ratios (ICERs). QALYs for P4P patients and non-P4P patients were 2.80 and 2.71 for the DM alone cohort and 2.74 and 2.66 for the DMHH patient cohort. The average incremental intervention costs per QALYs was TWD$167,251 in the DM alone cohort and TWD$145,474 in the DMHH cohort. The average incremental all-cause medical costs saved by the P4P program per QALYs were TWD$434,815 in DM alone cohort and TWD$506,199 in the DMHH cohort. The findings indicated that the P4P program for both cohorts were cost-effective and the resulting return on investment (ROI) was 2.60:1 in the DM alone cohort and 3.48:1 in the DMHH cohort. We conclude that the diabetes P4P program in both cohorts enabled the long-term cost-effective use of resources and cost-savings, especially for patients with multiple comorbid conditions.

  5. A case of collegial communication and a patient who does not pay.

    PubMed

    Peltier, Bruce; Rosenblum, Alvin; Bebeau, Muriel J; Koerber, Anne

    2011-01-01

    Four individuals who teach ethics in dental schools comment on a case in which negative financial information is revealed by one dentist when transferring records of a potential patient to another dentist. All commentators find varying degrees of ethical problem with disclosing such information. Professional codes discourage this practice. All commentators stress the importance of the potential new dentist developing a relationship based on professional standards, with the greatest emphasis placed on the patient's health needs. Several of the commentators discuss positive ways of conducting a patient interview, including specific useful language.

  6. Using third-party financing to help today's patient pay for treatment and care.

    PubMed

    Morris, Rob

    2012-01-01

    Patients walking into your practice today are different than the ones you saw a few years ago. Larger deductibles and out-of-pocket costs may cause many of them to put off recommended treatment. What can you do to ease patients' cost concerns and help them move forward with the care they want and need? Creating a comprehensive financial policy that includes a third-party patient financing program is a good place to start. Here's how to ensure that you select the best program for you.

  7. Consulting private health care providers aggravates treatment delay in urban South African tuberculosis patients.

    PubMed

    Van Wyk, S S; Enarson, D A; Beyers, N; Lombard, C; Hesseling, A C

    2011-08-01

    An urban primary health care facility in Khayelitsha, South Africa. To determine the difference in total tuberculosis (TB) treatment delay in patients who initially seek care at National TB Control Programme (NTP) facilities after the onset of TB-related symptoms, compared to patients who initially seek care from non-NTP health care practitioners (HCP); and to describe the relative contributions of diagnostic, treatment initiation, patient and health system (HS) delay. A cross-sectional study of adult TB patients treated by the NTP. A total of 210 patients (median age 31 years) were enrolled from May to December 2009: 46% were male, and 58% were human immunodeficiency virus (HIV) infected. The median duration of total delay was 31 days, diagnostic delay 26, treatment initiation delay 0, patient delay 8 and HS delay 17 days. Initial visit to a non-NTP HCP was independently associated with total (P = 0.007), HS (P = 0.014) and diagnostic delays (P = 0.012). HIV infection was an independent risk factor for total (P = 0.047) and HS delay (P = 0.021); 27% of patients reported first going to a non-NTP HCP. Initial care sought from non-NTP HCP was the main determinant of total, HS and diagnostic delays. Engagement and education of private HCPs is recommended.

  8. Advanced Imaging Utilization Trends in Privately Insured Patients From 2007 to 2013.

    PubMed

    Horný, Michal; Burgess, James F; Cohen, Alan B

    2015-12-01

    The aim of the study was to investigate whether the increase in utilization of advanced diagnostic imaging for privately insured patients in 2011 was the beginning of a new trend in imaging utilization growth, or an isolated deviation from the declining trend that began in 2008. We extracted outpatient and inpatient CT, diagnostic ultrasound, MRI, and PET procedures from databases, for the years 2007 to 2013. This study extended previous work, covering 2012 to 2013, using the same methodology. For every year of the study period, we calculated the following: number of procedures per person-year covered by private health insurance; proportion of office and emergency visits that resulted in an imaging session; average payments per procedure; and total payments per person-year covered by private health insurance. Outpatient utilization of CT and PET decreased in both 2012 and 2013; outpatient utilization of MRI mildly increased in 2012, but then decreased in 2013. Outpatient utilization of diagnostic ultrasound showed a very different pattern, increasing throughout the study period. Inpatient utilization of all imaging modalities except PET decreased in both 2012 and 2013. Adjusted payments for all imaging modalities increased in 2012, and then dropped substantially in 2013, except the adjusted payments for diagnostic ultrasound that increased in 2013 again. The trend of increasing utilization of advanced diagnostic imaging seems to be over for some, but not all, imaging modalities. A combination of policy (eg, breast density notification laws), technologic advancement, and wider access seems to be responsible for at least part of an increasing utilization of diagnostic ultrasound. Copyright © 2015 American College of Radiology. All rights reserved.

  9. IDENTIFYING ELEVEN FACTORS OF SERVICE MARKETING MIX (4PS) EFFECTIVE ON TENDENCY OF PATIENTS TOWARD PRIVATE HOSPITAL

    PubMed Central

    Hosseini, Seyed Mojtaba; Etesaminia, Samira; Jafari, Mehrnoosh

    2016-01-01

    Introduction: One of the important factors of correct management is to identify the reasons for patient tendency toward private hospitals. This study measures these factors based on service marketing mixes. Patients and methods: This study used a cross sectional descriptive methodology. The study was conducted during 6 months in 2015. The studied population included patients of private hospitals in Tehran. Random sampling was used (n = 200). Data was collected by an author-made questionnaire for service marketing factors. Reliability and validity of the questionnaire were confirmed. Data analysis was done using factor analysis test in SPSS 20. Results: The results showed that constant attendance of physicians and nurses has the highest effect (0.707%) on patient tendency toward private hospitals. PMID:27999486

  10. Using qualitative methods to understand the determinants of patients' willingness to pay for cataract surgery: a study in Tanzania.

    PubMed

    Geneau, Robert; Massae, Patrick; Courtright, Paul; Lewallen, Susan

    2008-02-01

    Cataract is the leading cause of avoidable blindness in Africa. There are various documented barriers to the uptake of cataract surgery, cost being one of them. There is, however, little evidence regarding patients' willingness to pay (WTP) for cataract surgery in Africa and the best way to measure it. We conducted a grounded theory study in order to understand better cataract patients' WTP for surgery in Tanzania. A total of 47 cataract patients from three regions of Tanzania were interviewed. The interviews were tape-recorded and transcribed verbatim. The coding process involved identifying emerging themes and categories and their interconnection. Our study reveals that the main factors behind patients' WTP for cataract surgery are (1) the level of perceived need for sight and cataract surgery; (2) the decision-making processes at the family level and (3) the characteristics of local eye care programs. Our study shows that WTP concerns not only the patients but also their relatives. For most patients and families, the amount of $20-$30 is deemed reasonable for a sight-restoring procedure. It does not appear realistic for eye care program managers to charge the real cost of cataract surgery at present (about US $70-in Kilimanjaro). However, eye care programs can influence WTP for cataract surgery by providing quality services and by offering adequate counseling about the procedure. The qualitative findings enriched the interpretation of a previously reported quantitative survey and yield implications for both researchers and decision-makers using or relying on WTP methodologies in developing countries.

  11. Monetary Value of Quality-Adjusted Life Years (QALY) among Patients with Cardiovascular Disease: a Willingness to Pay Study (WTP).

    PubMed

    Moradi, Najmeh; Rashidian, Arash; Rasekh, Hamid Reza; Olyaeemanesh, Alireza; Foroughi, Mahnoosh; Mohammadi, Teymoor

    2017-01-01

    The aim of this study was to estimate the monetary value of a QALY among patients with heart disease and to identify its determinants. A cross-sectional survey was conducted through face-to-face interview on 196 patients with cardiovascular disease from two heart hospitals in Tehran, Iran, to estimate the value of QALY using disaggregated and aggregated approaches. The EuroQol-5 Dimension (EQ-5D) questionnaire, Visual Analogue Scale (VAS), Time Trade-Off (TTO) and contingent valuation WTP techniques were employed, first to elicit patients' preferences and then, to estimate WTP for QALY. The association of patients' characteristics with WTP for QALY, was assessed through Heckman selection model. The Mean willingness to pay per QALY, estimated by the disaggregated approach ranged from 2,799 to 3599 US dollars. It is higher than the values, estimated from aggregated methods (USD 2,256 to 3,137). However, in both approaches, the values were less than one Gross Domestic Product (GDP) per capita of Iran. Significant variables were: Current health state, education, age, marital status, number of comorbidities, and household's cost group. Our results challenge two major issues: the first, is a policy challenge which concerns the WHO recommendation to use less than 3 GDP per capita as a cost-effectiveness threshold value. The second, is an analytical challenge related to patients with zero QALY gain. More scrutiny is suggested on the issue of how patients with full health state valuation should be dealt with and what arbitrary value could be included in the estimation value of QALY when the disaggregated approach used.

  12. Private prayer as a suitable intervention for hospitalised patients: a critical review of the literature.

    PubMed

    Hollywell, Claire; Walker, Jan

    2009-03-01

    This critical review seeks to identify if there is evidence that private (personal) prayer is capable of improving wellbeing for adult patients in hospital. The review was conducted in the belief that the spiritual needs of hospitalised patients may be enhanced by encouragement and support to engage in prayer. Systematic review. A systematic approach was used to gather evidence from published studies. In the absence of experimental research involving this type of population, evidence from qualitative and correlational studies was critically reviewed. Results. The findings indicate that private prayer, when measured by frequency, is usually associated with lower levels of depression and anxiety. Most of the studies that show positive associations between prayer and wellbeing were located in areas that have strong Christian traditions and samples reported a relatively high level of religiosity, church attendance and use of prayer. Church attenders, older people, women, those who are poor, less well educated and have chronic health problems appear to make more frequent use of prayer. Prayer appears to be a coping action that mediates between religious faith and wellbeing and can take different forms. Devotional prayers involving an intimate dialogue with a supportive God appear to be associated with improved optimism, wellbeing and function. In contrast, prayers that involve pleas for help may, in the absence of a pre-existing faith, be associated with increased distress and possibly poorer function. Future research needs to differentiate the effects of different types of prayer. Encouragement to engage in prayer should be offered only following assessment of the patient's faith and likely content and form of prayer to be used. Hospitalised patients who lack faith and whose prayers involve desperate pleas for help are likely to need additional support from competent nursing and chaplaincy staff.

  13. What Predicts Patients' Willingness to Undergo Online Treatment and Pay for Online Treatment? Results from a Web-Based Survey to Investigate the Changing Patient-Physician Relationship.

    PubMed

    Roettl, Johanna; Bidmon, Sonja; Terlutter, Ralf

    2016-02-04

    Substantial research has focused on patients' health information-seeking behavior on the Internet, but little is known about the variables that may predict patients' willingness to undergo online treatment and willingness to pay additionally for online treatment. This study analyzed sociodemographic variables, psychosocial variables, and variables of Internet usage to predict willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the general practitioner (GP). An online survey of 1006 randomly selected German patients was conducted. The sample was drawn from an e-panel maintained by GfK HealthCare. Missing values were imputed; 958 usable questionnaires were analyzed. Variables with multi-item measurement were factor analyzed. Willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the GP were predicted using 2 multiple regression models. Exploratory factor analyses revealed that the disposition of patients' personality to engage in information-searching behavior on the Internet was unidimensional. Exploratory factor analysis with the variables measuring the motives for Internet usage led to 2 separate factors: perceived usefulness (PU) of the Internet for health-related information searching and social motives for information searching on the Internet. Sociodemographic variables did not serve as significant predictors for willingness to undergo online treatment offered by the GP, whereas PU (B=.092, P=.08), willingness to communicate with the GP more often in the future (B=.495, P<.001), health-related information-seeking personality (B=.369, P<.001), actual use of online communication with the GP (B=.198, P<.001), and social motive (B=.178, P=.002) were significant predictors. Age, gender, satisfaction with the GP, social motive, and trust in the GP had no significant impact on the willingness to pay additionally for online treatment, but it was predicted by

  14. Individual and social concerns in American surgical education: paying patients, prepaid health insurance, Medicare and Medicaid.

    PubMed

    O'Shea, John S

    2010-05-01

    The education of the U.S. surgeon was traditionally based on a system in which surgeons-in-training cared for a population of largely indigent patients in a setting of graded responsibility. To ensure an ethically appropriate bargain, senior surgeons served as mentors, assumed ultimate responsibility for the patient, and supervised the surgical care of the ward patient by the surgical trainee. During the 20th century, changes in health care financing challenged this comfortable accommodation between charity care and medical education. As others have also written, the introduction of prepaid health insurance plans such as Blue Cross/Blue Shield in the early third of the century, the rapid expansion of employment-based health benefits during World War II, and the enactment of the Medicare and Medicaid legislation under Titles XVIII and XIX of the Social Security Act all contributed to a dramatic reduction in hospital ward (i.e., service) populations. The tension between education and patient care remains incompletely resolved; the proper balance between supervision and graded responsibility for the resident is ultimately worked out on an individual basis. Newer issues facing U.S. surgical education, including the justifiable demand for greater transparency, are likely to upset this suspended truce and lead to renewed discussions about such fundamental concepts as the definition of the resident and the role of the patient in the education of future surgeons.

  15. P4P4P: An Agenda for Research on Pay for Performance for Patients

    PubMed Central

    Volpp, Kevin G.; Pauly, Mark V.; Loewenstein, George; Bangsberg, David

    2012-01-01

    Unhealthy behaviors are a major cause of poor health outcomes and high health care costs. In this Commentary, we describe an agenda for research to guide broader use of patient-targeted financial incentives either in conjunction with provider-targeted financial incentives (P4P) or in clinical contexts where provider-targeted approaches are unlikely to be effective. We discuss evidence of proven effectiveness and limitations of the existing evidence, reasons for underutilization of these approaches, and options for operationalizing wider use. Patient-targeted incentives have great potential, and systematic testing will help determine how they can best be used to improve population health. PMID:19124872

  16. Association between the Value-Based Purchasing pay for performance program and patient mortality in US hospitals: observational study

    PubMed Central

    Figueroa, Jose F; Tsugawa, Yusuke; Zheng, Jie; Orav, E John

    2016-01-01

    Objective To determine the impact of the Hospital Value-Based Purchasing (HVBP) program—the US pay for performance program introduced by Medicare to incentivize higher quality care—on 30 day mortality for three incentivized conditions: acute myocardial infarction, heart failure, and pneumonia. Design Observational study. Setting 4267 acute care hospitals in the United States: 2919 participated in the HVBP program and 1348 were ineligible and used as controls (44 in general hospitals in Maryland and 1304 critical access hospitals across the United States). Participants 2 430 618 patients admitted to US hospitals from 2008 through 2013. Main outcome measures 30 day risk adjusted mortality for acute myocardial infarction, heart failure, and pneumonia using a patient level linear spline analysis to examine the association between the introduction of the HVBP program and 30 day mortality. Non-incentivized, medical conditions were the comparators. A secondary outcome measure was to determine whether the introduction of the HVBP program was particularly beneficial for a subgroup of hospital—poor performers at baseline—that may benefit the most. Results Mortality rates of incentivized conditions in hospitals participating in the HVBP program declined at −0.13% for each quarter during the preintervention period and −0.03% point difference for each quarter during the post-intervention period. For non-HVBP hospitals, mortality rates declined at −0.14% point difference for each quarter during the preintervention period and −0.01% point difference for each quarter during the post-intervention period. The difference in the mortality trends between the two groups was small and non-significant (difference in difference in trends −0.03% point difference for each quarter, 95% confidence interval −0.08% to 0.13% point difference, P=0.35). In no subgroups of hospitals was HVBP associated with better outcomes, including poor performers at baseline

  17. Association between the Value-Based Purchasing pay for performance program and patient mortality in US hospitals: observational study.

    PubMed

    Figueroa, Jose F; Tsugawa, Yusuke; Zheng, Jie; Orav, E John; Jha, Ashish K

    2016-05-09

    To determine the impact of the Hospital Value-Based Purchasing (HVBP) program-the US pay for performance program introduced by Medicare to incentivize higher quality care-on 30 day mortality for three incentivized conditions: acute myocardial infarction, heart failure, and pneumonia. Observational study. 4267 acute care hospitals in the United States: 2919 participated in the HVBP program and 1348 were ineligible and used as controls (44 in general hospitals in Maryland and 1304 critical access hospitals across the United States). 2 430 618 patients admitted to US hospitals from 2008 through 2013. 30 day risk adjusted mortality for acute myocardial infarction, heart failure, and pneumonia using a patient level linear spline analysis to examine the association between the introduction of the HVBP program and 30 day mortality. Non-incentivized, medical conditions were the comparators. A secondary outcome measure was to determine whether the introduction of the HVBP program was particularly beneficial for a subgroup of hospital-poor performers at baseline-that may benefit the most. Mortality rates of incentivized conditions in hospitals participating in the HVBP program declined at -0.13% for each quarter during the preintervention period and -0.03% point difference for each quarter during the post-intervention period. For non-HVBP hospitals, mortality rates declined at -0.14% point difference for each quarter during the preintervention period and -0.01% point difference for each quarter during the post-intervention period. The difference in the mortality trends between the two groups was small and non-significant (difference in difference in trends -0.03% point difference for each quarter, 95% confidence interval -0.08% to 0.13% point difference, P=0.35). In no subgroups of hospitals was HVBP associated with better outcomes, including poor performers at baseline. Evidence that HVBP has led to lower mortality rates is lacking. Nations considering similar pay for

  18. Education does pay off: pneumococcal vaccine screening and administration in hospitalized adult patients with pneumonia.

    PubMed

    Kruspe, Rachel; Lillis, Rebecca; Daberkow, Dayton W; Blais, Christopher M; Wilbright, Wayne; Gupta, Shaminder; Gould, Cynthia A; Sun, Tony; Martinez, Jorge A; deBoisblanc, Ben; Ladabaum, Uri; Sanders, Charles V; Lopez, Fred A

    2003-01-01

    Streptococcus pneumoniae-associated infections are an important cause of hospitalization and mortality in high-risk and elderly patients. Even in the setting of appropriate therapy, the case fatality rate of invasive pneumococcal disease in the elderly may approach 40%. Since approximately 40,000 people die annually from pneumococcal-associated disease, it represents a substantial target for vaccine-preventable, bacterial fatalities. The 23-valent pneumococcal polysaccharide vaccine has proven consistently effective in preventing invasive pneumococcal disease. Despite its endorsement by numerous specialty societies, the pneumococcal vaccine is underutilized in the inpatient setting. In a recent report of quality indicators for Medicare beneficiaries, the percentage of Medicare beneficiaries in Louisiana admitted with pneumonia who were screened or received the pneumococcal vaccination prior to discharge was only 4%, the lowest percentage in the United States. The Louisiana State University-New Orleans Internal Medicine Department and its house staff embarked upon a retrospective study to determine its baseline pneumococcal vaccination or screening rates for all patients with pneumonia on its inpatient services at the The Medical Center of Louisiana in New Orleans from July 2000 through June 2001. From July 2001 through June 2002 an intensive educational intervention concentrating on the indications and benefits of pneumococcal vaccination was directed toward the Louisiana State University Internal Medicine house staff assigned to the inpatient service. Retrospective analysis for pneumococcal vaccine screening and administration of charts of all patients with pneumonia on the LSU Medicine service from July 2001 through June 2002 was performed in order to determine the effects of the intervention. Data from the pre-educational intervention period revealed a baseline pneumococcal vaccine screening or administration rate of 11% for all patients with pneumonia on the

  19. Effects of Physician-Targeted Pay-for-Performance on Use of Spontaneous Breathing Trials in Mechanically Ventilated Patients.

    PubMed

    Barbash, Ian J; Pike, Francis; Gunn, Scott R; Seymour, Christopher W; Kahn, Jeremy M

    2016-12-12

    Rationale Pay-for-performance is an increasingly common quality improvement strategy despite the absence of robust supporting evidence. Objectives To determine the impact of a financial incentive program rewarding physicians for the completion of daily spontaneous breathing trials (SBTs) in three academic hospitals. Methods We compared data from mechanically ventilated patients from six months before to two years after introduction of a financial incentive program that provided annual payments to critical care physicians contingent on unit-level SBT completion rates. We used Poisson regression to compare the frequency of days on which SBTs were completed among eligible patients and days on which patients were excluded from SBT eligibility among all mechanically ventilated patients. We used multivariate regression to compare risk-adjusted duration of mechanical ventilation and in-hospital mortality. Measurements and Main Results The cohort included 7,291 mechanically ventilated patients with 75,621 ventilator days. Baseline daily SBT rates were 96.8% (Hospital A), 16.4% (Hospital B), and 74.7% (Hospital C). In hospital A, with the best baseline performance, there was no change in SBT rates, exclusion rates, or duration of mechanical ventilation across time periods. In hospitals B and C, with lower SBT completion rates at baseline, there was an increase in daily SBT completion rates and a concomitant increase in exclusions from eligibility. Duration of mechanical ventilation decreased in hospital C but not hospital B. Mortality was unchanged for all hospitals. Conclusions In hospitals with low baseline SBT completion, physician-targeted financial incentives were associated with increased SBT rates driven in part by increased exclusion rates, without consistent improvements in outcome.

  20. Measuring melasma patients' quality of life using willingness to pay and time trade-off methods in thai population

    PubMed Central

    2011-01-01

    Background Melasma is a common hyperpigmentation disorder that has a significant effect on an individual's quality of life. However, there is no preference-based measurement that reflects quality of life in patients with melasma. The objective of this study was to assess the impact of melasma on quality of life by using a health status measurement - the Dermatology Life Quality Index (DLQI) - and a preference-based measurement - Willingness to Pay (WTP) and Time Trade-Off (TTO). Methods A cross-sectional descriptive study was conducted. Seventy-eight patients with melasma who attended the melasma clinic at Siriraj Hospital from February to March 2009 were recruited in this study. The Thai version of the DLQI, questionnaires about WTP, standard TTO, and daily TTO were used to assess patients' quality of life. Results Seventy-seven (98.7%) patients were female with a mean age of 47.8 ± 7.9 years. The mean health utility based on standard TTO was 0.96. The utility obtained by the daily TTO method was 0.92 and was significantly correlated with an economically inactive occupation (p < 0.05). The mean monthly WTP for the most effective treatment was 1,157 baht (7.2% of monthly income), ranging from 100 to 5,000 baht (1 USD ~ 35.1 baht). The WTP was significantly correlated with monthly personal income and the total DLQI score. Conclusion The WTP method could be a useful tool with which to measure the quality of life of patients with melasma. PMID:22182399

  1. Mystery Of The Chargemaster: Examining The Role Of Hospital List Prices In What Patients Actually Pay.

    PubMed

    Batty, Michael; Ippolito, Benedic

    2017-04-01

    Hospitals in the United States maintain chargemasters that contain the official list prices for all billable services. The prices vary widely across hospitals and are more than three times what hospitals are paid for treating a patient, on average. From this it is tempting to conclude that list prices are a strange, yet ultimately inconsequential, quirk of US health care. However, using both state and national data sets covering the period 2002-14, we found considerable evidence suggesting that list prices reflect hospitals' strategic behavior and have meaningful effects on payments made by and on behalf of patients. Specifically, we found that list prices varied predominantly across hospitals and within markets, were well predicted by observable hospital characteristics, and were positively related to prices actually paid by patients and their insurers. Moreover, analyses of data before and after the implementation of California's Hospital Fair Pricing Act suggest that high list prices causally increased payments from the uninsured. However, list prices had at most a limited relationship with care quality. Project HOPE—The People-to-People Health Foundation, Inc.

  2. Treatment and prevention of malaria in pregnancy in the private health sector in Uganda: implications for patient safety.

    PubMed

    Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus; Clarke, Siân E; Lal, Sham; Hansen, Kristian S; Magnussen, Pascal; LaRussa, Philip

    2016-04-14

    of people at risk of malaria, P = 0.02 and availability of malaria treatment guidelines, P = 0.03 were the factors that most influenced correct treatment of fever in pregnancy. Treatment of fever during pregnancy was poor in this study setting. These data highlight the need to develop interventions to improve patient safety and quality of care for pregnant women in the private health sector in Uganda.

  3. IDENTIFYING ELEVEN FACTORS OF SERVICE MARKETING MIX (4PS) EFFECTIVE ON TENDENCY OF PATIENTS TOWARD PRIVATE HOSPITAL.

    PubMed

    Hosseini, Seyed Mojtaba; Etesaminia, Samira; Jafari, Mehrnoosh

    2016-10-01

    One of the important factors of correct management is to identify the reasons for patient tendency toward private hospitals. This study measures these factors based on service marketing mixes. This study used a cross sectional descriptive methodology. The study was conducted during 6 months in 2015. The studied population included patients of private hospitals in Tehran. Random sampling was used (n = 200). Data was collected by an author-made questionnaire for service marketing factors. Reliability and validity of the questionnaire were confirmed. Data analysis was done using factor analysis test in SPSS 20. The results showed that constant attendance of physicians and nurses has the highest effect (0.707%) on patient tendency toward private hospitals.

  4. Will hypertension performance measures used for pay-for-performance programs penalize those who care for medically complex patients?

    PubMed Central

    Petersen, Laura A.; Woodard, LeChauncy D.; Henderson, Louise M.; Urech, Tracy H.; Pietz, Kenneth

    2009-01-01

    Background There is concern that performance measures, patient ratings of their care, and pay-for-performance programs may penalize health care providers of patients with multiple chronic co-existing conditions. We examined the impact of co-existing conditions on the quality of care for hypertension and patient perception of overall quality of their health care. Methods and Results 141,609 veterans with hypertension were classified into 4 condition groups: those with hypertension-concordant (diabetes, ischemic heart disease, dyslipidemia) and/or discordant (arthritis, depression, chronic obstructive pulmonary disease) conditions, or neither. We measured blood pressure control at the index visit, overall good quality of care for hypertension including a follow-up interval, and patient ratings of satisfaction with their care. Association between condition type and number of co-existing conditions on receipt of overall good quality of care were assessed using logistic regression. Relationship between patient assessment and objective measures of quality was assessed. Of the cohort, 49.5% had concordant-only comorbidities, 8.7% had discordant-only comorbidities, 25.9% had both, and 16.0% had none. Odds of receiving overall good quality after adjusting for age were higher for those with concordant comorbidities (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.70–1.87), discordant comorbidities (OR, 1.32; 95% CI 1.23–1.41) or both (OR, 2.25; 95% CI, 2.13–2.38), compared with neither. Findings did not change after adjusting for illness severity and/or number of primary care and specialty care visits. Patient assessment of quality did not vary by the presence of coexisting conditions and was not related to objective ratings of quality of care. Conclusions Contrary to expectation, patients with greater complexity had higher odds of receiving high quality care for hypertension. Subjective ratings of care did not vary with the presence or absence of the comorbid

  5. Does pay-for-performance benefit patients with multiple chronic conditions? Evidence from a universal coverage health care system.

    PubMed

    Chen, Chi-Chen; Cheng, Shou-Hsia

    2016-02-01

    Numerous studies have examined the impact of pay-for-performance (P4P) programmes, yet little is known regarding their effects on continuity of care (COC) and the role of multiple chronic conditions (MCCs). This study aimed to examine the effects of a P4P programme for diabetes care on health care provision, COC and health care outcomes in diabetic patients with and without comorbid hypertension. This study utilized a large-scale natural experiment with a 4-year follow-up period under a compulsory universal health insurance programme in Taiwan. The intervention groups consisted of patients with diabetes who were enrolled in the P4P programme in 2005. The comparison groups were selected via propensity score matching with patients who were seen by the same group of physicians. A difference-in-differences analysis was conducted using generalized estimating equation models to examine the effects of the P4P programme. Significant impacts were observed after the implementation of the P4P programme for diabetic patients with and without hypertension. The programme increased the number of necessary examinations/tests and improved the COC between patients and their physicians. The programme significantly reduced the likelihood of diabetes-related hospital admissions and emergency department visits [odds ratio (OR): 0.71; 95% confidence interval (CI): 0.63-0.80 for diabetic patients with hypertension; OR: 0.74; 95% CI: 0.64-0.86 for patients without hypertension]. However, the effects of the P4P programme diminished to some extent in the second year after its implementation. This study suggests that a financial incentive programme may improve the provision of necessary health care, COC and health care outcomes for diabetic patients both with and without comorbid hypertension. Health authorities could develop policies to increase participation in P4P programmes and encourage continued improvement in health care outcomes. © The Author 2015. Published by Oxford University

  6. Paying for healthy rivers.

    PubMed

    Pigram, J J J

    2002-01-01

    Concerted efforts are being made at state and federal levels to restore Australia's rivers and waterways to a healthy condition. Yet, there is little consensus on what constitutes a "healthy river" and even less on how to achieve this, or how far to go towards restoration. Some advocate removal of storages and weirs along rivers to revert to some natural state. Others, particularly water users, question the trade-offs involved in leaving more water in the rivers and how the costs of restoration are to be met. At present it seems that the major share of the costs is borne by irrigators, with the wider community essentially enjoying a "free-ride". This situation is justified on the basis of the impactor pays principle whereby water diversions, primarily for irrigation, are held to have contributed most to degradation of the river systems. The altemative-beneficiary pays principle--is of more relevance where demands are made on resource users to mitigate environmental impacts or bring about environmental improvements, eg. healthy rivers, where the beneficiaries are the wider public and the general community. Many resource users are voluntarily undertaking action on private land to conserve biodiversity and achieve sustainability. In these circumstances, the cost-sharing principle should apply, with governments, interest groups and the community contributing to the investment required to attain the desired resource condition objectives.

  7. Mortality, length of stay, and inpatient charges for heart failure patients at public versus private hospitals in South Korea.

    PubMed

    Kim, Sun Jung; Park, Eun-Cheol; Kim, Tae Hyun; Yoo, Ji Won; Lee, Sang Gyu

    2015-05-01

    This study compared in-hospital mortality within 30 days of admission, lengths of stay, and inpatient charges among patients with heart failure admitted to public and private hospitals in South Korea. We obtained health insurance claims data for all heart failure inpatients nationwide between November 1, 2011 and May 31, 2012. These data were then matched with hospital-level data, and multi-level regression models were examined. A total of 8406 patients from 253 hospitals, including 31 public hospitals, were analyzed. The in-hospital mortality rate within 30 days of admission was 0.92% greater and the mean length of stay was 1.94 days longer at public hospitals than at private hospitals (mortality: 5.18% and 4.26%, respectively; LOS: 12.08 and 10.14 days, respectively). The inpatient charges were 11.4% lower per case and 24.5% lower per day at public hospitals than at private hospitals. After adjusting for patient- and hospital-level confounders, public hospitals had a 1.62-fold higher in-hospital mortality rate, a 16.5% longer length of stay, and an 11.7% higher inpatient charge per case than private hospitals, although the charges of private hospitals were greater in univariate analysis. We recommend that government agencies and policy makers continue to monitor quality of care, lengths of stay in the hospital, and expenditures according to type of hospital ownership to improve healthcare outcomes and reduce spending.

  8. Who Pays? Coverage Challenges for Cardiovascular Genetic Testing in U.S. Patients

    PubMed Central

    Spoonamore, Katherine G.; Johnson, Nicole M.

    2016-01-01

    Inherited cardiovascular (CV) conditions are common, and comprehensive care of affected families often involves genetic testing. When the clinical presentations of these conditions overlap, genetic testing may clarify diagnoses, etiologies, and treatments in symptomatic individuals and facilitate the identification of asymptomatic, at-risk relatives, allowing for often life-saving preventative care. Although some professional society guidelines on inherited cardiac conditions include genetic testing recommendations, they quickly become outdated owing to the rapid expansion and use of such testing. Currently, these guidelines primarily discuss the benefits of targeted genetic testing for identifying at-risk relatives. Although most insurance policies acknowledge the benefit and the necessity of this testing, many exclude coverage for testing altogether or are vague about coverage for testing in probands, which is imperative if clinicians are to have the best chance of accurately identifying pathogenic variant(s) in a family. In response to uncertainties about coverage, many commercial CV genetic testing laboratories have shouldered the burden of working directly with commercial payers and protecting patients/institutions from out-of-pocket costs. As a result, many clinicians are unaware that payer coverage policies may not match professional recommendations for CV genetic testing. This conundrum has left patients, clinicians, payers, and laboratories at an impasse when determining the best path forward for meaningful and sustainable testing. Herein, we discuss the need for all involved parties to recognize their common goals in this process, which should motivate collaboration in changing existing frameworks and creating more sustainable access to genetic information for families with inherited CV conditions. PMID:27303673

  9. Examining adherence among challenging patients in public and private HIV care in Argentina

    PubMed Central

    Jones, Deborah; Cook, Ryan; Cecchini, Diego; Sued, Omar; Bofill, Lina; Weiss, Stephen; Waldrop-Valverde, Drenna; Lopez, Maria R; Spence, Andrew

    2015-01-01

    Treatment engagement, retention and adherence to care are required for optimal HIV outcomes. Yet, patients may fall below the treatment recommendations for achieving undetectable viral load or not be retained in care. This study examined the most challenging patients in Buenos Aires, Argentina, those non-adherent to HIV care. Men (n = 61) and women (n = 59) prescribed antiretrovirals (ARVs) and non-adherent to treatment in the prior 3 to 6 months were enrolled and assessed regarding adherence, knowledge, motivation and attitudes regarding treatment. Private clinic patients had lower viral load and higher self-reported adherence than public clinic patients. Motivations to be adherent and positive beliefs regarding ARVs were associated with increased adherence in public clinic participants. Increased self-efficacy was associated with increased adherence among participants from both clinics. Results support patient and provider interventions that strengthen the characteristics supporting adherence, engagement and retention in public and private clinic settings. Resumen El compromiso, la retención en el cuidado y adherencia al tratamiento son esenciales para el manejo óptimo del paciente con VIH. Sin embargo, muchos pacientes con VIH no siguen las el tratamiento para lograr tener una carga viral indetectable, o no permanecen bajo cuidado médico. Este estudio examina los pacientes más difíciles de retener en el cuidado médico en Buenos Aires, Argentina. Hombres (n = 61) y mujeres (n = 59) a los que se les habían recetado antiretrovirales pero seguían el tratamiento en los últimos 3 - 6 meses participaron en el estudio. Adherencia, conocimiento, motivación y actitudes frente al tratamiento fueron evaluados. Los pacientes en la clínica privada tenían menor carga viral y mejor adherencia que los de la clínica pública. Motivación y pensamientos positivos con respecto a antiretrovirales estaban asociados con mejor adherencia en los pacientes de la clínica p

  10. Innovative strategies for self-pay segmentation.

    PubMed

    Boehler, Adam; Hansel, John

    2006-01-01

    Risk segmentation of self-pay accounts can help healthcare financial managers determine where to use collection resources. Assessment of self-pay patients should consider each patient's estimated financial condition and potential eligibility for charity care of public assistance patients. Segmenting patients on the basis of demographic variances and potential fraud can help hospitals increase self-pay collections and reduce A/R days.

  11. [Discrepancy in attitudes toward diabetes between physicians and diabetic patients attending the private, social security or state medical services].

    PubMed

    Salinas-Martínez, Ana María; Mathiew-Quiros, Alvaro; Núñez-Rocha, Georgina Mayela; Garza-Elizondo, María Eugenia

    2004-01-01

    One of the biggest challenges of the Mexican Health System is to get results of the treatment goals in diabetic patients, which can be frustrated by physician and patient's attitudes. The present study evaluates divergence of attitude of health providers and diabetic patients according to health sectors: private, social security or State medical services. They contributed 255 physicians and 255 diabetic patients in ambulatory care from three health sectors: private, social security and welfare (employees and patients were exclusive providers and patients of corresponding institutions). The Diabetes Attitude Scale 3 (DAS-3) was applied, a self-administered instrument used to compare attitudes between health care professionals and patients. Discrepancies were analyzed with t-tests, chi2, one-way ANOVA and post hoc multiple comparisons for observed means based on the Tukey test. Physician and patient's attitudes differed in all scales except for psychosocial impact of diabetes, which was independent of the health sector. Attitudes were not alike with respect to severity of the disease, value of tight control of glucose levels and patient autonomy, with no distinction of health sector. Discrepancy of need for special training was the only attitude that varied by health sector (F = 4.1; p = 0.02); it was similar for the private and social security sector but different for the welfare sector. All health sectors should recognize attitude discrepancies between doctors and patients to favor collaborative strategies that benefit a better control of the disease.

  12. Justification for conducting neurological clinical trials as part of patient care within private practice.

    PubMed

    Beran, R G; Stepanova, D; Beran, M E

    2016-05-01

    The aim of this review was to assess the benefits and drawbacks of conducting neurological clinical trials and research in private practice for the patients, clinician, Practice Manager, sponsors/Clinical Research Organisations (CROs) and Clinical Trial Coordinator (CTC) to determine if this is justified for all involved. A combination of literature reviews, original research articles and books were selected from 2005 to 2015. Provided that the practice has sufficient number of active trials to prevent financial loss, support staff, adequate facilities and equipment and time, the benefits outweigh the drawbacks. Clinical trials provide patients with more thorough monitoring, re-imbursement of trial-related expenses and the opportunity to try an innovative treatment at no charge when other options have failed. For the clinician, clinical trials provide more information to ensure better care for their patients and improved treatment methods, technical experience and global recognition. Trials collect detailed and up-to-date information on the benefits and risks of drugs, improving society's confidence in clinical research and pharmaceuticals, allow trial sponsors to explore new scientific questions and accelerate innovation. For the CTC, industry-sponsored clinical trials allow potential entry for a career in clinical research giving CTCs the opportunity to become Clinical Research Associates (CRAs), Study Start-Up Managers or Drug Safety Associates. © 2016 John Wiley & Sons Ltd.

  13. How Medical Students View Their Relationships with Patients: The Role of Private and Public Self-Consciousness.

    ERIC Educational Resources Information Center

    Jaimovich, Susana

    1999-01-01

    Examines the relations among self-consciousness, attribution of responsibility, and differentiation of emotions by interviewing 30 Israeli medical students. Finds that in terms of student-patient interactions, students high in public self-consciousness made more internal attributions while students high in private self-consciousness made more…

  14. Civil commitment for substance use disorder patients under the Florida Marchman Act: demographics and outcomes in the private clinical setting.

    PubMed

    Sweeney, Timothy J; Strolla, Michael P; Myers, David P

    2013-01-01

    The Florida Marchman Act, a statutory process for civil commitment of persons with substance use disorders. The paper describes the various methods by which the Act may be employed, and examines the demographics and outcomes of 100 patients admitted to a private treatment setting pursuant to Marchman Act authority.

  15. Privatization of hospitals: meeting divergent interests.

    PubMed

    Weil, Thomas P

    2011-01-01

    The United States, Germany, and the United Kingdom are experiencing a trend toward the privatization of hospitals--most frequently involving poorly positioned facilities that need: additional capital for replacement of plant and equipment; improved management systems to reduce the number of their nondirect patient care employees; and an aggressive physician recruitment effort. A number of these institutions might have been otherwise shut down, resulting in the loss of good paying jobs; however, these closures would have reduced the nation's total health care expenditures. The acquisition in the United States and Germany by investor-owned hospital corporations of major teaching institutions suggests that the for-profits have become an integral part of their country's health care delivery system. Privatization now even occurs within the egalitarian British National Health Service with the availability of private medical insurance, private hospitals, and private beds in public hospitals being managed by investor-owned groups. Being acquired by a for-profit is often a means to secure needed capital and is politically less fractious than closing down a marginally needed government-sponsored or a not-for-profit facility.

  16. Characteristics of Orthopaedic Malpractice Claims of Pediatric and Adult Patients in Private Practice.

    PubMed

    Oetgen, Matthew E; Parikh, P Divya

    2016-03-01

    Medical liability exposure varies based on scope of practice, patient demographics, and location of practice. There is a generally held belief that treatment of pediatric patients increases one's medicolegal risk. We examined a large national database of orthopaedic malpractice claims to determine if pediatric malpractice claims were associated with a less favorable medicolegal outcome compared with adults. Physician Insurers Association of America is an association of medical liability insurance carriers providing liability coverage for 60% of private practice physicians in the United States. The Physician Insurers Association of America data registry of closed medical liability claims was examined, including all orthopaedic claims between 1985 and 2012 in this review. Claims were categorized based on the age of the claimant (pediatric: less than 21 y, adult: 21 y or older). These groups were compared based on percentage of claims resulting in payment, indemnity paid, and years between occurrence of incident and filing of claim. In addition, the top 10 most prevalent claims were identified and compared between groups. A total of 25,702 closed orthopaedic claims were included. Pediatric claims accounted for 13% of the data. The average time from incident to claim filing was 1.92 years for pediatrics and 1.59 years for adults. Pediatric claims resulted in a higher percent of payment (33% vs. 30%) and average indemnity paid ($189,732 vs. $180,171) compared with adults. Five of the top 10 conditions resulting in a claim in each group were the same. Comparing these 5 conditions, in general there were minimal differences in the average time to claim filing between the groups, but larger average indemnity paid in the pediatric group. There appear to be moderate differences in outcomes of orthopaedic malpractice claims between adult and pediatric patients. The longer statute of limitations associated with pediatric claims does not appear to portend a less favorable

  17. Patient choice and private provision decreased public provision and increased inequalities in Scotland: a case study of elective hip arthroplasty.

    PubMed

    Kirkwood, G; Pollock, A M

    2017-09-01

    This is the first research to examine how the policy of patient choice and commercial contracting where NHS funds are given to private providers to tackle waiting times, impacted on direct NHS provision and treatment inequalities. An ecological study of NHS funded elective primary hip arthroplasties in Scotland using routinely collected inpatient data 1 April 1993-31 March 2013. An increased use of private sector provision by NHS Boards was associated with a significant decrease in direct NHS provision in 2008/09 (P < 0.01) and with widening inequalities by age and socio-economic deprivation. National treatment rate fell from 143.8 (140.3, 147.3) per 100 000 in 2006/07 to 137.8 (134.4, 141.2) per 100 000 in 2007/08. By 2012/13, territorial NHS Boards had not recovered 2006/07 levels of provision; this was most marked for NHS Boards with the greatest use of private sector, namely Fife, Grampian and Lothian. Patients aged 85 years and over or living in the more deprived areas of Scotland appear to have been disadvantaged since the onset of patient choice in 2002. NHS funding of private sector provision for elective hip arthroplasty was associated with a decrease in public provision and may have contributed to an increase in age and socio-economic inequalities in treatment rates.

  18. Patients' preferences and willingness-to-pay for postmenopausal hormone receptor-positive, HER2-negative advanced breast cancer treatments after failure of standard treatments.

    PubMed

    Ngorsuraches, Surachat; Thongkeaw, Klangjai

    2015-01-01

    Patients' preferences increasingly play roles in cancer treatments. The objective of this study is to examine breast cancer patients' preferences and willingness-to-pay (WTP) for postmenopausal hormone receptor-positive, HER2-negative advanced breast cancer treatments after failure of standard treatments. Four attributes, i.e. progression free survival (PFS), anemia, pneumonitis, and cost, and their levels of exemestane and exemestane plus everolimus from literature and patient interviews were used to develop a discrete choice experiment questionnaire. Each questionnaire was composed of seven choice sets and each choice set contained those four attributes with different levels. Breast cancer patients were asked to choose one treatment alternative in each choice set. Multinomial logit model was used to determine relative preferences of each attribute and the WTP for all attributes and treatments were calculated. A total of 146 patients were included in study analyses. Results showed that the patients preferred treatments with higher PFS and lower side effects. The patients were willing to pay US$151.6, US$69.8, and US$278.3 per month in exchange for every 1 month increase in PFS and every 1 % decreased risk of anemia and pneumonitis, respectively. The patients were willing to pay for exemestane and exemestane plus everolimus US$551.8 and US$414.2 per month, respectively. In conclusion, patients weighted importance on PFS, anemia, and pneumonitis, when they needed to choose an aromatase inhibitor plus mammalian target of rapamycin (mTOR) inhibitor for advanced breast cancer treatments after failure of standard treatments. They valued exemestane alone more than exemestane plus everolimus.

  19. Cancer patients' willingness to pay for blood transfusions at home: results from a contingent valuation study in a French cancer network.

    PubMed

    Havet, Nathalie; Morelle, Magali; Remonnay, Raphaël; Carrere, Marie-Odile

    2012-06-01

    Home blood transfusion may be an interesting alternative to hospital transfusion, especially when given with curative or palliative intent or for terminal care in advanced-stage cancer patients. However, there is limited information about patients' attitude toward this type of care. The purpose of this study was to measure French cancer patients' willingness to pay (WTP) for home blood transfusion and to analyze determinants of their choice. A contingent valuation survey was administered to 139 patients receiving transfusions in the framework of a regional home care network or in the hospital outpatient department. Participation was high (90%). Most patients (65%) had received home care, including 43% blood transfusions. Just under half of the patients gave a zero WTP, among which we identified 8 protest bidders. The median WTP for home blood transfusion was 26.5 per patient. In multivariate analysis, long home-hospital distance, poor quality of life, and previous experience of home care were identified as important factors in determining how much more patients would be willing to pay for transfusion at home. These results demonstrate the benefits of developing domiciliary services to improve patient well-being, notably for the weakest among them. The significant impact of previous home care experience on WTP is probably related to the strong involvement of physicians from the blood center and to their active contribution to a high-level homecare network. Some of our findings could be useful for policy decision-making regarding home care.

  20. 33 CFR 52.71 - Authority to pay.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... FOR CORRECTION OF MILITARY RECORDS OF THE COAST GUARD Payment of Claims and Implementation of Orders... authorized to pay any claim heretofore compensated by Congress through enactment of private law, or to...

  1. Behind the Pay Gap

    ERIC Educational Resources Information Center

    Dey, Judy Goldberg; Hill, Catherine

    2007-01-01

    Women have made remarkable gains in education during the past three decades, yet these achievements have resulted in only modest improvements in pay equity. The gender pay gap has become a fixture of the U.S. workplace and is so ubiquitous that many simply view it as normal. "Behind the Pay Gap" examines the gender pay gap for college graduates.…

  2. Mental health leadership and patient access to care: a public-private initiative in South Africa.

    PubMed

    Szabo, Christopher Paul; Fine, Jennifer; Mayers, Pat; Naidoo, Shan; Zabow, Tuviah

    2017-01-01

    Mental health leadership is a critical component of patient access to care. More specifically, the ability of mental health professionals to articulate the needs of patients, formulate strategies and engage meaningfully at the appropriate level in pursuit of resources. This is not a skill set routinely taught to mental health professionals. A public-private mental health leadership initiative, emanating from a patient access to care programme, was developed with the aim of building leadership capacity within the South African public mental health sector. The express aim was to equip health care professionals with the requisite skills to more effectively advocate for their patients. The initiative involved participants from various sites within South Africa. Inclusion was based on the proposal of an ongoing "project", i.e. a clinician-initiated service development with a multidisciplinary focus. The projects were varied in nature but all involved identification of and a plan for addressing an aspect of the participants' daily professional work which negatively impacted on patient care due to unmet needs. Six such projects were included and involved 15 participants, comprising personnel from psychiatry, psychology, occupational therapy and nursing. Each project group was formally mentored as part of the initiative, with mentors being senior professionals with expertise in psychiatry, public health and nursing. The programme design thus provided a unique practical dimension in which skills and learnings were applied to the projects with numerous and diverse outcomes. Benefits were noted by participants but extended beyond the individuals to the health institutions in which they worked and the patients that they served. Participants acquired both the skills and the confidence which enabled them to sustain the changes that they themselves had initiated in their institutions. The initiative gave impetus to the inclusion of public mental health as part of the curriculum

  3. Factors influencing the missed nursing care in patients from a private hospital

    PubMed Central

    Hernández-Cruz, Raúl; Moreno-Monsiváis, María Guadalupe; Cheverría-Rivera, Sofía; Díaz-Oviedo, Aracely

    2017-01-01

    ABSTRACT Objective: to determine the factors that influence the missed nursing care in hospitalized patients. Methods: descriptive correlational study developed at a private hospital in Mexico. To identify the missed nursing care and related factors, the MISSCARE survey was used, which measures the care missed and associated factors. The care missed and the factors were grouped in global and dimension rates. For the analysis, descriptive statistics, Spearman’s correlation and simple linear regression were used. Approval for the study was obtained from the ethics committee. Results: the participants were 71 nurses from emergency, intensive care and inpatient services. The global missed care index corresponded to M=7.45 (SD=10.74); the highest missed care index was found in the dimension basic care interventions (M=13.02, SD=17.60). The main factor contributing to the care missed was human resources (M=56.13, SD=21.38). The factors related to the care missed were human resources (rs=0.408, p<0.001) and communication (rs=0.418, p<0.001). Conclusions: the nursing care missed is mainly due to the human resource factor; these study findings will permit the strengthening of nursing care continuity. PMID:28699991

  4. The protection of the patient's private life: the computer challenge. Second part.

    PubMed

    Van Overstraeten, M; Michel, Luc

    2002-12-01

    Today, medical practice is invaded by a growing number of technologies of all kinds, among which computer techniques have an important place. Although they have significant advantages, for instance in terms of medical record management, they give rise to several problems, particularly concerning the confidentiality of the patient's data with regards to third party. A great number of specific provisions, complementary to the general texts protecting private life (examined in the first part of this two parts article), endeavour to solve these problems. It is true that these provisions are recent, have various origins and often appear as rules difficult to understand. Yet, they are partially inspired by a common logic. Relying on these common features, the authors make two suggestions for the future, in order to avoid that the growing computerisation of medical practice eventually destabilises the health care relationship: a) Any dictatorship of confidentiality must be rejected b) Stimulating a sense of professionalism is most likely the way to avoid an anarchic and unrealistic development of rules aimed at regulating the health care relationship.

  5. Paying for College: Plot a Course Now.

    ERIC Educational Resources Information Center

    Business Week, 1984

    1984-01-01

    Provided are suggestions for parents to take to pay for their children's college education. Making systematic payments to a college fund, setting up a Clifford Trust, zero-coupons, and other areas (such as part-time student employment) are considered. Also suggests considering the cost factor of public over private institutions. (JN)

  6. The quality of outpatient primary care in public and private sectors in Sri Lanka--how well do patient perceptions match reality and what are the implications?

    PubMed

    Rannan-Eliya, Ravindra P; Wijemanne, Nilmini; Liyanage, Isuru K; Jayanthan, Janaki; Dalpatadu, Shanti; Amarasinghe, Sarasi; Anuranga, Chamara

    2015-03-01

    To compare the quality of clinical care and patient satisfaction in public and private outpatient primary care services in Sri Lanka. A prospective, cross-sectional comparison was done by direct observation of patient encounters and exit interviews of outpatients in 10 public hospital general outpatient clinics and 66 private practitioner clinics in three districts of Sri Lanka. A total of 1027 public sector patients and 944 private sector patients were surveyed. Data were collected for 39 quality indicators covering diarrhoea, cough, hypertension, diabetes, asthma, upper respiratory tract infections (URTI) and five other conditions, along with prescribing indicators. The exit interviews collected data for 10 patient satisfaction indicators. The public sector performed better for some conditions (diarrhoea, cough and asthma) and the private sector performed better for others (hypertension, diabetes, URTI and tonsillitis). Overall quality was similar between the sectors in the domains of history taking, examination and investigations and management, but the private sector performed much better on patient education (57 vs 12%). Overall patient satisfaction was high in both sectors (98%), although the private sector performed much better in interpersonal satisfaction (94 vs 84%) and system-related indicators (95 vs 84%). Comparisons with studies from other countries suggest that both sectors perform considerably better than India, and similarly in many indicators to high-income countries. Quality of outpatient primary care in Sri Lanka is generally high for a lower-middle income developing country. The public and private sectors perform similarly, except that private sector patients have longer consultations, are more likely to receive education and advice, and obtain better interpersonal satisfaction. The public system, with its limited funding, is able to deliver care in diagnosis and management that is similar to the private sector, while private sector patients

  7. Mortality, Length of Stay, and Inpatient Charges for Heart Failure Patients at Public versus Private Hospitals in South Korea

    PubMed Central

    Kim, Sun Jung; Park, Eun-Cheol; Kim, Tae Hyun; Yoo, Ji Won

    2015-01-01

    Purpose This study compared in-hospital mortality within 30 days of admission, lengths of stay, and inpatient charges among patients with heart failure admitted to public and private hospitals in South Korea. Materials and Methods We obtained health insurance claims data for all heart failure inpatients nationwide between November 1, 2011 and May 31, 2012. These data were then matched with hospital-level data, and multi-level regression models were examined. A total of 8406 patients from 253 hospitals, including 31 public hospitals, were analyzed. Results The in-hospital mortality rate within 30 days of admission was 0.92% greater and the mean length of stay was 1.94 days longer at public hospitals than at private hospitals (mortality: 5.18% and 4.26%, respectively; LOS: 12.08 and 10.14 days, respectively). The inpatient charges were 11.4% lower per case and 24.5% lower per day at public hospitals than at private hospitals. After adjusting for patient- and hospital-level confounders, public hospitals had a 1.62-fold higher in-hospital mortality rate, a 16.5% longer length of stay, and an 11.7% higher inpatient charge per case than private hospitals, although the charges of private hospitals were greater in univariate analysis. Conclusion We recommend that government agencies and policy makers continue to monitor quality of care, lengths of stay in the hospital, and expenditures according to type of hospital ownership to improve healthcare outcomes and reduce spending. PMID:25837196

  8. [Frequency of musculoskeletal pathology among elderly patients and its treatment at a Private Hospital in Mexico City].

    PubMed

    Espinosa-Mendoza, R L; Soto-Padilla, M; Gómez-Garcia, F

    2015-01-01

    The elderly represent a growing sector of the Mexican population and they are expected to outgrow the number of youths in the coming years. Musculoskeletal conditions are a major cause of disability among the elders; they affect up to 80%. In Mexico City 36% of the population uses private health care services. To contribute with epidemiologic data about the frequency of musculoskeletal conditions and their hospital-based treatment in patients ages 65 and over admitted to a private hospital in Mexico City. Male and female patients ages 65 and over, admitted for a musculoskeletal illness. 390 patients were studied; 276 females and 114 males. The age group 65-69 years was predominant. The predominating musculoskeletal conditions included fractures, which represented 29.4%, and gonarthrosis, 23.30%. Patients were treated surgically accounted for 91.02%. Among the elderly, chronic conditions are more frequent than acute ones; however, fractures are the most frequent diagnosis. There are no studies in Mexico analyzing the frequency of both, traumatic or degenerative conditions, and their treatment in elderly patients admitted to a private hospital. These results will therefore provide epidemiologic information about our population.

  9. Military Pay Comparability

    DTIC Science & Technology

    1993-04-01

    for promotions and for pay based on ability. Also included in this idea is one of equal pay for basically equal work. Thus, the sub-principle of...Report established for the first time the idea that pay within the services for basically equal jobs should be the same and that the pay should be...foundation for legislation creating the first idea of 4 P "regular military compensation" (basic pay , subsistence allowance and quarters allowance) as a

  10. Pay for performance in orthopaedic surgery.

    PubMed

    Pierce, Read G; Bozic, Kevin J; Bradford, David S

    2007-04-01

    In recent decades American medicine has undergone tremendous changes. Numerous reimbursement and systems approaches to controlling medical inflation and improving quality have failed to provide cost-effective, high-quality health care in most circumstances. Public and private payers are currently implementing pay for performance, a new reimbursement method linking physician pay to evidence of adherence to performance measures, to constrain costs, encourage efficiency, and maximize value for health care dollars. High-quality research regarding pay for performance and its impact is scarce, particularly in orthopaedic surgery. Although supporters argue pay for performance will remedy the fragmented, costly delivery of health services in the United States, skeptics raise concerns about disagreement over quality guidelines, financial implications for providers and hospitals, inadequate infrastructure, public reporting, system gaming, and physician support. Our survey of orthopaedic surgeons reveals limited understanding of pay for performance, marked skepticism of nonphysician stakeholders' intentions, and a strong desire for greater clinician involvement in shaping the pay for performance movement. As pay for performance will likely be a long-term change that will have an impact on every orthopaedic surgeon, clinician awareness and participation will be fundamental in creating successful pay for performance programs.

  11. The association of willingness-to-pay and patient attributes: a cost-volume-profit analysis of cardiac catheter unit services in Ramallah Hospital, Palestine.

    PubMed

    Jabr, Samer F K; Younis, Mustafa Mike Z; Forgione, Dana A

    2009-01-01

    The purpose of this study is to examine the association of willingness-to-pay and patient attributes in relation to the multi-service cost-volume-profit structure of a cardiac catheter unit in Ramallah Hospital. This article contributes to the literature by providing primary evidence on patient willingness-to-pay, by identifying the specific break-even parameters of three hospital cardiac catheter unit service types (diagnosis, balloon, and pacemaker), and by demonstrating the cross-subsidization of patient income groups that is inherent in the existing hospital rate structure. Our results provide information useful for (1) evidence-based policy making with respect to hospital rate setting and cross-subsidies of patient income groups; (2) the advancement of hospital management, by demonstrating the estimated variable and fixed cost parameters and the impact of patient revenue mix on the profitability of cardiac catheter unit services; and (3) the advancement of theory, by documenting the relationship of patient demand and the cost of supply in a multi-patient-group, multi-service hospital setting.

  12. Willingness and ability to pay for unexpected dental expenses by Finnish adults

    PubMed Central

    2012-01-01

    Background Since 2002, adults have been able to choose oral health care services in the public sector or in the private sector in Finland. Though various subsidies for care exist in both sectors, the Public Dental Service (PDS) is a cheaper option for the patient but, on the other hand, there are no waiting lists for private care. The aim of this study was to assess middle-aged adults' use of dental services, willingness to pay (WTP) and ability to pay (ATP) for unexpected, urgent dental treatment. Methods Postal questionnaires on use of dental services were sent to a random sample of 1500 47-59 year old adults living in three large municipalities in the Helsinki region. The initial response rate was 65.8%. Two hypothetical scenarios were presented: "What would be the highest price you would be prepared to pay to have a lost filling replaced immediately, or, at the latest, the day after losing the filling?" and " How much could you pay for unexpected dental expenses at two weeks notice, if you suddenly needed more comprehensive treatment?" Logistic regression analysis was used to analyse factors related to WTP and ATP. Results Most respondents (89.6%) had visited a dentist recently and a majority (76.1%) had used private services. For immediate replacement of a lost filling, almost all respondents (93.2%) were willing to pay the lower price charged in the PDS and 46.2% were willing to pay the private fee. High income and no subjective need for dental treatment were positively associated with the probability of paying a higher price. Most respondents (93.0%) were able to pay a low fee, EUR 50 and almost half (41.6%) at least EUR 300 for unexpected treatment at short notice. High income and male sex were associated with high ATP. Conclusion There was a strong and statistically significant relationship between income and WTP and ATP for urgent dental care, indicating that access to publicly provided services improved equity for persons with low income. PMID:22935077

  13. Patients' willingness to pay for their drugs in primary care clinics in an urbanized setting in Malaysia: a guide on drug charges implementation.

    PubMed

    Puteh, Sharifa Ezat Wan; Ahmad, Siti Nurul Akma; Aizuddin, Azimatun Noor; Zainal, Ramli; Ismail, Ruhaini

    2017-01-01

    Malaysia is an upper middle income country that provides subsidized healthcare to ensure universal coverage to its citizens. The challenge of escalating health care cost occurs in most countries, including Malaysia due to increase in disease prevalence, which induced an escalation in drug expenditure. In 2009, the Ministry of Health has allocated up to Malaysian Ringgit (MYR) 1.402 billion (approximately USD 390 million) on subsidised drugs. This study was conducted to measure patients' willingness to pay (WTP) for treatment of chronic condition or acute illnesses, in an urbanized population. A cross-sectional study, through face-to-face interview was conducted in an urban state in 2012-2013. Systematic random sampling of 324 patients was selected from a list of patients attending ten public primary cares with Family Medicine Specialist service. Patients were asked using a bidding technique of maximum amount (in MYR) if they are WTP for chronic or acute illnesses. Patients are mostly young, female, of lower education and lower income. A total of 234 respondents (72.2%) were not willing to pay for drug charges. WTP for drugs either for chronic or acute illness were at low at median of MYR10 per visit (USD 3.8). Bivariate analysis showed that lower numbers of dependent children (≤3), higher personal and household income are associated with WTP. Multivariate analysis showed only number of dependent children (≤3) as significant (p = 0.009; 95% CI 1.27-5.44) predictor to drugs' WTP. The result indicates that primary care patients have low WTP for drugs, either for chronic condition or acute illness. Citizens are comfortable in the comfort zone whereby health services are highly subsidized through universal coverage. Hence, there is a resistance to pay for drugs.

  14. Religiosity/spirituality of German doctors in private practice and likelihood of addressing R/S issues with patients.

    PubMed

    Voltmer, Edgar; Bussing, Arndt; Koenig, Harold G; Al Zaben, Faten

    2014-12-01

    This study examined the self-assessed religiosity and spirituality (R/S) of a representative sample of German physicians in private practice (n = 414) and how this related to their addressing R/S issues with patients. The majority of physicians (49.3 %)reported a Protestant denomination, with the remainder indicating mainly either Catholic(12.5 %) or none (31.9 %). A significant proportion perceived themselves as either religious(42.8 %) or spiritual (29.0 %). Women were more likely to rate themselves R/S than did men. Women (compared to men) were also somewhat more likely to attend religious services (7.4 vs. 2.1 % at least once a week) and participate in private religious activities(14.9 vs. 13.7 % at least daily), although these differences were not statistically significant.The majority of physicians (67.2 %) never/seldom addressed R/S issues with a typical patient. Physicians with higher self-perceived R/S and more frequent public and private religious activity were much more likely to address R/S issues with patients. Implications for patient care and future research are discussed.

  15. [Gynecological and obstetrics aspects of patients treated in public and private health services: are there any differences?].

    PubMed

    Zimmermmann, Juliana Barroso; Nani, Amanda Carolina Garcia; Junqueira, Camila Barbosa; Iani, Gabriela Campos de Melo; Gomes, Gustavo; Bahia, Souza

    2011-12-01

    To evaluate the epidemiological and clinical aspects of gynecological patients seeking care in the private and public health networks. In this cross-sectional study we analyzed the records of 243 patients (122 public service patients and 121 private service ones), from January 2007 to January 2008. We excluded records of pregnant patients with vaginal bleeding, history of using vaginal creams or gels at intervals of less than 15 days and patients who had sexual intercourse within less than five days before their visit and with incomplete clinical data. Data were analyzed statistically using the Stata software, version 9.2, with a 5% level of significance. The mean age of the patients attending the public health service was 27±12 years-old and 25.9±10.4 years-old for patients attending the private health service, with no statistical difference between means (F=0.5 and p=0.4). Patients attending the public health service had lower education (p<0.001), they were preferentially housewives (p<0.001), began sexual life early, had a greater number of partners (p<0.001), of pregnancies (p<0.001) and of deliveries (p=0.004), and mainly used the condom as a contraceptive method (p=0.013). There was no statistical difference between groups regarding the history of sexual transmitted diseases, diagnosis of candidiasis, bacterial vaginosis, trichomoniasis, or neoplasia. Patients attending the public health service have a higher number of pregnancies and births. They are usually housewives with low educational level, their sex life begins early, and they have more partners. However, there was no difference between groups when evaluating breast diseases, gynecological infections, or cancer of the cervix, which suggests that socioeconomic status is not the only element in the determination of the disease and, therefore, other variables should be evaluated.

  16. Pay rise or better conditions?

    PubMed

    Taylor, Stephen

    2017-08-09

    Have we even been given the option? I can't remember the government saying if you decline a pay rise, we will cut all wards down to 20 patients, ensure they are air conditioned for summer and provide more care workers for patients with high needs.

  17. Pay-for-virtue: an option to improve pay-for-performance?

    PubMed

    Buetow, Stephen; Entwistle, Vikki

    2011-10-01

    Pay-for-performance schemes reward standardized professional behaviours associated with effective care. However, they neglect the significance of virtue and devalue and erode professional motivation based on virtue. Pay for training to cultivate virtue, and/or pay-for-virtue, may mitigate these dangers. Although virtue is typically considered its own reward, and the assessment of virtue is problematic, pay-for-virtue could involve (1) stringent checks on the appropriateness of the standardized care currently rewarded by pay-for-performance for individual patients or (2) pay for indicators of virtue. These indicators could be based on virtues identified from a framework of universal virtues and through logical inferences from features of practice. It is possible that pay-for-virtue could ultimately strengthen health professionals' intrinsic motivation for good practice, but this and the broader effects of pay-for-virtue would need careful investigation. © 2011 Blackwell Publishing Ltd.

  18. Comparison of Federal and Private Sector Pay and Benefits. Report to the Chairman, Subcommittee on Civil Service, Post Office, and General Services Committee on Government Affairs, United States Senate.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC.

    A study compared the compensation packages offered to private sector and Federal white-collar employees. The conclusions drawn in the study were based on data from previous and ongoing research conducted by the General Accounting Office (GAO). Analysis of these data revealed that whereas the Employment Cost Index has shown a cumulative increase of…

  19. A retrospective cohort study of mode of delivery among public and private patients in an integrated maternity hospital setting

    PubMed Central

    Murphy, Deirdre J; Fahey, Tom

    2013-01-01

    Objective To examine the associations between mode of delivery and public versus privately funded obstetric care within the same hospital setting. Design Retrospective cohort study. Setting Urban maternity hospital in Ireland. Population A total of 30 053 women with singleton pregnancies who delivered between 2008 and 2011. Methods The study population was divided into those who booked for obstetric care within the public (n=24 574) or private clinics (n=5479). Logistic regression analyses were performed to examine the associations between operative delivery and type of care, adjusting for potential confounding factors. Main outcome measures Caesarean section (scheduled or emergency), operative vaginal delivery (vacuum or forceps), indication for caesarean section as classified by the operator. Results Compared with public patients, private patients were more likely to be delivered by caesarean section (34.4% vs 22.5%, OR 1.81; 95% CI 1.70 to 1.93) or operative vaginal delivery (20.1% vs 16.5%, OR 1.28; 95% CI 1.19 to 1.38). The greatest disparity was for scheduled caesarean sections; differences persisted for nulliparous and parous women after controlling for medical and social differences between the groups (nulliparous 11.9% vs 4.6%, adjusted (adj) OR 1.82; 95% CI 1.49 to 2.24 and parous 26% vs 12.2%, adj OR 2.08; 95% CI 1.86 to 2.32). Scheduled repeat caesarean section accounted for most of the disparity among parous patients. Maternal request per se was an uncommonly reported indication for caesarean section (35 in each group, p<0.000). Conclusions Privately funded obstetric care is associated with higher rates of operative deliveries that are not fully accounted for by medical or obstetric risk differences. PMID:24277646

  20. Orthodontic treatment need among young Saudis attending public versus private dental practices in Riyadh

    PubMed Central

    Al-Jobair, Asma M; Baidas, Laila F; Al-Hamid, Anfal A; Al-Qahtani, Sara G; Al-Najjar, Amani T; Al-Kawari, Huda M

    2016-01-01

    Objective To assess and compare the severity of malocclusion and orthodontic treatment need among young Saudis receiving free treatment at public dental practices versus those paying for treatment at private practices. Materials and methods This retrospective study evaluated the records of 300 patients (179 females, 121 males; age 13–21 years) treated at orthodontic clinics from 2013 through 2015. The public sample was selected from orthodontic clinics at the College of Dentistry, King Saud University (KSU); the private sample was selected from five private orthodontic clinics in Riyadh, Saudi Arabia. The records were examined for the severity of malocclusion and for orthodontic treatment need using the Dental Health Component of the Index of Orthodontic Treatment Need. The prevalence of each occlusal discrepancy and the Dental Health Component grade were recorded. The severity of malocclusion and orthodontic treatment need were compared between practice types, age groups, and sexes with the chi-square test. Results Displacement, increased overjet, and Class II and III malocclusion were the most common orthodontic problems in this study. Patients attending public clinics at KSU generally had more severe malocclusion than the patients attending private clinics. Seventy-seven percent of orthodontically treated patients at KSU clinics were in great need of treatment, compared with 58.5% of patients treated at private clinics (P=0.003). Among the patients with great treatment need, approximately 62% of male patients and 70% of patients ≤16 years of age were treated at KSU clinics, compared with 38% and 48%, respectively, treated at private clinics (P<0.0001). Conclusion Young Saudis receiving free orthodontic treatment at public clinics at KSU had more severe malocclusion with greater need of orthodontic treatment than the patients paying for treatment at private clinics. PMID:27843351

  1. Closing the Pay Gap

    DTIC Science & Technology

    2000-10-01

    the pay gap has been narrowed, hut only to just under 10 percent. And current military compensation legislation does not close the gap until 2026. There...will continue to be a pay gap until 2026 unless the next administration and the next Congress provide more for pay above the 1999 legislated ramp- up...of .5 percent (one half of one percent) per year to attain pay equality . That means that soldiers, sailors, airmen, marines and Coast Guardsmen

  2. Comparison of patient perceived primary care quality in public clinics, public hospitals and private clinics in rural China.

    PubMed

    Wang, Wenhua; Maitland, Elizabeth; Nicholas, Stephen; Loban, Ekaterina; Haggerty, Jeannie

    2017-10-03

    In rural China, patients have free choice of health facilities for outpatient services. Comparison studies exploring the attributes of different health facilities can help identify optimal primary care service models. Using a representative sample of Chinese provinces, this study aimed to compare patients' rating of three primary care service models used by rural residents (public clinics, public hospitals and private clinics) on a range of health care attributes related to responsiveness. This was a secondary analysis using the household survey data from World Health Organization (WHO) Study on global AGEing and adult health (SAGE). Using a multistage cluster sampling strategy, eight provinces were selected and finally 3435 overall respondents reporting they had visited public clinics, public hospitals or private clinics during the last year, were included in our analysis. Five items were used to measure patient perceived quality in five domains including prompt attention, communication and autonomy, dignity and confidentiality. ANOVA and Turkey's post hoc tests were used to conduct comparative analysis of five domains. Separate multivariate linear regression models were estimated to examine the association of primary care service models with each domain after controlling for patient characteristics. The distribution of last health facilities visited was: 29.5% public clinics; 31.2% public hospitals and; 39.3% private clinics. Public clinics perform best in all five domains: prompt attention (4.15), dignity (4.17), communication (4.07), autonomy (4.05) and confidentiality (4.02). Public hospitals perform better than private clinics in dignity (4.03 vs 3.94), communication (3.97 vs 3.82), autonomy (3.92 vs 3.74) and confidentiality (3.94 vs 3.73), but equivalently in prompt attention (3.92 vs 3.93). Rural residents who are older, wealthier, and with higher self-rated health status have significantly higher patient perceived quality of care in all domains. Rural

  3. Comparison of anal cancer outcomes in public and private hospital patients treated at a single radiation oncology center

    PubMed Central

    Bitterman, Danielle S.; Grew, David; Gu, Ping; Cohen, Richard F.; Sanfilippo, Nicholas J.; Leichman, Cynthia G.; Leichman, Lawrence P.; Moore, Harvey G.; Gold, Heather T.

    2015-01-01

    Objective To compare clinical and treatment characteristics and outcomes in locally advanced anal cancer, a potentially curable disease, in patients referred from a public or private hospital. Methods We retrospectively reviewed 112 anal cancer patients from a public and a private hospital who received definitive chemoradiotherapy at the same cancer center between 2004 and 2013. Tumor stage, radiotherapy delay, radiotherapy duration, and unplanned treatment breaks ≥10 days were compared using t-test and χ2 test. Overall survival (OS), disease free survival (DFS), and colostomy free survival (CFS) were examined using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazard models for OS and DFS were developed. Results The follow-up was 14.9 months (range, 0.7-94.8 months). Public hospital patients presented with significantly higher clinical T stage (P<0.05) and clinical stage group (P<0.05), had significantly longer radiotherapy delays (P<0.05) and radiotherapy duration (P<0.05), and had more frequent radiation therapy (RT) breaks ≥10 days (P<0.05). Three-year OS showed a marked trend in favor of private hospital patients for 3-year OS (72.8% vs. 48.9%; P=0.171), 3-year DFS (66.3% vs. 42.7%, P=0.352), and 3-year CFS (86.4% vs. 68.9%, P=0.299). Referral hospital was not predictive of OS or DFS on multivariate analysis. Conclusions Public hospital patients presented at later stage and experienced more delays in initiating and completing radiotherapy, which may contribute to the trend in poorer DFS and OS. These findings emphasize the need for identifying clinical and treatment factors that contribute to decreased survival in low socioeconomic status (SES) populations. PMID:26487947

  4. [Willingness of Psychotherapists in Private Practice to Treat Patients With Complex Post-Traumatic Stress and Dissociative Disorders].

    PubMed

    Schnell, T; von Katte, S; Gast, U

    2015-09-01

    Analyses of patient care with severe mental disorders. Psychotherapists in private praxis were interviewed about their willingness to treat patients with a range of diagnoses in the context of post-traumatic disorders. Therapists were found more willing to treat "less severe" disorders, independent of years in practice, school of psychotherapy, a rural or urban practice setting. Therapists criticized the quality of their training and the health insurance review process. Therapists are generally willing to treat patients with severe mental disorders, but experience limits of competency attributed to training deficits. They further experience the bureaucratic procedures of the health insurance review process as barriers to accepting these patients into treatment.These results indicate that recently developed concepts of psychotherapy for these patient groups should be more intensively integrated into the existing training curricula. Furthermore, a simplified health insurance review process ought to be considered. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Efficacy of intense pulsed light for the treatment of burn scar dyschromias: a pilot study to assess patient satisfaction, safety, and willingness to pay.

    PubMed

    Hultman, Charles Scott; Friedstat, Jonathan S; Edkins, Renee E

    2015-06-01

    No treatment algorithms exist to reliably treat burn scar dyschromias. Intense pulsed light (IPL) has been used successfully to treat hyperpigmentation disorders, but has not been studied extensively in the treatment of burn scars. The purpose of this investigation was to assess clinical efficacy and patient satisfaction with IPL for the treatment of burn scar dyschromia. Patients with burn scar dyschromias were treated using the Lume 1 platform (Lumenis) to target pigmented lesions, using fluences between 10 and 22 joules/cm and filters ranging from 560 to 650 nm. At the conclusion of the study, providers assessed changes in burn scar dyschromia, whereas patients were queried regarding satisfaction and perceived efficacy, using a 1 to 5 Likert scale. The patients, who were not charged for the IPL treatment, were queried regarding willingness to pay. Twenty patients (mean age, 35.4 years; mean total body surface area, 27.6%; mean composite Fitzpatrick score, 3.9) underwent IPL treatment of burn scar dyschromias, an average of 3.2 years after injury. Mean fluence was 15.4 J/cm (range, 10-22 J/cm), and the most common filter used was 590 nm (range, 560-650 nm). Mean area treated was 90.7 cm, with a range of 4 to 448 cm. Complications included pain (4), hyperpigmentation (1), and blistering (2). Sixteen patients noted mild to moderate improvement, reporting a 4.5 for efficacy and a 4.4 for satisfaction. Regarding willingness to pay, patients would spend a mean of U.S. $7429 to completely remove their scars, but only a median of U.S. $350 to get the actual results that they received. Mean length of follow-up was 3.8 months, with a standard deviation of 2.2 months. Patients perceived IPL as an efficacious modality in the treatment of burn scar dyschromia, with a high level of satisfaction, despite the potential for morbidity. However, we are reluctant to recommend IPL for routine treatment of burn scar dyschromias, given only minimal improvement observed, potential for

  6. Privatizing Libraries

    ERIC Educational Resources Information Center

    Jerrard, Jane; Bolt, Nancy; Strege, Karen

    2012-01-01

    This timely special report from ALA Editions provides a succinct but comprehensive overview of the "privatization" of public libraries. It provides a history of the trend of local and state governments privatizing public services and assets, and then examines the history of public library privatization right up to the California…

  7. Private Rehabilitation.

    ERIC Educational Resources Information Center

    McMahon, Brian T., Ed.

    1983-01-01

    Discusses the expanding role of the rehabilitation counselor into private sector rehabilitation in the seven articles of this special issue. Topics cover private rehabilitation in an insurance context including forensics issues, computer applications, recent trends, services in a multiprogram private clinic, and rehabilitation counselor training.…

  8. Privatizing Libraries

    ERIC Educational Resources Information Center

    Jerrard, Jane; Bolt, Nancy; Strege, Karen

    2012-01-01

    This timely special report from ALA Editions provides a succinct but comprehensive overview of the "privatization" of public libraries. It provides a history of the trend of local and state governments privatizing public services and assets, and then examines the history of public library privatization right up to the California…

  9. Therapy Preferences in Melanoma Treatment - Willingness to Pay and Preference of Quality versus Length of Life of Patients, Physicians and Healthy Controls

    PubMed Central

    Krammer, Ramona; Heinzerling, Lucie

    2014-01-01

    Background New melanoma therapies, like e.g. ipilimumab, improve survival. However, only a small subset of patients benefits while 60% encounter side effects. Furthermore, these marginal benefits come at a very high price of €110’000 per treatment. This study examines attitudes towards melanoma therapy options of physicians, healthy individuals and patients, their willingness to pay and preference of quality versus length of life. Methods Based on findings from a focus group questionnaires were developed and pretested. After obtaining ethical approval and informed consent surveys were conducted in a total of 90 participants (n = 30 for each group). Statistical analyses were conducted using R. Findings Attitudes vastly differed between healthy participants, physicians and melanoma patients. Whereas melanoma patients show a high willingness to endure side effects despite very small survival gains (down to 1 extra week) or even only hope with no survival benefit, healthy controls are more critical, while physicians are the most therapy adverse. Consequently, if given €100’000 and the free decision what to spend the money on the willingness to pay for therapy was much higher in the patient group (68%) compared to 28% of healthy controls and only 43% of the physicians, respectively. When lowering the amount of cash that could be received instead of ipilimumab to €50’000 or €10’000 to test price sensitivity 69% (+1%) and 76% (+8%) of melanoma patients, respectively, preferred ipilimumab over cash. When judging on societal spending even melanoma patients opted for spending on ipilimumab in only 21%. Conclusion The judgment about the benefits of new treatment options largely differs between groups, physicians being the most critical against therapy. Price elasticity was low. PMID:25369124

  10. Therapy preferences in melanoma treatment--willingness to pay and preference of quality versus length of life of patients, physicians and healthy controls.

    PubMed

    Krammer, Ramona; Heinzerling, Lucie

    2014-01-01

    New melanoma therapies, like e.g. ipilimumab, improve survival. However, only a small subset of patients benefits while 60% encounter side effects. Furthermore, these marginal benefits come at a very high price of €110'000 per treatment. This study examines attitudes towards melanoma therapy options of physicians, healthy individuals and patients, their willingness to pay and preference of quality versus length of life. Based on findings from a focus group questionnaires were developed and pretested. After obtaining ethical approval and informed consent surveys were conducted in a total of 90 participants (n = 30 for each group). Statistical analyses were conducted using R. Attitudes vastly differed between healthy participants, physicians and melanoma patients. Whereas melanoma patients show a high willingness to endure side effects despite very small survival gains (down to 1 extra week) or even only hope with no survival benefit, healthy controls are more critical, while physicians are the most therapy adverse. Consequently, if given €100'000 and the free decision what to spend the money on the willingness to pay for therapy was much higher in the patient group (68%) compared to 28% of healthy controls and only 43% of the physicians, respectively. When lowering the amount of cash that could be received instead of ipilimumab to €50'000 or €10'000 to test price sensitivity 69% (+1%) and 76% (+8%) of melanoma patients, respectively, preferred ipilimumab over cash. When judging on societal spending even melanoma patients opted for spending on ipilimumab in only 21%. The judgment about the benefits of new treatment options largely differs between groups, physicians being the most critical against therapy. Price elasticity was low.

  11. How receptive are patients to medical students in Australian hospitals? A cross-sectional survey of a public and a private hospital.

    PubMed

    Tiong, M K; Levinson, M R; Oldroyd, J C; Staples, M P

    2013-04-01

    Medical student numbers in Australian universities have more than doubled since 2000. There are concerns about the ability for existing clinical training sites to accommodate this increase in student numbers, and there have been calls to increase training in private hospitals. The receptiveness of patients in private hospitals will influence the success of such placements. We aimed to evaluate whether patients in a private hospital are as receptive to medical students as patients in a public hospital. Cross-sectional survey of patients conducted at a private and a public teaching hospital in Melbourne, Australia. Main outcome measures were willingness to allow a medical student to participate in an interview, physical examination and procedures (electrocardiogram, venepuncture and digital rectal examination), and patient attitudes towards medical students as assessed by a series of 20 attitude statements and a summative attitude score. Patients at the private hospital were more willing than patients at the public hospital to allow a medical student to take their history unsupervised (112/146, 76.7% vs 90/141, 63.8%; P = 0.02). The distribution of patient willingness did not otherwise differ between hospitals for physical examination or procedures. There was no difference in the mean attitude score between hospitals (15.3 ± 0.8 private vs 15.4 ± 1.2 public, P = 0.38), and responses differed between hospitals for only four of the 20 attitude statements. Our findings suggest that patients in a private hospital are at least as receptive to medical students as patients in a public hospital. © 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

  12. What Predicts Patients’ Willingness to Undergo Online Treatment and Pay for Online Treatment? Results from a Web-Based Survey to Investigate the Changing Patient-Physician Relationship

    PubMed Central

    Bidmon, Sonja; Terlutter, Ralf

    2016-01-01

    Background Substantial research has focused on patients’ health information–seeking behavior on the Internet, but little is known about the variables that may predict patients’ willingness to undergo online treatment and willingness to pay additionally for online treatment. Objective This study analyzed sociodemographic variables, psychosocial variables, and variables of Internet usage to predict willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the general practitioner (GP). Methods An online survey of 1006 randomly selected German patients was conducted. The sample was drawn from an e-panel maintained by GfK HealthCare. Missing values were imputed; 958 usable questionnaires were analyzed. Variables with multi-item measurement were factor analyzed. Willingness to undergo online treatment and willingness to pay additionally for online treatment offered by the GP were predicted using 2 multiple regression models. Results Exploratory factor analyses revealed that the disposition of patients’ personality to engage in information-searching behavior on the Internet was unidimensional. Exploratory factor analysis with the variables measuring the motives for Internet usage led to 2 separate factors: perceived usefulness (PU) of the Internet for health-related information searching and social motives for information searching on the Internet. Sociodemographic variables did not serve as significant predictors for willingness to undergo online treatment offered by the GP, whereas PU (B=.092, P=.08), willingness to communicate with the GP more often in the future (B=.495, P<.001), health-related information–seeking personality (B=.369, P<.001), actual use of online communication with the GP (B=.198, P<.001), and social motive (B=.178, P=.002) were significant predictors. Age, gender, satisfaction with the GP, social motive, and trust in the GP had no significant impact on the willingness to pay additionally

  13. 34 CFR 76.660 - Use of private school personnel.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Use of private school personnel. 76.660 Section 76.660... Be Met by the State and Its Subgrantees? Participation of Students Enrolled in Private Schools § 76.660 Use of private school personnel. A subgrantee may use program funds to pay for the services of an...

  14. When Negotiation Fails: Private Education as a Disciplinary Strategy

    ERIC Educational Resources Information Center

    de Regt, Ali; Weenink, Don

    2005-01-01

    This articles deals with the question why Dutch upper-middle-class parents resort to fee-paying private education, a tiny, recently developed sector of the Dutch educational system. The research is based on interviews with 37 parents and 20 students attending private schools, and on a survey among 376 parents involved in private schooling. From…

  15. Measuring Preferences for a Diabetes Pay-for-Performance for Patient (P4P4P) Program using a Discrete Choice Experiment.

    PubMed

    Chen, Tsung-Tai; Tung, Tao-Hsin; Hsueh, Ya-Seng Arthur; Tsai, Ming-Han; Liang, Hsiu-Mei; Li, Kay-Lun; Chung, Kuo-Piao; Tang, Chao-Hsiun

    2015-07-01

    To elicit a patient's willingness to participate in a diabetes pay-for-performance for patient (P4P4P) program using a discrete choice experiment method. The survey was conducted in March 2013. Our sample was drawn from patients with diabetes at five hospitals in Taiwan (International Classification of Diseases, Ninth Revision, Clinical Modification code 250). The sample size was 838 patients. The discrete choice experiment questionnaire included the attributes monthly cash rewards, exercise time, diet control, and program duration. We estimated a bivariate probit model to derive willingness-to-accept levels after accounting for the characteristics (e.g., severity and comorbidity) of patients with diabetes. The preferred program was a 3-year program involving 30 minutes of exercise per day and flexible diet control. Offering an incentive of approximately US $67 in cash per month appears to increase the likelihood that patients with diabetes will participate in the preferred P4P4P program by approximately 50%. Patients with more disadvantageous characteristics (e.g., elderly, low income, greater comorbidity, and severity) could have less to gain from participating in the program and thus require a higher monetary incentive to compensate for the disutility caused by participating in the program's activities. Our result demonstrates that a modest financial incentive could increase the likelihood of program participation after accounting for the attributes of the P4P4P program and patients' characteristics. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  16. Aetna to pay up.

    PubMed

    Conde, Crystal

    2013-03-01

    In December, Aetna became the latest insurer to agree to a proposed settlement to pay physicians and patients $120 million because it used Ingenix databases that deflated payments for out-of-network physician services. The decision stems from settlement of a 2009 lawsuit against Aetna by the Texas Medical Association, the American Medical Association, and state medical societies in California, Connecticut, Florida, Georgia, New Jersey, New York, North Carolina, Tennessee, and Washington. They alleged Aetna used databases created by Ingenix, Inc., a subsidiary of UnitedHealthcare, to set usual, customary, and reasonable (UCR) rates for out-of-network services. They said Ingenix was inherently flawed and unable to establish proper UCR rates.

  17. [A double-blind nomifensine-nortriptyline trial in ambulatory patients conducted by psychiatrists in private practice: results and comments].

    PubMed

    Coudray, J P; Dufour, H; Garello, J L; Mollo, Y; Pascal, F; Poisson, D; Scotto, J C; Simart, G; Sormani, J; Tourame, G

    1978-06-28

    Nomifensine and nortriptyline were compared in a collaborative trial by psychiatrists in private practice. The trial impiled:--selection of ambulatory depressed patients--randomization in parallel groups (respectively 31 and 34 subjects)--administration in double-blind condition of 4 capsuels daily of either compound during 4 weeks--quotation of depressvie syndrom with Hamilton depression scale before treatment after 2 and 4 weeks. The analysis of results shows clear improvment of depression scores, equivalent in both groups (non significant difference and posterior rejection of an alternative hypothesis). Practical problems encountered in controlled trials in psychiatrist's outpatients are discussed.

  18. Managing uncertainty around HIV/AIDS in an urban setting: private medical providers and their patients in Pune, India.

    PubMed

    Kielmann, Karina; Deshmukh, Deepali; Deshpande, Sucheta; Datye, Vinita; Porter, John; Rangan, Sheela

    2005-10-01

    Changing epidemiological patterns and the advent of new rapid diagnostic technologies and therapies have created considerable uncertainty for providers working in HIV. In India, the demand for HIV care is increasingly being met by private practitioners (PPs), yet little is known about how they deal with the challenges of managing HIV patients. To explore HIV management practices in the private medical sector, a survey was conducted with 215PPs in Pune, India, followed by in-depth interviews focusing on the social context of practice among a sub-set of 27PPs. Drawing primarily on interview data, this paper illustrates a number of uncertainties that underlie the reported actions of providers in a competitive medical market. PPs perceive HIV as a 'new' and challenging disease for which they lack adequate knowledge and skills. Combined with the perceived high cost and complexity of antiretroviral treatment, preconceptions about HIV patients' social, financial and mental capacity lead to highly individualistic management practices. While these fall short of clinical 'best practice' guidelines, they reflect adaptive responses to the wider uncertainties surrounding HIV care in urban India. By highlighting contextual issues in PPs' management of HIV patients, the paper suggests the need to explicitly acknowledge the social, moral and economic bases of uncertainty beyond the clinical setting.

  19. Private hospital accreditation and inducement of care under the ghanaian national insurance scheme

    PubMed Central

    2011-01-01

    The Ghanaian National Health Insurance Scheme pays providers according to the fee for service payment scheme, a method of payment that is likely to encourage inducement of care. The goal of this paper is to test for the presence of supplier induced demand among patients who received care in private, for profit, hospitals accredited to provide care to insured patients. An instrumental variable Poisson estimation was used to compare the demand curves for health care by insured outpatients in the public and private hospitals. The results showed that supplier induced demand existed in the private sector among patients within the ages 18 and 60 years. Impact on cost of care and patients' welfare is discussed. PMID:22827881

  20. Methylnaltrexone in the treatment of opioid-induced constipation in cancer patients receiving palliative care: willingness-to-pay and cost-benefit analysis.

    PubMed

    Iskedjian, Michael; Iyer, Shrividya; Librach, S Lawrence; Wang, Mike; Farah, Bechara; Berbari, Jade

    2011-01-01

    When laxative regimens have failed, methylnaltrexone may be indicated for the relief of opioid-induced constipation (OIC) in patients with advanced illness receiving palliative care. A cost-benefit analysis (CBA), based on a willingness-to-pay (WTP) approach, was performed to determine if methylnaltrexone should be added to the formulary list of drugs being reimbursed by third-party payers in Canada for the treatment of cancer patients in palliative care suffering from OIC. The WTP study had two components: a decision board explaining treatment options (Component A) and a questionnaire to measure individual WTP using a bidding game approach (Component B). Component A had two options: Option 1 (laxatives only) and Option 2 (laxatives+methylnaltrexone injection). Only participants choosing Option 2 were invited to complete Component B. The results of the WTP survey were then incorporated into a CBA. Within a hypothetical cohort, additional monthly premiums that individuals were willing to pay for methylnaltrexone were compared with the monthly costs to the insurer for providing methylnaltrexone to all patients who would potentially be using it. Four hundred one Canadians, of age 18 years and older, were surveyed and yielded a WTP in additional monthly insurance premiums of Canadian dollar (CAD) $8.65 (95% confidence interval: CAD$6.17-CAD$11.13). The CBA resulted in additional CAD$89,307 with a cost of CAD$139,840 and benefits of CAD$229,147. A set of 10,000 Monte Carlo simulations resulted in average CBA savings of CAD$145,011 with a 99.86% probability of dominance. The present CBA provides pharmacoeconomic evidence for the adoption of methylnaltrexone for treating OIC in terminally ill cancer patients. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  1. Both Patient and Facility Contribute to Achieving the Centers for Medicare and Medicaid Services' Pay-for-Performance Target for Dialysis Adequacy

    PubMed Central

    Tighiouart, Hocine; Meyer, Klemens B.; Miskulin, Dana C.

    2011-01-01

    The Centers for Medicare and Medicaid Services (CMS) designated the achieved urea reduction ratio (URR) as a pay-for-performance measure, but to what extent this measure reflects patient characteristics and adherence instead of its intent to reflect facility performance is unknown. Here, we quantified the contributions of patient case-mix and adherence to the variability in achieving URR targets across dialysis facilities. We found that 92% of 10,069 hemodialysis patients treated at 173 facilities during the last quarter of 2004 achieved the target URR ≥65%. Mixed-effect models with random intercept for dialysis facility revealed a significant facility effect: 11.5% of the variation in achievement of target URR was attributable to the facility level. Adjusting for patient case-mix reduced the proportion of variation attributable to the facility level to 6.7%. Patient gender, body surface area, dialysis access, and adherence with treatment strongly associated with achievement of the URR target. We could not identify specific facility characteristics that explained the remaining variation between facilities. These data suggest that if adherence is not a modifiable patient characteristic, providers could be unfairly penalized for caring for these patients under current CMS policy. These penalties may have unintended consequences. PMID:22025629

  2. Comparative Investigation of Health Literacy Level of Cardiovascular Patients Hospitalized in Private and Educational Hospitals of Kerman City, Iran

    PubMed Central

    Malekzadeh, Sajedeh; Azami, Mohammad; Mirzaei, Moghadameh; Motamedi, Fatemeh

    2016-01-01

    Introduction: literacy involves a complex set of abilities to understand and use symbolic systems of a culture for personal development and social development in a diverse set of skills required as an adult to exercise behavior are considered in society Objectives: The aim of this study was to evaluate Comparative investigation of health literacy level of cardiovascular patients hospitalized in private and public educational hospitals of Kerman city Methods: This study used survey methods, analytical and cross-sectional manner. Data was collected through questionnaires distributed among 200 patients of cardiovascular-hospitalization took place in the city of Kerman. To analyze the data in the description of the mean, standard deviation and frequency distribution tables and the level of analysis to determine the relationship between gender and marital status of health literacy test or nonparametric test Mann-Whitney T-Test and, for the relationship between group employment and residence, a one-way analysis of variance or Kruskal-Wallis test, to evaluate the relationship between age and income, Pearson and Spearman correlation to investigate the relationship between level of education and health literacy of SPPS software version 21 was used. Results: The results showed that 10% of patients at educational hospitals in Kerman adequate health literacy, and 48% of patients in private hospitals had adequate health literacy. As a result, there is a significant difference of health literacy between the two types of hospital (p-value <0/0001). Conclusions: The results showed that most patients had inadequate and border health literacy have been. Health plans, preparation of simple educational system and understanding, spending more time and have a discussion with the lower speed In connection with the patient’s doctor and medical staff, Including ways to help patients with low health literacy and improve their health literacy is. PMID:27041812

  3. Healthcare resource utilization and costs by age and joint location among osteoarthritis patients in a privately insured population.

    PubMed

    Wang, Susanne X; Ganguli, Arijit X; Bodhani, Amit; Medema, Jeroen K; Reichmann, William M; Macaulay, Dendy

    2017-09-26

    To compare healthcare resource utilization and costs between patients aged 18-64 years with osteoarthritis (OA) and matched controls without OA in a privately insured population. Patients with OA were selected from de-identified US-based employer claims (Q1:1999-Q3:2011). The index date was defined as the first OA diagnosis indicated by ICD-9-CM codes. One year before and after the index date were defined as the baseline and study periods, respectively. A second OA diagnosis during the study period was also required. Patients with OA were matched one-to-one on age, gender, index date, and minimum length of follow-up to controls without OA. Baseline characteristics and study period resource utilization and costs (2016 USD) were compared between cohorts. This study identified 199,539 patients with OA (knee: 87,271, hip: 19,953, hand: 15,670, spine: 12,496). The average age was 54 years, and 58% were female. OA patients had higher healthcare resource utilization than matched controls in inpatient, emergency room, and outpatient settings (p < .001 for all). Further, patients with OA had 4-times the excess total medical costs of their matched controls ($14,521 vs $3,629; p < .001). Patients with hip OA had the highest medical costs among all joint locations. Outpatient and pharmacy costs were similar among patients with knee, hip, and hand OA, but higher in patients with spine OA. In sub-group analyses, older patients (45-64 years old) had higher costs. This sample, obtained using claims data, only includes patients who were actively seeking care for OA and were likely symptomatic. Asymptomatic patients would likely not be captured in this analysis. Patients with OA incur greater healthcare resource utilization and costs than patients without OA, with substantial variation by joint location.

  4. Primary-care physicians' patient referral patterns to private versus public hospitals for orthopaedic or trauma surgery-- French Sentinels® database, 1997-2011.

    PubMed

    Rousseau, A-C; Blanchon, T; Turbelin, C; Cabane, J; Hanslik, T; Feron, J-M; Rousseau, B; Fardet, L

    2013-10-01

    In France, primary-care physicians referring patients for admission can choose between public and private hospitals. The factors that govern their choices are unknown. Among all patient admissions reported from 1997 to 2011 by primary-care physicians participating in the Sentinels(®) network, we identified those due to orthopaedic conditions or trauma. We then identified the factors associated with referral to a private hospital rather than to a public hospital. Of 45,960 admissions reported to Sentinels(®) in 1997-2011, 2794 (6.1%) were for orthopaedic/trauma care. The main reasons for admission were hip fractures (27.5%), elective orthopaedic surgery (15.5%), fractures of the humerus (5.9%), wrist fractures (5.4%), soft-tissue lesions of the forearm or hand (5.0%), and spinal injuries (4.5%). Private hospitals were chosen more often for orthopaedic/trauma patients than for patients with other conditions (40% vs. 21.6% of cases, P<0.0001). When fracture of the humerus was used as the reference, referral to private hospitals was significantly more common for elective surgery (odds ratio, 3.30 [2.02-5.40]) and hip fracture (odds ratio, 1.50 [1.03-2.18]) and significantly less common for spinal injuries (odds ratio, 0.35 [0.19-0.66]). Other factors associated with referral to private hospitals were patient age, admission decision during an office visit or in a non-emergent setting, and admission decision made by the patient's usual physician. Specific factors seem to govern decisions by primary-care physicians to refer orthopaedic/trauma patients to private vs. public hospitals. Identical pricing scales for private and public hospitals will be implemented soon in France, a change that requires further analyses. Level IV. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  5. Not-for-profit hospital CEO performance and pay: some evidence from Connecticut.

    PubMed

    Kramer, Jeffrey; Santerre, Rexford E

    2010-01-01

    This paper uses observations from a panel data set of 35 chief executive officers (CEOs) from 29 not-for-profit hospitals in Connecticut over the period 1998 to 2006 to investigate the relationship between CEO performance and pay. Both economic and charity performance measures are specified in the empirical model. The multiple regression results reveal that not-for-profit hospital CEOs, at least in Connecticut, are driven at the margin to increase the occupancy rate of privately insured patients at the expense of uncompensated care and public-pay patients. This type of behavior on the part of not-for-profit hospital CEOs calls into question the desirability of allowing these hospitals a tax exemption on earned income, property, and purchases.

  6. A study on moral hazard in dentistry: costs of care in the private and the public sector.

    PubMed

    Tuominen, Risto; Eriksson, Anna-Leena

    2011-10-01

    The aim of this study was to evaluate the costs of subsidized care for an adult population provided by private and public sector dentists. A sample of 210 patients was drawn systematically from the waiting list for nonemergency dental treatment in the city of Turku. Questionnaire data covering sociodemographic background, dental care utilization and marginal time cost estimates were combined with data from patient registers on treatment given. Information was available on 104 patients (52 from each of the public and the private sectors). The overall time taken to provide treatment was 181 days in the public sector and 80 days in the private sector (P<0.002). On average, public sector patients had significantly (P < 0.01) more dental visits (5.33) than private sector patients (3.47), which caused higher visiting fees. In addition, patients in the public sector also had higher other out-of-pocket costs than in the private sector. Those who needed emergency dental treatment during the waiting time for comprehensive care had significantly more costly treatment and higher total costs than the other patients. Overall time required for dental visits significantly increased total costs. The total cost of dental care in the public sector was slightly higher (P<0.05) than in the private sector. There is no direct evidence of moral hazard on the provider side from this study. The observed cost differences between the two sectors may indicate that private practitioners could manage their publicly funded patients more quickly than their private paying patients. On the other hand, private dentists providing more treatment per visit could be explained by private dentists providing more than is needed by increasing the content per visit. © 2011 John Wiley & Sons A/S.

  7. Factors influencing the missed nursing care in patients from a private hospital.

    PubMed

    Hernández-Cruz, Raúl; Moreno-Monsiváis, María Guadalupe; Cheverría-Rivera, Sofía; Díaz-Oviedo, Aracely

    2017-07-10

    to determine the factors that influence the missed nursing care in hospitalized patients. descriptive correlational study developed at a private hospital in Mexico. To identify the missed nursing care and related factors, the MISSCARE survey was used, which measures the care missed and associated factors. The care missed and the factors were grouped in global and dimension rates. For the analysis, descriptive statistics, Spearman's correlation and simple linear regression were used. Approval for the study was obtained from the ethics committee. the participants were 71 nurses from emergency, intensive care and inpatient services. The global missed care index corresponded to M=7.45 (SD=10.74); the highest missed care index was found in the dimension basic care interventions (M=13.02, SD=17.60). The main factor contributing to the care missed was human resources (M=56.13, SD=21.38). The factors related to the care missed were human resources (rs=0.408, p<0.001) and communication (rs=0.418, p<0.001). the nursing care missed is mainly due to the human resource factor; these study findings will permit the strengthening of nursing care continuity. determinar os fatores que influenciam o cuidado de enfermagem omitido em pacientes hospitalizados. estudo descritivo correlacional, desenvolvido em um hospital particular do México. Para identificar o cuidado omitido e fatores relacionados, utilizou-se o instrumento MISSCARE, que mede o cuidado omitido e os fatores associados. O cuidado omitido e os fatores foram agrupados em índices globais e por dimensões. Para fins de análise, foi utilizada estatística descritiva, correlação de Spearman e regressão linear simples. O estudo recebeu aprovação de comité de ética. participaram 71 enfermeiras dos serviços de urgências, terapia intensiva e hospitalização. O índice global de cuidado omitido mostrou um coeficiente M=7,45 (DE=10,74); o índice com maior cuidado omitido correspondeu à dimensão de intervenções de

  8. The Impact of Expressions of Treatment Efficacy and Out-of-pocket Expenses on Patient and Physician Interest in Osteoporosis Treatment: Implications for Pay-for-performance Programs

    PubMed Central

    Foreman-Hoffman, Valerie; Cram, Peter

    2007-01-01

    BACKGROUND Clinical practice guidelines (CPGs) are increasingly used as the basis for pay-for-performance (P4P) programs. It is unclear how support for guidelines varies when treatment efficacy is expressed in varying mathematically equivalent ways. OBJECTIVES To assess: (1) how patient and provider compliance with osteoporosis CPGs varies when pharmacotherapy efficacy is presented as relative risk reduction (RRR) versus absolute risk reduction (ARR) and (2) the impact of increasing out-of-pocket drug expenditures on acceptance of guideline concordant therapy. DESIGN Cross-sectional survey of patients and physicians. SUBJECTS AND SETTING Female patients age >50 years and providers drawn from academic and community outpatient clinics. MEASUREMENTS Patient and provider acceptance of pharmacotherapy when treatment efficacy (reduction in hip fractures) was expressed alternatively in relative terms (35% RRR) versus absolute terms (1% ARR); acceptance of pharmacotherapy as patient drug copayment increased from 0% to 100% of the total drug costs. RESULTS Compliance with CPGs fell significantly when the expression of treatment benefit was switched from RRR to ARR for both patients (86% vs 57% compliance; P < .001) and physicians (97% vs 56% compliance; P < .001). Increasing drug copayment from 0% to 10% of total drug cost decreased patient compliance with CPGs from 80% to 57% (P < .001) but did not impact physician compliance. With increasing levels of copay, both patient and provider interest in treatment decreased. LIMITATIONS Respondents may not have fully understood the risks and benefits associated with osteoporosis and its treatment. CONCLUSION Patient and provider interest in CPG-recommended treatment for osteoporosis is reduced when treatment benefit is expressed as ARR rather than RRR. In addition, minimal increases in drug copayment significantly decreased patient, but not provider, interest in osteoporosis treatment. Designers of P4P programs should

  9. [Treatment of depressive patients in private practice--empirical results, health political and social conditions and recommendations].

    PubMed

    Goesmann, Cornelia; Bühren, Astrid; Neuy-Bartmann, Astrid

    2007-09-01

    Although depression and symptoms of depression belong to the most common disorders in private practice, affected patients are not always diagnosed as early as possible in Germany and often not sufficiently treated. In order to improve the care for persons with depression it is necessary that family doctors are prepared to guide these patients with empathy, treat them adequately pharmacologically both in respect to the depression and to all other somatic aspects and to refer them in time to specialists for psychiatry, psychosomatic medicine or psychotherapy. Political and social conditions that have pathogenic effects should be changed and the shortage of psychotherapy needs to be overcome. In future, the integrated care in ambulant and clinical settings will probably be successful, first trials and test setups have shown good results.

  10. EQUAL PAY FACTS.

    ERIC Educational Resources Information Center

    Women's Bureau (DOL), Washington, DC.

    EQUAL PAY MEANS PAYMENT OF "RATE OF THE JOB" WITHOUT REGARD TO SEX. EQUAL PAY LAWS WERE ENACTED IN 29 STATES FROM 1919 TO 1965. FOUR ADDITIONAL STATES HAVE FAIR EMPLOYMENT PRACTICES LAWS. SUPPORT FOR SUCH LEGISLATION HAS COME FROM WOMEN'S AND CIVIC ORGANIZATIONS, AFL-CIO, AND THE PRESIDENT'S AND STATE COMMISSIONS ON THE STATUS OF WOMEN. THE…

  11. High Pay Makes Headlines

    ERIC Educational Resources Information Center

    Fain, Paul

    2006-01-01

    The skyrocketing pay and benefits of corporate executives have kept reporters and, sometimes, prosecutors busy in recent years. The resulting public outrage over these tales of excess has contributed to a backlash. Now the news media, in searching for excessive pay in places where there seems to be no cap on costs, have increasingly focused their…

  12. EQUAL PAY FACTS.

    ERIC Educational Resources Information Center

    Women's Bureau (DOL), Washington, DC.

    EQUAL PAY MEANS PAYMENT OF "RATE OF THE JOB" WITHOUT REGARD TO SEX. EQUAL PAY LAWS WERE ENACTED IN 29 STATES FROM 1919 TO 1965. FOUR ADDITIONAL STATES HAVE FAIR EMPLOYMENT PRACTICES LAWS. SUPPORT FOR SUCH LEGISLATION HAS COME FROM WOMEN'S AND CIVIC ORGANIZATIONS, AFL-CIO, AND THE PRESIDENT'S AND STATE COMMISSIONS ON THE STATUS OF WOMEN. THE…

  13. Financial Advice: Who Pays

    ERIC Educational Resources Information Center

    Finke, Michael S.; Huston, Sandra J.; Winchester, Danielle D.

    2011-01-01

    Using a cost-benefit framework for financial planning services and proprietary data collected in the summer of 2008, the client characteristics that are associated with the likelihood of paying for professional financial advice, as well as the type of financial services purchased, are identified. Results indicate that respondents who pay for…

  14. Factors Associated with Treatment Delay among Pulmonary Tuberculosis Patients in Public and Private Health Facilities in Addis Ababa, Ethiopia

    PubMed Central

    Adenager, Getinet Shewaseged; Alemseged, Fessahaye; Asefa, Henok

    2017-01-01

    Background. Early detection and diagnosis of tuberculosis (TB) and the timely commencement of antituberculosis (anti-TB) treatment are the parts of efficient tuberculosis prevention and control program. Delay in the commencement of anti-TB treatment worsens the prognosis and increases the risk of death and the chance of transmission in the community and among health care workers. Objective. To assess tuberculosis treatment delay and associated factors among pulmonary TB patients in Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted in 10 public and 10 private health facilities that provide TB treatment. The data were collected from 425 newly registered pulmonary TB patients using pretested structured questionnaire from April to June 2012. Data were entered in EPI info version 3.5.1 and analyzed using SPSS version 16.0. Findings. The median durations of a patient, health care system, and total treatment delays were 17, 9, and 35 days, respectively. Overall 179 (42.1%), 233 (54.8%), and 262 (61.6%) of patients experienced patient delay, health care system delay, and total treatment delay, respectively. Distance more than 2.5 km from TB treatment health facility [AOR = 1.6, 95% CI (1.1–2.5)] and the presence of TB-associated stigma [AOR = 2.1, 95% CI (1.3, 3.4)] indicate higher odds of patient delay, whereas, being unemployed, patients with the hemoptysis symptom complain indicated lower odds of health care system delay [AOR = 0.41, 95% CI (0.24, 0.70)] and [AOR = 0.61 (0.39, 0.94)], respectively. Conclusions. A significant proportion of clients experienced patient and health care system delay. Thus, there is a need for designing and implementing appropriate strategies to decrease the delays. Efforts to reduce delays should give focus on integrating prevention programs such as active case detection and expanding access to TB care. PMID:28348887

  15. University clinic and private practice treatment outcomes in Class I extraction and nonextraction patients: A comparative study with the American Board of Orthodontics Objective Grading System.

    PubMed

    Mislik, Barbara; Konstantonis, Dimitrios; Katsadouris, Alexios; Eliades, Theodore

    2016-02-01

    The aim of this study was to compare treatment outcomes in university vs private practice settings with Class I patients using the American Board of Orthodontics Objective Grading System. A parent sample of 580 Class I patients treated with and without extractions of 4 first premolars was subjected to discriminant analysis to identify a borderline spectrum of 66 patients regarding the extraction modality. Of these patients, 34 were treated in private orthodontic practices, and 32 were treated in a university graduate orthodontic clinic. The treatment outcomes were evaluated using the 8 variables of the American Board of Orthodontics Objective Grading System. The total scores ranged from 10 to 47 (mean, 25.44; SD, 9.8) for the university group and from 14 to 45 (mean, 25.94; SD, 7.7) for the private practice group. The university group achieved better scores for the variables of buccolingual inclination (mean difference, 2.28; 95% confidence interval [CI], 0.59, 3.98; P = 0.01) and marginal ridges (mean difference, 1.32; 95% CI, 0.28, 2.36; P = 0.01), and the private practice group achieved a better score for the variable of root angulation (mean difference, -0.65; 95% CI, -1.26, -0.03; P = 0.04). However, no statistically intergroup differences were found between the total American Board of Orthodontics Objective Grading System scores (mean difference, -0.5; 95% CI, -3.82, 4.82; P = 0.82). Patients can receive similar quality of orthodontic treatment in a private practice and a university clinic. The orthodontists in the private practices were more successful in angulating the roots properly, whereas the orthodontic residents accomplished better torque control of the posterior segments and better marginal ridges. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  16. Oral health care professionals' identification of cardiovascular disease risk among patients in private dental offices in Sweden.

    PubMed

    Jontell, Mats; Glick, Michael

    2009-11-01

    The authors conducted a study to investigate whether general private dental practitioners in Sweden could identify patients at risk of experiencing a fatal outcome of cardiovascular disease (CVD) within a set time frame and to what extent those practitioners' findings would result in medical interventions. The authors enrolled 200 patients who met the following inclusion criteria: age of 45 years or older; no history of or use of medications for hypertension, hypercholesterolemia or diabetes; and having had no visits to a health care professional during the preceding 12 months during which glucose levels, total cholesterol levels or blood pressure had been assessed. The participating dentists and their staff members used a computerized system, HeartScore (European Society of Cardiology, Sophia Antipolis, France), to calculate the risk, in percentages, of a patient's dying as a result of a CVD event within the next 10 years. Dentists advised patients with HeartScores of 10 percent or higher to seek medical advice. After six to 12 months, one of the authors conducted structured telephone interviews to ascertain the results of the medical referrals. Six percent of the participants, all men (n = 12), had HeartScores of 10 percent or higher. No woman had a HeartScore higher than 5 percent. Fifty percent of the identified patients (n = 6) with a HeartScore of 10 percent or higher received prescriptions for antihypertensive medications after undergoing an evaluation by a medical care provider. For three patients, the physician was not able to confirm the dentists' assessment and took no further action. Oral health care professionals can identify patients who are unaware of their risk of developing serious complications as a result of CVD and who are in need of medical intervention. The authors' findings suggest the need for more studies with larger sample populations.

  17. Baseline traits of low vision patients served by private outpatient clinical centers in the United States.

    PubMed

    Goldstein, Judith E; Massof, Robert W; Deremeik, James T; Braudway, Sonya; Jackson, Mary Lou; Kehler, K Bradley; Primo, Susan A; Sunness, Janet S

    2012-08-01

    To characterize the traits of low vision patients who seek outpatient low vision rehabilitation (LVR) services in the United States. In a prospective observational study, we enrolled 764 new low vision patients seeking outpatient LVR services from 28 clinical centers in the United States. Before their initial appointment, multiple questionnaires assessing daily living and vision, physical, psychological, and cognitive health states were administered by telephone. Baseline clinical visual impairment measures and disorder diagnoses were recorded. Patients had a median age of 77 years, were primarily female (66%), and had macular disease (55%), most of which was nonneovascular age-related macular degeneration. More than one-third of the patients (37%) had mild vision impairment with habitual visual acuity (VA) of 20/60 or greater. The VA correlated well with contrast sensitivity (r = -0.52) but poorly with self-reported vision quality. The intake survey revealed self-reported physical health limitations, including decreased endurance (68%) and mobility problems (52%). Many patients reported increased levels of frustration (42%) and depressed mood (22%); memory and cognitive impairment (11%) were less frequently endorsed. Patients relied on others for daily living support (87%), but many (31%) still drove. Most patients seeking LVR are geriatric and have macular disease with relatively preserved VA. The disparity between VA and subjective quality of vision suggests that LVR referrals are based on symptoms rather than on VA alone. Patients seen for LVR services have significant physical, psychological, and cognitive disorders that can amplify vision disabilities and decrease rehabilitation potential.

  18. Hospitalized Patients' Awareness Of Their Rights-A Cross Sectional Survey In A Public And Private Tertiary Care Hospitals Of Punjab, Pakistan.

    PubMed

    Tabassum, Tahirah; Ashraf, Mariam; Thaver, Inayat

    2016-01-01

    The awareness of patient's rights is negligible in developing countries where no legal framework is present to protect these rights and Pakistan is no exception. Not only is there an absence of legal structure for protection of patients' rights, but the enforcement and implementation for existing law is also questionable. Pakistan has an Islamic Charter of Medical and Health Ethics which includes the medical behaviour and physician's rights and duties towards the patients. Despite all these charters on patients' rights, there is little to no awareness regarding these rights and their practice remains low in healthcare system of Pakistan. This assessment of awareness among patients about their rights will guide in formulating recommendations to improve the existing system of healthcare delivery in the country. This descriptive cross-sectional comparative study was conducted in two hospitals in Lahore, each belonging to public and private sector. A structured questionnaire was used to collect data from patients. A total of 220 patients were selected to participate in the study, 110 belonging to each private and public hospital. The findings indicate that most of the patients (64%) were not aware of their rights. The awareness level was better in patients seeking care from private hospital than those from public hospital. Education, monthly income and type of hospital utilized were found to be positively associated with the level of awareness. Most of the patients were not satisfied with the practices of their rights, especially in public hospitals. The lack of awareness regarding the rights of a patient was more common in patients of public/government hospitals compared to private hospitals. A nation-wide healthcare education program is needed to increase awareness and practice of patients' rights in the country.

  19. History of Combat Pay

    DTIC Science & Technology

    2011-08-01

    effect on morale and provided a secondary justification for token compensation. Unlike its successors, Badge Pay was not a combat pay in the...designated “combat units” or those wounded, injured, or killed by hostile fire. Defined by statute, “combat units” were effectively restricted to...favored by the Army, eligibility would be restricted to those serving at least six days with designated frontline “combat units,” effectively

  20. A retrospective analysis of isolates from patients with vaginitis in a private Greek obstetric/gynecological hospital (2003-2006).

    PubMed

    Iavazzo, Christos; Vogiatzi, Christine; Falagas, Matthew E

    2008-04-01

    Vaginitis is a common cause of complaints in women in various parts of the world. Through our literature search, we identified noteworthy differences in the etiology of vaginitis based on the geographic location. This study was conducted to describe microbial etiology in a population of symptomatic women with vaginitis in Greece. Data for pathogens isolated from cultures of vaginal fluid specimens or identified with microscopy testing of such specimens of women with symptomatic vaginitis who were examined at "Lito" Private Obstetric/Gynecological Hospital, Athens, Greece, during the period 1/2003-12/2006 were analyzed retrospectively. During this period, 1632 women were examined. The mean age of the patients was 28 years, ranging from 18 to 57 years. Three hundred and eighty five from 1632 cultures/tests contributed no pathogen, whereas 1247/1632 cultures/tests were positive. Of the isolates, in which twelve species were identified, 504 (40.4%) were Gardnerella vaginalis, 530 (42.5%) Candida spp, and 101 (8.1%) Trichomonas vaginalis. Less usual isolates were Escherichia coli, Streptococcus agalactiae, Enterococcus spp., Streptococcus viridans, Staphylococcus epidermidis, Peptostreptococcus spp., and Staphylococcus saprophyticus. The authors believe that this study adds to the relevant literature of information regarding the pathogens implicated in patients with symptomatic vaginitis by reporting data from a cohort of patients in Greece. Ninety-one percent of the isolated and identified pathogens from vaginal cultures of symptomatic Greek women included Candida albicans, Gardnerella vaginalis, and Trichomonas vaginalis, with the first two species representing the great majority.

  1. Chronic Care Improvement in Primary Care: Evaluation of an Integrated Pay-for-Performance and Practice-Based Care Coordination Program among Elderly Patients with Diabetes

    PubMed Central

    Fagan, Peter J; Schuster, Alyson B; Boyd, Cynthia; Marsteller, Jill A; Griswold, Michael; Murphy, Shannon M E; Dunbar, Linda; Forrest, Christopher B

    2010-01-01

    Objective To examine the effects of an intervention comprising (1) a practice-based care coordination program, (2) augmented by pay for performance (P4P) for meeting quality targets, and (3) complemented by a third-party disease management on quality of care and resource use for older adults with diabetes. Data Sources/Study Setting Claims files of a managed care organization (MCO) for 20,943 adults aged 65 and older with diabetes receiving care in Alabama, Tennessee, or Texas, from January 2004 to March 2007. Study Design A quasi-experimental, longitudinal study in which pre- and postdata from 1,587 patients in nine intervention primary care practices were evaluated against 19,356 patients in MCO comparison practices (>900). Five incentivized quality measures, two nonincentivized measures, and two resource-use measures were investigated. We examined trends and changes in trends from baseline to follow-up, contrasting intervention and comparison group member results. Principal Findings Quality of care generally improved for both groups during the study period. Only slight differences were seen between the intervention and comparison group trends and changes in trends over time. Conclusions This study did not generate evidence supporting a beneficial effect of an on-site care coordination intervention augmented by P4P and complemented by third-party disease management on diabetes quality or resource use. PMID:20849553

  2. Does the attention General Practitioners pay to their patients' mental health problems add to their workload? A cross sectional national survey.

    PubMed

    Zantinge, Else M; Verhaak, Peter F M; de Bakker, Dinny H; van der Meer, Klaas; Bensing, Jozien M

    2006-12-05

    The extra workload induced by patients with mental health problems may sometimes cause GPs to be reluctant to become involved in mental health care. It is known that dealing with patients' mental health problems is more time consuming in specific situations such as in consultations. But it is unclear if GPs who are more often involved in patients' mental health problems, have a higher workload than other GPs. Therefore we investigated the following: Is the attention GPs pay to their patients' mental health problems related to their subjective and objective workload? Secondary analyses were made using data from the Second Dutch National Survey of General Practice, a cross sectional study conducted in the Netherlands in 2000-2002. A nationally representative selection of 195 GPs from 104 general practices participated in this National Survey. Data from: 1) a GP questionnaire; 2) a detailed log of the GP's time use during a week and; 3) an electronic medical registration system, including all patients' contacts during a year, were used. Multiple regression analyses were conducted with the GP's workload as an outcome measure, and the GP's attention for mental health problems as a predictor. GP, patient, and practice characteristics were included in analyses as potential confounders. Results show that GPs with a broader perception of their role towards mental health care do not have more working hours or patient contacts than GPs with a more limited perception of their role. Neither are they more exhausted or dissatisfied with the available time. Also the number of patient contacts in which a psychological or social diagnosis is made is not related to the GP's objective or subjective workload. The GP's attention for a patient's mental health problems is not related to their workload. The GP's extra workload when dealing in a consultation with patients' mental health problems, as is demonstrated in earlier research, is not automatically translated into a higher overall

  3. 5 CFR 410.402 - Paying premium pay.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Paying premium pay. 410.402 Section 410... for Training Expenses § 410.402 Paying premium pay. (a) Prohibitions. Except as provided by paragraph (b) of this section, an agency may not use its funds, appropriated or otherwise available, to...

  4. Balancing the interests of patient data protection and medication safety monitoring in a public-private partnership.

    PubMed

    Dreyer, Nancy A; Blackburn, Stella; Hliva, Valerie; Mt-Isa, Shahrul; Richardson, Jonathan; Jamry-Dziurla, Anna; Bourke, Alison; Johnson, Rebecca

    2015-04-15

    Obtaining data without the intervention of a health care provider represents an opportunity to expand understanding of the safety of medications used in difficult-to-study situations, like the first trimester of pregnancy when women may not present for medical care. While it is widely agreed that personal data, and in particular medical data, needs to be protected from unauthorized use, data protection requirements for population-based studies vary substantially by country. For public-private partnerships, the complexities are enhanced. The objective of this viewpoint paper is to illustrate the challenges related to data protection based on our experiences when performing relatively straightforward direct-to-patient noninterventional research via the Internet or telephone in four European countries. Pregnant women were invited to participate via the Internet or using an automated telephone response system in Denmark, the Netherlands, Poland, and the United Kingdom. Information was sought on medications, other factors that may cause birth defects, and pregnancy outcome. Issues relating to legal controllership of data were most problematic; assuring compliance with data protection requirements took about two years. There were also inconsistencies in the willingness to accept nonwritten informed consent. Nonetheless, enrollment and data collection have been completed, and analysis is in progress. Using direct reporting from consumers to study the safety of medicinal products allows researchers to address a myriad of research questions relating to everyday clinical practice, including treatment heterogeneity in population subgroups not traditionally included in clinical trials, like pregnant women, children, and the elderly. Nonetheless, there are a variety of administrative barriers relating to data protection and informed consent, particularly within the structure of a public-private partnership.

  5. Treatment outcomes of HIV-positive patients on first-line antiretroviral therapy in private versus public HIV clinics in Johannesburg, South Africa

    PubMed Central

    Moyo, Faith; Chasela, Charles; Brennan, Alana T; Ebrahim, Osman; Sanne, Ian M; Long, Lawrence; Evans, Denise

    2016-01-01

    Background Despite the widely documented success of antiretroviral therapy (ART), stakeholders continue to face the challenges of poor HIV treatment outcomes. While many studies have investigated patient-level causes of poor treatment outcomes, data on the effect of health systems on ART outcomes are scarce. Objective We compare treatment outcomes among patients receiving HIV care and treatment at a public and private HIV clinic in Johannesburg, South Africa. Patients and methods This was a retrospective cohort analysis of ART naïve adults (≥18.0 years), initiating ART at a public or private clinic in Johannesburg between July 01, 2007 and December 31, 2012. Cox proportional-hazards regression was used to identify baseline predictors of mortality and loss to follow-up (>3 months late for the last scheduled visit). Generalized estimating equations were used to determine predictors of failure to suppress viral load (≥400 copies/mL) while the Wilcoxon rank-sum test was used to compare the median absolute change in CD4 count from baseline to 12 months post-ART initiation. Results 12,865 patients initiated ART at the public clinic compared to 610 at the private clinic. The patients were similar in terms of sex and age at initiation. Compared to public clinic patients, private clinic patients initiated ART at higher median CD4 counts (159 vs 113 cells/mm3) and World Health Organization stage I/II (76.1% vs 58.5%). Adjusted hazard models showed that compared to public clinic patients, private clinic patients were less likely to die (adjusted hazard ratio [aHR] 0.50; 95% confidence interval [CI] 0.35–0.70) but were at increased risk of loss to follow-up (aHR 1.80; 95% CI 1.59–2.03). By 12 months post-ART initiation, private clinic patients were less likely to have a detectable viral load (adjusted relative risk 0.65; 95% CI 0.49–0.88) and recorded higher median CD4 change from baseline (184 cells/mm3 interquartile range 101–300 vs 158 cells/mm3 interquartile

  6. The impact of total quality service (TQS) on healthcare and patient satisfaction: an empirical study of Turkish private and public hospitals.

    PubMed

    Bakan, Ismail; Buyukbese, Tuba; Ersahan, Burcu

    2014-01-01

    This paper attempts to measure patients' perceptions of the quality of services in public and private healthcare centers in Turkey. The main aim was to examine the impact of the dimensions of patient-perceived total quality service (TQS) on patients' satisfaction. The research framework and hypotheses are derived from a literature review of service quality and quality in the healthcare industry. The research data were collected through questionnaires and then statistically analyzed using descriptive statistics, Pearson product moment correlation and linear regression. The results suggest that service quality perceptions positively influence patient satisfaction with overall hospital care (SOHC). The most important factors identified in the regression model regarding patient SOHC are the quality of the hospital's social responsibility, administrative processes and overall experience of medical care received. These factors explain 74% of the variance in SOHC. The findings of the study can be used to improve TQS in both private and public hospitals. Copyright © 2013 John Wiley & Sons, Ltd.

  7. Are prescribing doctors sensitive to the price that their patients have to pay in the Spanish National Health System?

    PubMed Central

    2011-01-01

    Background This study aims to design an empirical test on the sensitivity of the prescribing doctors to the price afforded for the patient, and to apply it to the population data of primary care dispensations for cardiovascular disease and mental illness in the Spanish National Health System (NHS). Implications for drug policies are discussed. Methods We used population data of 17 therapeutic groups of cardiovascular and mental illness drugs aggregated by health areas to obtain 1424 observations ((8 cardiovascular groups * 70 areas) + (9 psychotropics groups * 96 areas)). All drugs are free for pensioners. For non-pensioner patients 10 of the 17 therapeutic groups have a reduced copayment (RC) status of only 10% of the price with a ceiling of €2.64 per pack, while the remaining 7 groups have a full copayment (FC) rate of 40%. Differences in the average price among dispensations for pensioners and non-pensioners were modelled with multilevel regression models to test the following hypothesis: 1) in FC drugs there is a significant positive difference between the average prices of drugs prescribed to pensioners and non-pensioners; 2) in RC drugs there is no significant price differential between pensioner and non-pensioner patients; 3) the price differential of FC drugs prescribed to pensioners and non-pensioners is greater the higher the price of the drugs. Results The average monthly price of dispensations to pensioners and non-pensioners does not differ for RC drugs, but for FC drugs pensioners get more expensive dispensations than non-pensioners (estimated difference of €9.74 by DDD and month). There is a positive and significant effect of the drug price on the differential price between pensioners and non-pensioners. For FC drugs, each additional euro of the drug price increases the differential by nearly half a euro (0.492). We did not find any significant differences in the intensity of the price effect among FC therapeutic groups. Conclusions Doctors

  8. Private specificities can dominate the humoral response to self-antigens in patients with cryptogenic fibrosing alveolitis

    PubMed Central

    Robinson, Cleo; Callow, Marinella; Stevenson, Sandra; Robinson, Bruce WS; Lake, Richard A

    2001-01-01

    Background The pathogenetic mechanisms that underlie the interstitial lung disease cryptogenic fibrosing alveolitis (CFA) may involve an immunological reaction to unidentified antigens in the lung, resulting in tissue damage. Method In order to identify the range of target autoantigens, we used expression cloning, employing serum from an index patient as the probe against an expressed cDNA library that was derived from a tumour cell line. We screened over 5 × 105 recombinants and obtained sequence information on three antigens that had provoked strong responses with immunoglobulin heavy chain class switching, presumably as a consequence of T-cell recognition. Results All of the antigens were identifiable by comparison with sequence data from the US National Center for Biotechnology Information. Alanyl tRNA synthetase (ATS) was picked on six occasions; five of these incidences reflected independent recombination events, indicating that the library was not biased. Antibodies to ATS (anti-PL-12) represent the most common reactivity that defines the antisynthetase syndrome, which is typically expressed as polymyositis, dermatomyositis and interstitial lung disease (ILD). The index patient never showed symptoms other than those associated with alveolitis, even though sera obtained from him over a period of 2 years contained antibodies with the same specificity. Autoantibodies to ATS were never detected in serial bleeds from 11 other patients with CFA, and neither did we detect antibodies to the other two antigens identified from the serum of the index patient. Conclusion The humoral response in patients with CFA can be dominated by autoantibodies with private specificities. This suggests that the antibodies are epiphenomenal and are a secondary feature of tissue damage induced by some other mechanism. PMID:11686873

  9. Willingness to pay per quality-adjusted life year: is one threshold enough for decision-making?: results from a study in patients with chronic prostatitis.

    PubMed

    Zhao, Fei-Li; Yue, Ming; Yang, Hua; Wang, Tian; Wu, Jiu-Hong; Li, Shu-Chuen

    2011-03-01

    To estimate the willingness to pay (WTP) per quality-adjusted life year (QALY) ratio with the stated preference data and compare the results obtained between chronic prostatitis (CP) patients and general population (GP). WTP per QALY was calculated with the subjects' own health-related utility and the WTP value. Two widely used preference-based health-related quality of life instruments, EuroQol (EQ-5D) and Short Form 6D (SF-6D), were used to elicit utility for participants' own health. The monthly WTP values for moving from participants' current health to a perfect health were elicited using closed-ended iterative bidding contingent valuation method. A total of 268 CP patients and 364 participants from GP completed the questionnaire. We obtained 4 WTP/QALY ratios ranging from $4700 to $7400, which is close to the lower bound of local gross domestic product per capita, a threshold proposed by World Health Organization. Nevertheless, these values were lower than other proposed thresholds and published empirical researches on diseases with mortality risk. Furthermore, the WTP/QALY ratios from the GP were significantly lower than those from the CP patients, and different determinants were associated with the within group variation identified by multiple linear regression. Preference elicitation methods are acceptable and feasible in the socio-cultural context of an Asian environment and the calculation of WTP/QALY ratio produced meaningful answers. The necessity of considering the QALY type or disease-specific QALY in estimating WTP/QALY ratio was highlighted and 1 to 3 times of gross domestic product/capita recommended by World Health Organization could potentially serve as a benchmark for threshold in this Asian context.

  10. Long-Term and Interactive Effects of Pay-For-Performance Interventions among Diabetic Nephropathy Patients at the Early Chronic Kidney Disease Stage

    PubMed Central

    Liao, Pei-Ju; Lin, Tzu-Yu; Wang, Tzu-Ching; Ting, Ming-Kuo; Wu, I-Wen; Huang, Hsin-Tsung; Wang, Fu-Chung; Chang, Huan-Cheng; Hsu, Kuang-Hung

    2016-01-01

    Abstract Chronic kidney disease (CKD) is a major health problem worldwide because of the aging population and lifestyle changes. One of the important etiologies of CKD is diabetes mellitus (DM). The long-term effects of pay-for-performance (P4P) on disease progression have not been thoroughly examined. This study is a retrospective population-based patient cohort design to examine the continuous effects of diabetes and CKD P4P interventions. This study used the health insurance claims database to conduct a longitudinal analysis. A total of 32,084 early CKD patients with diabetes were extracted from the outpatient claims database from January 2011 to December 2012, and the follow-up period was extended to August 2014. A 4-group matching design, including both diabetes and early CKD P4P interventions, with only diabetes P4P intervention, with only early CKD P4P intervention, and without any P4P interventions, was performed according to their descending intensity. The primary outcome of this study was all-cause mortality and the causes of death. The statistical methods included a Chi-squared test, ANOVA, and multi-variable Cox regression models. A dose–response relationship between the intervention groups and all-cause mortality was observed as follows: comparing to both diabetes and early CKD P4P interventions (reference), hazard ratio (HR) was 1.22 (95% confidence interval [CI], 1.00–1.50) for patients with only a diabetes P4P intervention; HR was 2.00 (95% CI, 1.66–2.42) for patients with only an early CKD P4P intervention; and HR was 2.42 (95% CI, 2.02–2.91) for patients without any P4P interventions. The leading cause of death of the total diabetic nephropathy patient cohort was infectious diseases (34.32%) followed by cardiovascular diseases (17.12%), acute renal failure (1.50%), and malignant neoplasm of liver (1.40%). Because the earlier interventions have lasting long-term effects on the patient's prognosis regardless of disease course, an integrated

  11. Medicaid Nursing Home Pay for Performance: Where Do We Stand?

    ERIC Educational Resources Information Center

    Arling, Greg; Job, Carol; Cooke, Valerie

    2009-01-01

    Purpose: Nursing home pay-for-performance (P4P) programs are intended to maximize the value obtained from public and private expenditures by measuring and rewarding better nursing home performance. We surveyed the 6 states with operational P4P systems in 2007. We describe key features of six Medicaid nursing home P4P systems and make…

  12. Medicaid Nursing Home Pay for Performance: Where Do We Stand?

    ERIC Educational Resources Information Center

    Arling, Greg; Job, Carol; Cooke, Valerie

    2009-01-01

    Purpose: Nursing home pay-for-performance (P4P) programs are intended to maximize the value obtained from public and private expenditures by measuring and rewarding better nursing home performance. We surveyed the 6 states with operational P4P systems in 2007. We describe key features of six Medicaid nursing home P4P systems and make…

  13. Comparing demographics, clinical presentation, treatments and outcome between systemic lupus erythematosus patients treated in a public and private health system in Santa Fe, Argentina.

    PubMed

    Schmid, María Marcela; Roverano, Susana Graciela; Paira, Sergio Oscar

    2014-01-01

    The study includes 159 SLE patients seen between 1987 and 2011, of whom 116 were treated in the public health system and 43 in private practice. In the comparison between both groups, it was shown that patients in the public health system were younger at first consultation and at the onset of SLE, and that the mean duration of their disease prior to nephropathy was statistically significantly shorter. They also presented with more SLE activity (measured by Systemic Lupus Erythematosus Activity Index) such as fever, lower levels of C4, and elevated erythrocyte sedimentation rate. Although cyclophosphamide was administered more frequently to patients in the public health system group, there were no statistically significant differences in renal histological findings. A second renal biopsy was performed on 20 patients due to the presence of persistent proteinuria, peripheral edema, urinary casts, or because of previous defective renal specimens. The overall 10-year survival of the patients in the public health system was 78% compared to a survival rate of 91% for the patients in private practices. When survival was evaluated at 15 years, however, no differences were found (log rank test: 0.65). Patients from both public and private groups attended medical specialist practices and received early diagnoses and close follow-ups. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  14. Do You Get What You Deserve? Factors Affecting the Relationship between Productivity and Pay.

    ERIC Educational Resources Information Center

    Konrad, Alison M.; Pfeffer, Jeffrey

    1990-01-01

    Using a sample of 5,645 academics in 200 colleges and universities across all academic fields, this study investigates factors affecting the relationship between productivity, measured by publication, and pay. Results indicate that productivity significantly affected pay in private, high quality institutions and research-oriented departments.…

  15. Engaging Stakeholders in Teacher Pay Reform. Emerging Issues. Report No. 1

    ERIC Educational Resources Information Center

    Max, Jeffrey; Koppich, Julia E.

    2009-01-01

    A growing number of states and school districts are experimenting with new approaches to paying teachers. These efforts to reform teacher pay can involve a range of state and local actors, including governors, state education officials, superintendents, local school boards, teacher unions, private foundations, community organizations, and local…

  16. Are Selective Private and Public Colleges Affordable?

    ERIC Educational Resources Information Center

    Karikari, John A.; Dezhbakhsh, Hashem

    2013-01-01

    We examine college affordability under the existing pricing and financial aid system that awards both non need-based and need-based aid. Using data of freshmen attending a large number of selective private and public colleges in the USA, we find that the prices students actually pay for college have increased over time. Need-based grant aid has…

  17. Are Selective Private and Public Colleges Affordable?

    ERIC Educational Resources Information Center

    Karikari, John A.; Dezhbakhsh, Hashem

    2013-01-01

    We examine college affordability under the existing pricing and financial aid system that awards both non need-based and need-based aid. Using data of freshmen attending a large number of selective private and public colleges in the USA, we find that the prices students actually pay for college have increased over time. Need-based grant aid has…

  18. Motivating the Private vs. Public Sector Managers.

    ERIC Educational Resources Information Center

    Khojasteh, Mak

    1993-01-01

    A questionnaire on intrinsic/extrinsic rewards received 362 responses from 380 managers. Pay and security were greater motivators for private than for public sector managers. Recognition had higher motivating potential in the public sector. Both groups were motivated by achievement and advancement. (SK)

  19. Motivating the Private vs. Public Sector Managers.

    ERIC Educational Resources Information Center

    Khojasteh, Mak

    1993-01-01

    A questionnaire on intrinsic/extrinsic rewards received 362 responses from 380 managers. Pay and security were greater motivators for private than for public sector managers. Recognition had higher motivating potential in the public sector. Both groups were motivated by achievement and advancement. (SK)

  20. Restoring and Maintaining Riparian Habitat on Private Pastureland

    Treesearch

    Nancy Reichard

    1989-01-01

    Protecting riparian habitat from livestock grazing on private land is a complex task that requires paying attention to sociological and economic as well as physical and biological factors. Six livestock exclusion fencing projects on private property in northwestern California are described. The importance of long term maintenance and the need for landowner incentives...

  1. Private and Nonpublic Schools: Elementary Enrollments, 2003-04.

    ERIC Educational Resources Information Center

    Bobek, Joanne R., Comp.

    2004-01-01

    This listing contains 2003-04 elementary enrollments for private and nonpublic schools that reported to the Division of Data Services. Listed are the school name, location address and affiliation of each reporting school having elementary enrollments. These enrollments reflect private-pay students only. An asterisk (*) preceding the school name…

  2. Private and Nonpublic Schools: Secondary Enrollments, 2003-04.

    ERIC Educational Resources Information Center

    Bobek, Joanne R., Comp.

    2004-01-01

    This listing contains 2003-04 secondary enrollments for private and nonpublic schools that reported to the Division of Data Services. Listed are the school name, location address and affiliation of each reporting school having secondary enrollments. These enrollments reflect private-pay students only. An asterisk (*) preceding the school name…

  3. Public and private maternal health service capacity and patient flows in Southern Tanzania: using a geographic information system to link hospital and national census data.

    PubMed

    Tabatabai, Patrik; Henke, Stefanie; Sušac, Katharina; Kisanga, Oberlin M E; Baumgarten, Inge; Kynast-Wolf, Gisela; Ramroth, Heribert; Marx, Michael

    2014-01-01

    Strategies to improve maternal health in low-income countries are increasingly embracing partnership approaches between public and private stakeholders in health. In Tanzania, such partnerships are a declared policy goal. However, implementation remains challenging as unfamiliarity between partners and insufficient recognition of private health providers prevail. This hinders cooperation and reflects the need to improve the evidence base of private sector contribution. To map and analyse the capacities of public and private hospitals to provide maternal health care in southern Tanzania and the population reached with these services. A hospital questionnaire was applied in all 16 hospitals (public n=10; private faith-based n=6) in 12 districts of southern Tanzania. Areas of inquiry included selected maternal health service indicators (human resources, maternity/delivery beds), provider-fees for obstetric services and patient turnover (antenatal care, births). Spatial information was linked to the 2002 Population Census dataset and a geographic information system to map patient flows and socio-geographic characteristics of service recipients. The contribution of faith-based organizations (FBOs) to hospital maternal health services is substantial. FBO hospitals are primarily located in rural areas and their patient composition places a higher emphasis on rural populations. Also, maternal health service capacity was more favourable in FBO hospitals. We approximated that 19.9% of deliveries in the study area were performed in hospitals and that the proportion of c-sections was 2.7%. Mapping of patient flows demonstrated that women often travelled far to seek hospital care and where catchment areas of public and FBO hospitals overlap. We conclude that the important contribution of FBOs to maternal health services and capacity as well as their emphasis on serving rural populations makes them promising partners in health programming. Inclusive partnerships could increase

  4. Public and private maternal health service capacity and patient flows in southern Tanzania: using a geographic information system to link hospital and national census data.

    PubMed

    Tabatabai, Patrik; Henke, Stefanie; Sušac, Katharina; Kisanga, Oberlin M E; Baumgarten, Inge; Kynast-Wolf, Gisela; Ramroth, Heribert; Marx, Michael

    2014-12-01

    Background Strategies to improve maternal health in low-income countries are increasingly embracing partnership approaches between public and private stakeholders in health. In Tanzania, such partnerships are a declared policy goal. However, implementation remains challenging as unfamiliarity between partners and insufficient recognition of private health providers prevail. This hinders cooperation and reflects the need to improve the evidence base of private sector contribution. Objective To map and analyse the capacities of public and private hospitals to provide maternal health care in southern Tanzania and the population reached with these services. Design A hospital questionnaire was applied in all 16 hospitals (public n=10; private faith-based n=6) in 12 districts of southern Tanzania. Areas of inquiry included selected maternal health service indicators (human resources, maternity/delivery beds), provider-fees for obstetric services and patient turnover (antenatal care, births). Spatial information was linked to the 2002 Population Census dataset and a geographic information system to map patient flows and socio-geographic characteristics of service recipients. Results The contribution of faith-based organizations (FBOs) to hospital maternal health services is substantial. FBO hospitals are primarily located in rural areas and their patient composition places a higher emphasis on rural populations. Also, maternal health service capacity was more favourable in FBO hospitals. We approximated that 19.9% of deliveries in the study area were performed in hospitals and that the proportion of c-sections was 2.7%. Mapping of patient flows demonstrated that women often travelled far to seek hospital care and where catchment areas of public and FBO hospitals overlap. Conclusions We conclude that the important contribution of FBOs to maternal health services and capacity as well as their emphasis on serving rural populations makes them promising partners in health

  5. Nurses, consumer satisfaction, and pay for performance.

    PubMed

    Lutz, Sandy L; Root, Deedie

    2007-10-01

    To prepare for foreseeable nurse workforce challenges that can affect patient satisfaction, hospitals can: Develop public-private partnerships to increase the pool of nurses; Allow for greater flexibility in nursing roles and structures; Establish performance-based metrics.

  6. Hospice providers' key approaches to support informal caregivers in managing medications for patients in private residences.

    PubMed

    Lau, Denys T; Joyce, Brian; Clayman, Marla L; Dy, Sydney; Ehrlich-Jones, Linda; Emanuel, Linda; Hauser, Joshua; Paice, Judith; Shega, Joseph W

    2012-06-01

    Managing and administering medications to relieve pain and symptoms are common, important responsibilities for informal caregivers of patients receiving end-of-life care at home. However, little is known about how hospice providers prepare and support caregivers with medication-related tasks. This qualitative study explores the key approaches that hospice providers use to facilitate medication management for caregivers. Semistructured, open-ended interviews were conducted with 22 providers (14 nurses, four physicians, and four social workers) from four hospice organizations around an urban setting in the midwestern U.S. Based on the interviews, the following five key approaches emerged, constituting how the hospice team collectively helped caregivers manage medications: 1) establishing trust; 2) providing information; 3) promoting self-confidence; 4) offering relief (e.g., provided in-home medication assistance, mobilized supportive resources, and simplified prescriptions); and 5) assessing understanding and performance. Each hospice discipline used multiple approaches. Nurses emphasized tailoring information to individual caregivers and patients, providing in-home assistance to help relieve caregivers, and assessing caregivers' understanding and performance of medication management during home visits. Physicians simplified medication prescriptions to alleviate burden and reassured caregivers using their perceived medical authority. Social workers facilitated medication management by providing emotional support to promote self-confidence and mobilizing resources in caregivers' support networks and the community at large. Hospice nurses, physicians, and social workers identified distinct, yet overlapping, approaches in aiding caregivers with medication management. These findings emphasize the importance of interdisciplinary teamwork among hospice providers. Future research should investigate how common, standardized, effective, and efficient these approaches are in

  7. [Interviews with physicians in private practice as a starting point for quality improvement in hospitals].

    PubMed

    Spiessl, H; Semsch, I; Cording, C; Klein, H E

    2001-07-01

    Subjective criteria gain importance in care research and quality management. Therefore, psychiatrists in private practice and general practitioners working in the catchment area of a psychiatric hospital were surveyed by questionnaire evaluating expectations and satisfaction concerning their collaboration with the hospital. Psychiatrists and general practitioners rated legible interim discharge letters, good in-patient treatment, adequate diagnostics, and direct referral to the hospital as most important. Psychiatrists express dissatisfaction regarding prescription of expensive drugs, lack of involvement in planning new psychiatric institutions, delivery of discharge summaries, referring back the patient after in-patient care, and delay of hospital admission. As conclusion, quality management should pay more attention to ambulatory care physicians' points of view to reduce problems of interaction between clinicians and their colleagues in private practice and to improve the treatment continuity of psychiatric patients.

  8. The impact of erlotinib use in non-small-cell lung cancer patients treated in a private reference general hospital and in a private cancer clinic from 2005 to 2011

    PubMed Central

    Bognar, Cinthia Leite Frizzera Borges; Simon, Sergio Daniel; Gansl, Rene Claudio; Abramoff, Roberto; Aisen, Marcelo; Lopes, Gilberto de Lima; Smaletz, Oren; Peres, Stela Verzinhasse; Tabacof, Jacques

    2015-01-01

    ABSTRACT Objective: To report the demographic data and clinical outcomes of non-small-cell lung cancer patients exposed to erlotinib in any line of treatment. Methods: This was a retrospective cohort study of nonsmall-cell lung cancer patients from a reference general hospital and a private oncology clinic, who received erlotinib from 2005 to 2011. Statistical analysis was performed and we evaluated demographic data and response to treatment, by correlating the results of this first cohort published in Brazil with results of current literature. Results: A total of 44 patients were included; 65.9% were diagnosed with adenocarcinoma, and 63.6% had metastatic disease. The mean age was 63.3 years. The median follow-up was 47.9 months. Epidermal growth factor receptor mutation screening was performed in 22.7% of patients (n=10), with mutation present in 30% of patients. The median overall survival was 46.3 months, and there was a higher probability of survival at 60 months for females compared to males (29.4% versus 15.8%; p=0.042). The other variables did not present significant statistical difference. Conclusion: We collected the largest cohort of patients with non-small-cell lung cancer who have used erlotinib in Brazil to date, and demonstrated that outcomes of patients treated at our clinic during the study period were consistent with the results of current literature in similar patients. PMID:26154542

  9. The willingness of private-sector doctors to manage public-sector HIV/AIDS patients in the eThekwini metropolitan region of KwaZulu-Natal

    PubMed Central

    Jinabhai, Champaklal C.; Taylor, Myra

    2010-01-01

    ABSTRACT Background South Africa is severely affected by the AIDS pandemic and this has resulted in an already under-resourced public sector being placed under further stress, while there remains a vibrant private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients. Objectives To gauge the willingness of private-sector doctor to manage public-sector HIV and AIDS patients and to describe factors that may influence their responses. Method A descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists, working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Chi-square and independent t-tests were used to evaluate associations. Odds ratios were determined using a binary logistic regression model. A p value < 0.05 was considered statistically significant. Results Most of the doctors were male GPs aged 30–50 years who had been in practice for more than 10 years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling, was the distance from public-sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public-sector HIV and AIDS patients

  10. Medicare Pays for Chronic Care Management.

    PubMed

    Sorrel, Amy Lynn

    2015-09-01

    As of January, the Centers for Medicare & Medicaid Services began paying for chronic care management of patients with two or more conditions under its Chronic Care Management program. The payment applies to patients in traditional fee-for-service and noncapitated Medicare Advantage plan arrangements. Texas Medical Association leaders caution the program has some hefty requirements.

  11. Agency nursing goes PAYE.

    PubMed

    Moore, Alison

    2017-04-19

    Many agency nurses bill for their services through a limited or personal services company. In the past, this has reduced the tax they need to pay, allowing some profits to be taken as dividends. It has also allowed them to offset costs, such as travel, against their profits.

  12. Is Teacher Pay "Adequate?"

    ERIC Educational Resources Information Center

    Podgursky, Michael

    2006-01-01

    In school finance lawsuits plaintiffs often claim that pay levels are not sufficient to recruit teachers who can deliver constitutionally-mandated levels of educational services. In this paper I consider several ways in which one might bring economic theory and data to bear on that question. I conclude that at present, and at least for the near…

  13. The Poor Pay More.

    ERIC Educational Resources Information Center

    Folse, Kimberly A.

    2002-01-01

    Describes a sociology experiential learning assignment where students learned why people living in poverty can sometimes pay more for products than people with better incomes. Focuses specifically on the rent to own concept. States students achieved the goal of learning how life constraints of poverty can hinder the poor from overcoming their…

  14. Consultancy pay for nurses.

    PubMed

    1998-01-01

    Nurses working for NHS Direct could be paid at medical consultant level based on equal pay for equal work initiatives, according to Rob Crouch, Deputy Director and Research Fellow (A&E), Centre for the Advancement of Clinical Practice, University of Surrey.

  15. The Equal Pay Boondoggle

    ERIC Educational Resources Information Center

    Lester, Richard A.

    1975-01-01

    Problems of extending the Equal Pay Act to university faculty are examined in light of the complicated market forces and merit systems affecting faculty appointments and salaries. Solutions to the problem are suggested including guidelines for the Wage and Hour Division of the Department of Labor to use in identifying sex discrimination. (JT)

  16. The Poor Pay More.

    ERIC Educational Resources Information Center

    Folse, Kimberly A.

    2002-01-01

    Describes a sociology experiential learning assignment where students learned why people living in poverty can sometimes pay more for products than people with better incomes. Focuses specifically on the rent to own concept. States students achieved the goal of learning how life constraints of poverty can hinder the poor from overcoming their…

  17. Performance Pay for Teachers

    ERIC Educational Resources Information Center

    Protheroe, Nancy

    2011-01-01

    During the past few years, interest in shifting at least a portion of what teachers are paid away from a reliance on a traditional salary schedule to one that incorporates a pay for performance component has reached a new high. Proponents of the approach view it as a way to improve teacher quality by both motivating teachers and--through higher…

  18. Reputation Effects in Public and Private Interactions

    PubMed Central

    Ohtsuki, Hisashi; Iwasa, Yoh; Nowak, Martin A.

    2015-01-01

    We study the evolution of cooperation in a model of indirect reciprocity where people interact in public and private situations. Public interactions have a high chance to be observed by others and always affect reputation. Private interactions have a lower chance to be observed and only occasionally affect reputation. We explore all second order social norms and study conditions for evolutionary stability of action rules. We observe the competition between “honest” and “hypocritical” strategies. The former cooperate both in public and in private. The later cooperate in public, where many others are watching, but try to get away with defection in private situations. The hypocritical idea is that in private situations it does not pay-off to cooperate, because there is a good chance that nobody will notice it. We find simple and intuitive conditions for the evolution of honest strategies. PMID:26606239

  19. Reputation Effects in Public and Private Interactions.

    PubMed

    Ohtsuki, Hisashi; Iwasa, Yoh; Nowak, Martin A

    2015-11-01

    We study the evolution of cooperation in a model of indirect reciprocity where people interact in public and private situations. Public interactions have a high chance to be observed by others and always affect reputation. Private interactions have a lower chance to be observed and only occasionally affect reputation. We explore all second order social norms and study conditions for evolutionary stability of action rules. We observe the competition between "honest" and "hypocritical" strategies. The former cooperate both in public and in private. The later cooperate in public, where many others are watching, but try to get away with defection in private situations. The hypocritical idea is that in private situations it does not pay-off to cooperate, because there is a good chance that nobody will notice it. We find simple and intuitive conditions for the evolution of honest strategies.

  20. Initial care and outcome of glioblastoma multiforme patients in 2 diverse health care scenarios in Brazil: does public versus private health care matter?

    PubMed Central

    Loureiro, Luiz Victor Maia; Pontes, Lucíola de Barros; Callegaro-Filho, Donato; Koch, Ludmila de Oliveira; Weltman, Eduardo; Victor, Elivane da Silva; Santos, Adrialdo José; Borges, Lia Raquel Rodrigues; Segreto, Roberto Araújo; Malheiros, Suzana Maria Fleury

    2014-01-01

    Background The aim of this study was to describe the epidemiological and survival features of patients with glioblastoma multiforme treated in 2 health care scenarios—public and private—in Brazil. Methods We retrospectively analyzed clinical, treatment, and outcome characteristics of glioblastoma multiforme patients from 2003 to 2011 at 2 institutions. Results The median age of the 171 patients (117 public and 54 private) was 59.3 years (range, 18–84). The median survival for patients treated in private institutions was 17.4 months (95% confidence interval, 11.1–23.7) compared with 7.1 months (95% confidence interval, 3.8–10.4) for patients treated in public institutions (P < .001). The time from the first symptom to surgery was longer in the public setting (median of 64 days for the public hospital and 31 days for the private institution; P = .003). The patients at the private hospital received radiotherapy concurrent with chemotherapy in 59.3% of cases; at the public hospital, only 21.4% (P < .001). Despite these differences, the institution of treatment was not found to be an independent predictor of outcome (hazard ratio, 1.675; 95% confidence interval, 0.951–2.949; P = .074). The Karnofsky performance status and any additional treatment after surgery were predictors of survival. A hazard ratio of 0.010 (95% confidence interval, 0.003–0.033; P < .001) was observed for gross total tumor resection followed by radiotherapy concurrent with chemotherapy. Conclusions Despite obvious disparities between the hospitals, the medical assistance scenario was not an independent predictor of survival. However, survival was directly influenced by additional treatment after surgery. Therefore, increasing access to resources in developing countries like Brazil is critical. PMID:24463356

  1. Federal Personnel: Federal/Private Sector Pay Comparisons

    DTIC Science & Technology

    1994-12-01

    Federal Employees Covered by Social Security, December 1984. ^This finding is based on a comparison of employer cost associated with the various...and gender. Specifically, ’For a further discussion, see Robert Willis, "Wage Determinante : A Survey and ReinterpreteÜori of Human Capital Earnings

  2. Nuclear privatization

    SciTech Connect

    Jeffs, E.

    1995-11-01

    The United Kingdom government announced in May 1995 plans to privatize the country`s two nuclear generating companies, Nuclear Electric and Scottish Nuclear. Under the plan, the two companies will become operating divisions of a unified holding company, to be called British Electric, with headquarters in Scotland. Britain`s nuclear plants were left out of the initial privatization in 1989 because the government believed the financial community would be unwilling to accept the open-ended liability of decommissioning the original nine stations based on the Magnox gas-cooled reactor. Six years later, the government has found a way around this by retaining these power stations in state ownership, leaving the new nuclear company with the eight Advanced Gas-cooled Reactor (AGR) stations and the recently completed Sizewell B PWR stations. The operating Magnox stations are to be transferred to BNFL, which operates two Magnox stations of their own at Calder Hall and Chapelcross.

  3. Paying for Undergraduate Business Education: Recent Trends in Tuition, Income, Institution Choice, and Debt

    ERIC Educational Resources Information Center

    Ball, Jennifer A.; Ockree, Kanalis A.

    2017-01-01

    In 1999-2000, business students borrowed substantially less to pay for their educations than nonbusiness students. By 2011-2012 this difference had disappeared. The authors describe changes in tuition, grants, incomes, and choice of institution type (public, private not-for-profit, or private for-profit) to help explain this observation. They find…

  4. Caregivers' Willingness to Pay for Technologies to Support Caregiving.

    PubMed

    Schulz, Richard; Beach, Scott R; Matthews, Judith T; Courtney, Karen; De Vito Dabbs, Annette; Mecca, Laurel Person

    2016-10-01

    We report the results of a study designed to assess whether and how much informal caregivers are willing to pay for technologies designed to help monitor and support care recipients (CRs) in performing kitchen and personal care tasks. We carried out a web survey of a national sample of adult caregivers (age 18-64) caring for an older adult (N = 512). Respondents completed a 25min online survey that included questions about their caregiving situation, current use of everyday technology, use of specific caregiving technologies, general attitudes toward technology, and questions about technologies designed to help them monitor and provide assistance for CRs' kitchen and self-care activities. About 20% of caregivers were not willing to pay anything for kitchen and self-care technologies. Among those willing to pay something, the mean amount was approximately $50 per month for monitoring technologies and $70 per month for technologies that both monitored and provided some assistance. Younger caregivers, those caring for a person with Alzheimer's disease, and caregivers with more positive attitudes toward and experience with technology were willing to pay more. Most caregivers feel that the government or private insurance should help pay for these technologies. Caregivers are receptive and willing to pay for technologies that help them care for their CR, although the amount they are willing to pay is capped at around $70 per month. The combination of private pay and government subsidy may facilitate development and dissemination of caregiver technologies. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. A qualitative study of patient (dis)trust in public and private hospitals: the importance of choice and pragmatic acceptance for trust considerations in South Australia.

    PubMed

    Ward, Paul R; Rokkas, Philippa; Cenko, Clinton; Pulvirenti, Mariastella; Dean, Nicola; Carney, Simon; Brown, Patrick; Calnan, Michael; Meyer, Samantha

    2015-07-30

    This paper explores the nature and reasoning for (dis)trust in Australian public and private hospitals. Patient trust increases uptake of, engagement with and optimal outcomes from healthcare services and is therefore central to health practice, policy and planning. A qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals). 'Private patients' made active choices about both their hospital and doctor, playing the role of the 'consumer', where trust and choice went hand in hand. The reputation of the doctor and hospital were key drivers of trust, under the assumption that a better reputation equates with higher quality care. However, making a choice to trust a doctor led to personal responsibility and the additional requirement for self-trust. 'Public patients' described having no choice in their hospital or doctor. They recognised 'problems' in the public healthcare system but accepted and even excused these as 'part of the system'. In order to justify their trust, they argued that doctors in public hospitals tried to do their best in difficult circumstances, thereby deserving of trust. This 'resigned trust' may stem from a lack of alternatives for free health care and thus a dependence on the system. These two contrasting models of trust within the same locality point to the way different configurations of healthcare systems, hospital experiences, insurance coverage and related forms of 'choice' combine to shape different formats of trust, as patients act to manage their vulnerability within these contexts.

  6. Military Pay Gaps and Caps.

    DTIC Science & Technology

    1994-01-01

    RATIOS AND ENLISTED RECRUIT QUALITY AND RETENTION 27 C. MILITARY-CrVIL SERVICE PAY ADJUSTMENT LINKAGE: LEGISLATIVE BACKGROUND, 1967-1993 30...DECI), which we constructed previously and have updated to include fiscal 1992. We compare pay gaps based on the ECI versus the DECI and present DECI...do. There is no claim that the levels of military and civilian pay are equal at base point. If pay levels are equal at the base point, the divergence

  7. Occupancy and patient care quality benefits of private room relative to multi-bed patient room designs for five different children's hospital intensive and intermediate care units.

    PubMed

    Smith, Thomas J

    2016-07-25

    Prior research documents occupancy and patient care quality (OPCQ) benefits for private room (PR) relative to multi-bed (MB) designs in neonatal intensive care units (NICUs). To extend this research design to four additional types of children's hospital units: a cardiovascular care center (CVCC), an infant care center (ICC), a medical/surgical unit (Med/Surg), and a pediatric intensive care unit (PICU). Staff comments, task activities, patient care demands, and perceptual survey rankings for twelve major indicators of OPCQ were assessed with nursing staff on these units plus an NICU. With the PR designs, for 38 of 48 pairwise comparisons for the twelve major OPCQ indicators, CVCC staff rankings are significantly lower than those by staff on the other four units. For 47 of 48 pairwise comparisons for the twelve major OPCQ indicators, NICU, ICC, Med/Surg, and PICU staff rankings for PR designs do not differ significantly from those for MB designs. Comments by staff on all five units target numerous PR OPCQ defects. Design, operation and management of the patient care environments on the five different PR units evaluated in this research confront a challenge in realizing OPCQ benefits that match experience with PR NICU designs in other contexts.

  8. The Delivery and Quality of Sexually Transmitted Infections Treatment by Private General Practitioners in Windhoek Namibia

    PubMed Central

    Iipinge, Scholastika N; Pretorius, Louise

    2012-01-01

    Introduction: The main objective for this study was to investigate the quality of Sexually Transmitted Infections (STI) treatment and control by the private sector in Namibia. Method: This was a cross-sectional study employing quantitative methodology using different methods of data collection. A self-administered questionnaire exploring General Practitioners (GPs) perceptions of factors that influence the way they manage Sexually Transmitted Infections (STI) which was then concluded with the face to face interviews and the checklist that was used while doing observations in the consulting rooms Results: A total of 50 private general practitioners in the area of Windhoek were interviewed, 48 self-administered questionnaires plus all checklists were received back from the private general practitioners. None of the private general practitioners interviewed had specific training in the syndromic management of the STIs. The 86% of all patients were seen by these private general practitioners on a medical aid, while 14 % pay cash for service provided. With regard to Urethral Discharge, an average of 56.5% of GPs could treat urethral discharge correctly as per the Namibian syndromic approach guidelines. None of the GPs could demonstrate the correct treatment of genital ulcer (whether they received medical aid or not) as recommended in the syndromic approach guidelines in Namibia (GRN, 1999; 2000). Only 28% of the GPs could demonstrate the correct treatment of Pelvic Inflammatory Disease (PID) as per the syndromic management of the STIs. For patients without medical aid the drugs prescribed and their dosages for PID are correct but the frequencies are not in line with the guidelines as for patients with medical aid. Discussion: In general, patients presenting with STIs to the GPs in private practices are not given quality of care because not all private general practitioners have time to do investigations, counseling, give condoms and to notify the partners of those with

  9. Higher Education and the State in Latin American: Private Challenges to Public Dominance.

    ERIC Educational Resources Information Center

    Levy, Daniel C.

    Major patterns of relationship between the public and private sectors in Latin American higher education are discussed. Three key evolutionary waves are identified that have led to three private-public patterns dominant in Latin America today. For both the public and private sectors, attention is directed to origins and growth, who pays and rules,…

  10. Value-Added Merit Pay.

    ERIC Educational Resources Information Center

    Twomey, Daniel F.

    The purpose of merit pay is to reward employees for their accomplishments and motivate them to continue improving. Critics of merit pay say the increased extrinsic motivation that it prompts is more than offset by the decrease in intrinsic motivation. Supporters of performance-based pay claim several benefits of the practice. This study addressed…

  11. Equal Pay: The Emerging Terrain.

    ERIC Educational Resources Information Center

    Weeks, Kent M.

    1985-01-01

    Colleges and universities can employ several statutory defenses to alleged pay disparities and demonstrate that there are legitimate reasons for pay differentials. Several preventive strategies in response to the emerging legal terrain of equal pay litigation are suggested. (Author/MLW)

  12. Military Pay Gaps and Caps

    DTIC Science & Technology

    1994-01-01

    annual military pay legislation suspended 37 USC 1009; this provision called for equal percentage increases in all three cash components of RMC, with the...SERVICE PAY ADJUSTMENT LINKAGE: LEGISLATIVE BACKGROUND, 1967-1993 .................... 30 Bibliography...personnel. We do so via the Defense Employment Cost Index (DECI), which we constructed previously and have updated to include fiscal 1992. We compare pay

  13. Health literacy, health information seeking behaviors and internet use among patients attending a private and public clinic in the same geographic area.

    PubMed

    Gutierrez, Natalia; Kindratt, Tiffany B; Pagels, Patti; Foster, Barbara; Gimpel, Nora E

    2014-02-01

    Despite the growing body of health information available online, patients with limited health literacy may lack either internet access or skills necessary to utilize this information. Nonetheless, patients at all health literacy levels may prefer other primary sources to obtain health information. We conducted a cross-sectional study to measure health literacy of patients attending two clinics in Dallas, TX and determine associations between health literacy, health information access and internet usage before and after controlling for confounders. Patients from both clinics (county N = 265; private N = 233) completed a brief survey which included sociodemographics, internet patterns, confidence in filling out medical forms and a self-administered Newest Vital Sign to measure health literacy. In the county clinic, most patients (61.5 %) were Hispanic, had low income (<$19,000/year), limited education (<11th grade) and a high likelihood or possibility of limited health literacy (68.5 %). In the private clinic, participants were mostly black (40.4 %) or white (38.6 %), had higher incomes (≥$46,000), higher education (technical college or college) and adequate health literacy (75.1 %). The primary source of obtaining health information in both clinics was their health care professional (50.6 % county; 40.1 % private). In multivariate analyses to determine differences by health literacy level, there were no statistically significant differences between patients with limited and adequate health literacy and their primary information source. Regardless of health literacy, patients rely on their health care providers to obtain health information. These results showcase the importance of providers' effective communication with patients to make shared decisions about their health regardless of other factors.

  14. Peru privatizes

    SciTech Connect

    Suttil, K.R.

    1993-02-01

    Peru has been undergoing a revolution since the election of Alberto Fujimori as president in 1990. A revolution that is reversing many of the policies of the past 25 years and one which aims to bring Peru back into the mainstream of the world economy. All the enterprises nationalized in the heady days of the early 1970s are set up for privatization. The most important are the three mining companies: Hierro-Peru, Centromin, and Mineroo-Peru. It will not be easy to attract foreign investment after such a long period of political and economic instability but the rewards are there for the intrepid.

  15. Paying the Piper.

    ERIC Educational Resources Information Center

    Loconte, Joe

    1999-01-01

    Examines the question of exemption from religious instruction or activities in voucher programs in private religious schools. Much concern relates to the program's admissions policy, part of which involves using the lottery if there are too many applicants. This could compromise a school's religious teachings. (MMU)

  16. Section 1: Looking Broadly at the Politics of Privatization: The Politics of Privatization in American Education

    ERIC Educational Resources Information Center

    Boyd, William L.

    2007-01-01

    The long-sustained effort of conservatives and their think tanks and media outlets to win support for school choice, market forces, and privatization schemes in education is paying off. But it is encountering steady resistance from the public education establishment and its supporting teachers' unions. Actions, reactions, strategies, and the…

  17. Section 1: Looking Broadly at the Politics of Privatization: The Politics of Privatization in American Education

    ERIC Educational Resources Information Center

    Boyd, William L.

    2007-01-01

    The long-sustained effort of conservatives and their think tanks and media outlets to win support for school choice, market forces, and privatization schemes in education is paying off. But it is encountering steady resistance from the public education establishment and its supporting teachers' unions. Actions, reactions, strategies, and the…

  18. Ambulatory care for HIV-infected patients: differences in outcomes between hospital-based units and private practices: analysis of the RESINA cohort.

    PubMed

    Oette, Mark; Reuter, Stefan; Kaiser, Rolf; Jensen, Björn; Lengauer, Thomas; Fätkenheuer, Gerd; Knechten, Heribert; Hower, Martin; Sagir, Abdurrahman; Pfister, Herbert; Häussinger, Dieter

    2013-11-21

    The efficacy of highly active antiretroviral therapy (HAART) in the treatment of HIV infection is influenced by factors such as potency of applied drugs, adherence of the patient, and resistance-associated mutations. Up to now, there is insufficient data on the impact of the therapeutic setting. Since 2001, the prospective multicenter RESINA study has examined the epidemiology of transmitted HIV drug resistance in Nordrhein-Westfalen, the largest federal state of Germany by population. Characteristics of patients treated in hospital-based outpatient units were compared to those of patients treated in medical practices. Longitudinal data of all participants are being followed in a cohort study. Overall, 1,591 patients were enrolled between 2001 and 2009 with follow-up until the end of 2010. Of these, 1,099 cases were treated in hospital-based units and 492 in private practices. Significant differences were found with respect to baseline characteristics. A higher rate of patients with advanced disease and non-European nationality were cared for in hospital units. Patients in medical practices were predominantly Caucasian men who have sex with men (MSM) harboring HIV-1 subtype B, with lower CDC stage and higher CD4 cell count. Median viral load was 68,828 c/mL in hospital-based units and 100,000 c/mL in private practices (P = 0.041). Only median age and rate of transmitted drug resistance were not significantly different. After 48 weeks, 81.9% of patients in hospital units and 85.9% in private practices had a viral load below the limit of detection (P = 0.12). A similar result was seen after 96 weeks (P = 0.54). Although the baseline CD4 cell count was different (189.5/μL in hospital units and 246.5/μL in private practices, P <0.001), a consistent and almost identical increase was determined in both groups. The RESINA study covers a large HIV-infected patient cohort cared for in specialized facilities in Germany. Despite significant differences of

  19. Differentially private distributed logistic regression using private and public data

    PubMed Central

    2014-01-01

    Background Privacy protecting is an important issue in medical informatics and differential privacy is a state-of-the-art framework for data privacy research. Differential privacy offers provable privacy against attackers who have auxiliary information, and can be applied to data mining models (for example, logistic regression). However, differentially private methods sometimes introduce too much noise and make outputs less useful. Given available public data in medical research (e.g. from patients who sign open-consent agreements), we can design algorithms that use both public and private data sets to decrease the amount of noise that is introduced. Methodology In this paper, we modify the update step in Newton-Raphson method to propose a differentially private distributed logistic regression model based on both public and private data. Experiments and results We try our algorithm on three different data sets, and show its advantage over: (1) a logistic regression model based solely on public data, and (2) a differentially private distributed logistic regression model based on private data under various scenarios. Conclusion Logistic regression models built with our new algorithm based on both private and public datasets demonstrate better utility than models that trained on private or public datasets alone without sacrificing the rigorous privacy guarantee. PMID:25079786

  20. Assessment of Economic Impact Among In-Patients with Non-Communicable Diseases in a Private Tertiary Care Hospital in Southern India

    PubMed Central

    Gupta, Shilpa

    2016-01-01

    Introduction Non-communicable diseases (NCDs) are currently responsible for tremendous economic impact on households. Aim This study was done to estimate the direct, indirect and total costs incurred by households of in-patients with non-communicable diseases admitted in a Private tertiary care hospital. Materials and Methods It was a cross-sectional study conducted in a private tertiary care hospital of Mangalore city in June 2012 by interviewing 30 patients and their attenders using a validated interview schedule. Results Direct cost constituted 58.6% of the total expenses during the course of stay in the hospital. Mean direct cost was more among patients with cancers (p=0.049). Indirect cost was associated with educational status (p=0.04), occupational status (p<0.001) and socio economic status (ses) (p<0.001) of patients. Total cost was more among patients from upper middle ses households (p=0.012). Direct and indirect cost constituted 5-10% each and total cost > 20% of the annual income of majority of households. Medical insurance scheme was not availed by 26 (86.7%) patients due to ignorance. Conclusion Economic burden imposed by a single admission among inpatients with NCDs was tremendous on their households. Hence, information on various medical insurance schemes needs to be popularized among people to improve its utilization. Health care providers need to introduce more financial schemes to minimize health care costs among poor households. PMID:27504316

  1. Ambulatory care for HIV-infected patients: differences in outcomes between hospital-based units and private practices: analysis of the RESINA cohort

    PubMed Central

    2013-01-01

    Background The efficacy of highly active antiretroviral therapy (HAART) in the treatment of HIV infection is influenced by factors such as potency of applied drugs, adherence of the patient, and resistance-associated mutations. Up to now, there is insufficient data on the impact of the therapeutic setting. Methods Since 2001, the prospective multicenter RESINA study has examined the epidemiology of transmitted HIV drug resistance in Nordrhein-Westfalen, the largest federal state of Germany by population. Characteristics of patients treated in hospital-based outpatient units were compared to those of patients treated in medical practices. Longitudinal data of all participants are being followed in a cohort study. Results Overall, 1,591 patients were enrolled between 2001 and 2009 with follow-up until the end of 2010. Of these, 1,099 cases were treated in hospital-based units and 492 in private practices. Significant differences were found with respect to baseline characteristics. A higher rate of patients with advanced disease and non-European nationality were cared for in hospital units. Patients in medical practices were predominantly Caucasian men who have sex with men (MSM) harboring HIV-1 subtype B, with lower CDC stage and higher CD4 cell count. Median viral load was 68,828 c/mL in hospital-based units and 100,000 c/mL in private practices (P = 0.041). Only median age and rate of transmitted drug resistance were not significantly different. After 48 weeks, 81.9% of patients in hospital units and 85.9% in private practices had a viral load below the limit of detection (P = 0.12). A similar result was seen after 96 weeks (P = 0.54). Although the baseline CD4 cell count was different (189.5/μL in hospital units and 246.5/μL in private practices, P <0.001), a consistent and almost identical increase was determined in both groups. Conclusions The RESINA study covers a large HIV-infected patient cohort cared for in specialized facilities in Germany

  2. When Punishment Pays

    PubMed Central

    Roberts, Gilbert

    2013-01-01

    Explaining cooperation in groups remains a key problem because reciprocity breaks down between more than two. Punishing individuals who contribute little provides a potential answer but changes the dilemma to why pay the costs of punishing which, like cooperation itself, provides a public good. Nevertheless, people are observed to punish others in behavioural economic games, posing a problem for existing theory which highlights the difficulty in explaining the spread and persistence of punishment. Here, I consider the apparent mismatch between theory and evidence and show by means of instructive analysis and simulation how much of the experimental evidence for punishment comes from scenarios in which punishers may expect to obtain a net benefit from punishing free-riders. In repeated games within groups, punishment works by imposing costs on defectors so that it pays them to switch to cooperating. Both punishers and non-punishers then benefit from the resulting increase in cooperation, hence investing in punishment can constitute a social dilemma. However, I show the conditions in which the benefits of increased cooperation are so great that they more than offset the costs of punishing, thereby removing the temptation to free-ride on others' investments and making punishment explicable in terms of direct self-interest. Crucially, this is because of the leveraging effect imposed in typical studies whereby people can pay a small cost to inflict a heavy loss on a punished individual. In contrast to previous models suggesting punishment is disadvantaged when rare, I show it can invade until it comes into a producer-scrounger equilibrium with non-punishers. I conclude that adding punishment to an iterated public goods game can solve the problem of achieving cooperation by removing the social dilemma. PMID:23483907

  3. When punishment pays.

    PubMed

    Roberts, Gilbert

    2013-01-01

    Explaining cooperation in groups remains a key problem because reciprocity breaks down between more than two. Punishing individuals who contribute little provides a potential answer but changes the dilemma to why pay the costs of punishing which, like cooperation itself, provides a public good. Nevertheless, people are observed to punish others in behavioural economic games, posing a problem for existing theory which highlights the difficulty in explaining the spread and persistence of punishment. Here, I consider the apparent mismatch between theory and evidence and show by means of instructive analysis and simulation how much of the experimental evidence for punishment comes from scenarios in which punishers may expect to obtain a net benefit from punishing free-riders. In repeated games within groups, punishment works by imposing costs on defectors so that it pays them to switch to cooperating. Both punishers and non-punishers then benefit from the resulting increase in cooperation, hence investing in punishment can constitute a social dilemma. However, I show the conditions in which the benefits of increased cooperation are so great that they more than offset the costs of punishing, thereby removing the temptation to free-ride on others' investments and making punishment explicable in terms of direct self-interest. Crucially, this is because of the leveraging effect imposed in typical studies whereby people can pay a small cost to inflict a heavy loss on a punished individual. In contrast to previous models suggesting punishment is disadvantaged when rare, I show it can invade until it comes into a producer-scrounger equilibrium with non-punishers. I conclude that adding punishment to an iterated public goods game can solve the problem of achieving cooperation by removing the social dilemma.

  4. Private ownership of primary care providers associated with patient perceived quality of care: A comparative cross-sectional survey in three big Chinese cities.

    PubMed

    Wei, Xiaolin; Yin, Jia; Wong, Samuel Y S; Griffiths, Sian M; Zou, Guanyang; Shi, Leiyu

    2017-01-01

    Ownership of primary care providers varies in different cities in China. Shanghai represented the full public ownership model of primary providers; Shenzhen had public-owned but private-operated providers; and Hong Kong represented the full private ownership. The study aims to assess the association of primary care ownership and patient perceived quality of care in 3 Chinese megacities.We conducted multistage stratified random surveys in 2013 in the 3 cities. Quality scores of primary care were measured using the validated primary care assessment tools. Multivariate linear regression models were used to compare quality scores after controlling potential confounders of patient demographic, socioeconomic, and healthcare utilization factors.Overall, 797 primary care users in Shanghai, 802 in Shenzhen, and 1325 in Hong Kong participated in the study. The mean total quality scores were reported the highest in Shanghai (28.39), followed by Shenzhen (25.82) and then Hong Kong (25.21) (P < 0.001). Shanghai participants reported the highest scores for 1st contact accessibility, coordination of information, comprehensiveness of service availability, and culture competence, while Hong Kong participants reported the lowest for these domains (P < 0.001). Hong Kong participants from rich households reported higher total scores than those from poor households (P < 0.05); however, this was not found in Shanghai and Shenzhen.The study suggests that private primary care ownership may be associated with lower quality and less equitable care distribution. In China, it suggests that it may be beneficial to promote public-owned and nonprofit providers. Promoting privatization in primary care may be at the cost of quality and equity of primary care.

  5. Evaluation in usual practice of the bevacizumab-FOLFIRI combination for the first-line treatment of patients with unresectable metastatic colorectal cancer treated in 2006: focus on resected patients and oncogeriatrics: AVASTIN OUEST cohort of the Observatory of Cancer of the Brittany and Pays de la Loire Areas (Observatoire dédié au Cancer Bretagne / Pays de la Loire).

    PubMed

    Metges, J P; Lebot, M A; Faroux, R; Riaud, F; Gamelin, E; Capitain, O; Guérin Meyer, V; Leynia, P; Douillard, J Y; Senellart, H; Rochard, S; Louvigné, C; Campion, L; Dupuis, O; Grollier, C; Achour, N A; Person, B; Raoul, J L; Boucher, E; Bertrand, C; Ramée, J F; Guivarch, L; Etienne, P L; Roussel, S; Desclos, H; Julien, M N; Labarre, M I; Klein, V; Bessard, R; Stampfli, C; Royet, F; Faycal, J; Gouva, S; Le Bihan, G; Couturier, M; Gourlaouen, A; Bertholom, C; Porneuf, M; Jobard, E; Peguet, E; Grasset, D; Bouret, J F; Bicheler, V; Ulvoas, A; Miglianico, L; Chouzenoux, C; Deguiral, P; Derenne, L; Martin, D; Langlet, P Michel; Bodin, C; Rossi, V; Barré, S; Cojocarasu, O; Naveau Ploux, C; Vidal, A M; Cumin, I; Egreteau, J; Brouard, A; Matysiak Budnik, T; Thomaré, P; Le Bris Michel, A S; Piriou, G; Largeau, R; Elhannani, C; Crespeau, E; Suberville, F; Bourgeois, H; Riche, C; Lagadec, D Déniel; Marhuenda, F; Grudé, F

    En 2006, bevacizumab-FOLFIRI représente la thérapie ciblée administrable dès la première ligne chez les patients porteurs d’un cancer colorectal métastatique non opérable. Une série homogène de 111 patients colligés en région Bretagne et Pays de la Loire ayant reçu du bevacizumab- FOLFIRI en première ligne en 2006 révèle les résultats suivants: 51 réponses, 29 stabilités, 21 progressions et 10 toxicités avant évaluation. La médiane de survie globale (OS) est de 25,1 mois et la médiane de survie sans progression (PFS) de 10,2 mois. Dans le cas d’une chirurgie secondaire, l’OS médian triple de 18,8 mois chez les patients non réséqués versus 59,2 mois ceux réséqués. En comparant les sujets âgés de plus et de moins de 70 ans, aucune différence n’a été mise en évidence en termes de bénéfice ou de risque. Bevacizumab-FOLFIRI pourrait être administré en pratique courante chez les personnes âgées sous couvert d’une évaluation gériatrique et d’une approche multidisciplinaire.

  6. Demographic and anthropometrical analysis and genotype distribution of chronic hepatitis C patients treated in public and private reference centers in Brazil.

    PubMed

    Focaccia, R; Baraldo, D C M; Ferraz, M L G; Martinelli, A L C; Carrilho, F J; Gonçales, F L; Pedroso, M L A; Coelho, H S M; Lacerda, M A; Brandão, C E; Mattos, A A; Lira, L G C; Zamin, I; Pinheiro, J O P; Tovo, C V; Both, C T; Soares, J A S; Dittrich, S

    2004-10-01

    Hepatitis C virus (HCV) infection is a serious public health problem, since 80% to 85% of HCV carriers develop a persistent infection that can progress into liver cirrhosis and hepatocarcinoma. Considering that the response of hepatitis C patients to combination therapy with interferon and ribavirin depends on HCV characteristics as well as on host features, we made a retrospective analysis of demographic and anthropometrical data and HCV genotype distribution of chronic hepatitis C patients treated in public and private reference centers in Brazil. The medical records of 4,996 patients were reviewed, 81% from public and 19% from private institutions. Patients' median age was 46 years, and there was a higher prevalence of male (62%) and white patients (80%). The analysis of HCV-infecting strains showed a predominance of genotype 1 (64%) over genotypes 2 and 3. The patients' mean weight was 70.6 kg, and 65% of the patients weighed less than 77 kg. Overweight and obesity were observed in 37.8% and 13.6% of the patients, respectively. Since a body weight of 75 kg or less has been considered an independent factor that significantly increases the odds of achieving a sustained virological response, the Brazilian population seems to have a more favorable body weight profile to achieve a sustained response than the American and European populations. The finding that 65% of chronic hepatitis C patients have a body weight of 77 kg or less may have a positive pharmacoeconomic impact on the treatment of genotype 1 HCV patients with weight-based doses of peginterferon.

  7. Assessing willingness to pay for health care quality improvements.

    PubMed

    Pavel, Md Sadik; Chakrabarty, Sayan; Gow, Jeff

    2015-02-01

    Contingent valuation (CV) is used to estimate the willingness to pay (WTP) of consumers for specific attributes to improve the quality of health care they received in three hospitals in Bangladesh. Random sample of 252 patients were interviewed to measure their willingness to pay for seven specified improvements in the quality of delivered medical care. Partial tobit regression and corresponding marginal effects analysis were used to analyze the data and obtain WTP estimates. Patients are willing to pay more if their satisfaction with three attributes of care are increased. These are: a closer doctor-patient relationship, increased drug availability and increased chances of recovery. The doctor patient relationship is considered most important by patients and exhibited the highest willingness to pay. This study provides important information to policy makers about the monetary valuation of patients for improvements in certain attributes of health care in Bangladesh.

  8. Nurse Level of Education, Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-Sectional Study

    PubMed Central

    Rahman, Hamzah Abdul; Jarrar, Mu’taman; Don, Mohammad Sobri

    2015-01-01

    Background and Objective: Nursing knowledge and skills are required to sustain quality of care and patient safety. The number of nurses with Bachelor degrees in Malaysia is very limited. This study aims to predict the impact of nurse level of education on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. Methodology: A cross-sectional survey by questionnaire was conducted. A total of 652 nurses working in the medical and surgical wards in 12 private hospitals participated in the study. Multistage stratified simple random sampling performed to invite nurses working in small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals to participate in the study. This allowed nurses from all shifts to participate in this study. Results: Nurses with higher education were not significantly associated with both quality of care and patient safety. However, a total 355 (60.9%) of respondents who participated in this study were working in teaching hospitals. Teaching hospitals offer training for all newly appointed staff. They also provide general orientation programs and training to outline the policies, procedures of the nurses’ roles and responsibilities. This made the variances between the Bachelor and Diploma nurses not significantly associated with the outcomes of care. Conclusions: Nursing educational level was not associated with the outcomes of care in Malaysian private hospitals. However, training programs and the general nursing orientation programs for nurses in Malaysia can help to upgrade the Diploma-level nurses. Training programs can increase their self confidence, knowledge, critical thinking ability and improve their interpersonal skills. So, it can be concluded that better education and training for a medical and surgical wards’ nurses is required for satisfying client expectations and sustaining the outcomes of patient care. PMID:26153190

  9. Nurse Level of Education, Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-sectional Study.

    PubMed

    Abdul Rahman, Hamzah; Jarrar, Mu'taman; Don, Mohammad Sobri

    2015-04-23

    Nursing knowledge and skills are required to sustain quality of care and patient safety. The numbers of nurses with Bachelor degrees in Malaysia are very limited. This study aims to predict the impact of nurse level of education on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals. A cross-sectional survey by questionnaire was conducted. A total 652 nurses working in the medical and surgical wards in 12 private hospitals were participated in the study. Multistage stratified simple random sampling performed to invite nurses working in small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals to participate in the study. This allowed nurses from all shifts to participate in this study. Nurses with higher education were not significantly associated with both quality of care and patient safety. However, a total 355 (60.9%) of respondents participated in this study were working in teaching hospitals. Teaching hospitals offer training for all newly appointed staff. They also provide general orientation programs and training to outline the policies, procedures of the nurses' roles and responsibilities. This made the variances between the Bachelor and Diploma nurses not significantly associated with the outcomes of care. Nursing educational level was not associated with the outcomes of care in Malaysian private hospitals. However, training programs and the general nursing orientation programs for nurses in Malaysia can help to upgrade the Diploma-level nurses. Training programs can increase their self confidence, knowledge, critical thinking ability and improve their interpersonal skills. So, it can be concluded that better education and training for a medical and surgical wards' nurses is required for satisfying client expectations and sustaining the outcomes of patient care.

  10. Self-efficacy, self-care behaviors and glycemic control among type-2 diabetes patients attending two private clinics in Yangon, Myanmar.

    PubMed

    Wynn Nyunt, Sandhi; Howteerakul, Nopporn; Suwannapong, Nawarat; Rajatanun, Thitipat

    2010-07-01

    This cross-sectional study aimed to estimate the prevalence of glycemic control and its associated factors among type-2 diabetes patients attending two private clinics in Yangon, Myanmar. Two hundred sixty-six diabetes patients attending two private diabetes clinics in Yangon during February and March, 2009 were included in the study. The participants completed a structured questionnaire. HbA(1c) was used as the index for glycemic control. The prevalence of successful glycemic control (HbA(1c) < or =7%) was 27.1%. The median HbA(1c) value was 7.8%. About 62.0% of patients had high self-efficacy levels, and 30.8% had good self-care behavior. Multiple logistic regression analysis revealed four variables associated with glycemic control: age > or =60 years (OR 2.46, 95% CI 1.17-5.21), taking one oral hypoglycemic agent (OHA) (OR 2.56, 95% CI 1.26-5.19), being overweight (OR 2.01, 95% CI 1.02-3.95) and having a high self-efficacy level (OR 5.29, 95% CI 2.20-12.75). Interventions to increase diabetic patient self-efficacy levels and self-care behavior, especially related to diet and exercise, are needed to reduce poor glycemic control.

  11. Paying for disease management.

    PubMed

    Levy, Phillip; Nocerini, Robert; Grazier, Kyle

    2007-08-01

    Disease Management (DM) first appeared in the United States in the early 1990s. Since then its incorporation into health plans has increased dramatically, yet proof of its effectiveness in terms of quality improvement and cost reduction remains to be seen. The following review provides an exploratory analysis of the basic principles of DM, its evolution and differences from traditional managed care, the ways in which programs are currently being used in the private and public sectors, and the challenges to determining a payment structure for incorporating DM into the current health insurance system.

  12. 41 CFR 302-9.11 - For what POV emergency or temporary storage expenses will my agency pay?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... or temporary storage expenses will my agency pay? 302-9.11 Section 302-9.11 Public Contracts and... PROPERTY 9-ALLOWANCES FOR TRANSPORTATION AND EMERGENCY OR TEMPORARY STORAGE OF A PRIVATELY OWNED VEHICLE General Rules § 302-9.11 For what POV emergency or temporary storage expenses will my agency pay?...

  13. 41 CFR 302-9.11 - For what POV emergency or temporary storage expenses will my agency pay?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... or temporary storage expenses will my agency pay? 302-9.11 Section 302-9.11 Public Contracts and... PROPERTY 9-ALLOWANCES FOR TRANSPORTATION AND EMERGENCY OR TEMPORARY STORAGE OF A PRIVATELY OWNED VEHICLE General Rules § 302-9.11 For what POV emergency or temporary storage expenses will my agency pay?...

  14. Pay as you throw

    SciTech Connect

    Dahlen, Lisa; Lagerkvist, Anders

    2010-01-15

    Householders' response to weight-based billing for the collection of household waste was investigated with the aim of providing decision support for waste management policies. Three questions were addressed: How much and what kind of information on weight-based billing is discernible in generic Swedish waste collection statistics? Why do local authorities implement weight-based billing, and how do they perceive the results? and, Which strengths and weaknesses of weight-based billing have been observed on the local level? The study showed that municipalities with pay-by-weight schemes collected 20% less household waste per capita than other municipalities. Surprisingly, no part of this difference could be explained by higher recycling rates. Nevertheless, the majority of waste management professionals were convinced that recycling had increased as a result of the billing system. A number of contradicting strengths and weaknesses of weight-based billing were revealed.

  15. Financing Higher Education Worldwide: Who Pays? Who Should Pay?

    ERIC Educational Resources Information Center

    Johnstone, D. Bruce; Marcucci, Pamela N.

    2010-01-01

    No issue in higher education is as salient, or as controversial, as finance. As demand for higher education around the world grows, so do the costs associated with it, especially as governments shoulder less of the burden. Tuition fees rise and student loan debt grows. Who pays for these surging costs? Who "should" pay? D. Bruce Johnstone and…

  16. Financing Higher Education Worldwide: Who Pays? Who Should Pay?

    ERIC Educational Resources Information Center

    Johnstone, D. Bruce; Marcucci, Pamela N.

    2010-01-01

    No issue in higher education is as salient, or as controversial, as finance. As demand for higher education around the world grows, so do the costs associated with it, especially as governments shoulder less of the burden. Tuition fees rise and student loan debt grows. Who pays for these surging costs? Who "should" pay? D. Bruce Johnstone and…

  17. 5 CFR 9901.212 - Pay schedules and pay bands.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Pay schedules and pay bands. 9901.212 Section 9901.212 Administrative Personnel DEPARTMENT OF DEFENSE HUMAN RESOURCES MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL...

  18. The poor pay more: health-related inequality in Thailand.

    PubMed

    Pannarunothai, S; Mills, A

    1997-06-01

    This paper examines the equality of utilization for equal need and equity of out-of-pocket expenditure for health services in a large urban area in Thailand. Data from a household health interview survey were used to explore patterns of perceived morbidity, utilization of various treatment sources, and out-of-pocket payment. Financial access to health care, as reflected in medical benefit/ insurance cover, appeared to influence reported illness and hospitalization rates. Gross lack of access to health care amongst lower socio-economic groups was not the main problem in this densely populated urban area because people could choose and use alternative health services according to their ability and willingness to pay. The corollary, however, was an inequitable pattern of out-of-pocket health expenditure by income quintile and per capita. The underprivileged were more likely to pay out of their own pocket for their health problems, and to pay out of proportion to their household income when compared with more privileged groups. Furthermore, the underprivileged were least likely to be covered by government health benefit schemes, in contrast in particular to civil servants, who paid less out of pocket and did not contribute to their medical benefit fund. The private health sector (private clinics and private hospitals) was the major provider of health care to urban dwellers for both outpatient and inpatient services. Policy options for the short and long term to improve the equity of payment systems for health care are discussed.

  19. The impact of financial incentives on physician empathy: a study from the perspective of patients with private and statutory health insurance.

    PubMed

    Neumann, Melanie; Bensing, Jozien; Wirtz, Markus; Wübker, Ansgar; Scheffer, Christian; Tauschel, Diethard; Edelhäuser, Friedrich; Ernstmann, Nicole; Pfaff, Holger

    2011-08-01

    We hypothesized that patients' ratings of physician empathy (PE) would be higher among those with private health insurance (PHI, referring to financial incentive) than among patients with statutory health insurance (SHI). A postal survey was administered to 710 cancer patients. PE was assessed using the Consultation-and-Relational-Empathy measure. T-tests were conducted to analyse whether PHI and SHI-patients differ in their ratings of PE and variables relating to contact time with the physician. Structural-equation-modelling (SEM) verified mediating effects. PHI-patients rated physician empathy higher. SEM revealed that PHI-status has a strong significant effect on frequency of talking with the physician, which has a strong significant effect (1) on PE and (2) has a moderate effect on patients' perception of medical staff stress, thereby also affecting patients' ratings of PE. Our findings suggest that PHI-status is one necessary precondition for physicians spending more time with the patient. Spending more time with the PHI-patient has two major effects: it results in a more positive perception of PE and positively impacts PHI-patients' perception of medical staff stress, which in turn, again influences PE. Health policy should discuss these findings in terms of equality in receiving high-quality care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  20. Paying for prevention: a critical opportunity for public health.

    PubMed

    O'Connor, Jean C; Gutelius, Bruce J; Girard, Karen E; Drum Hastings, Danna; Longoria, Luci; Kohn, Melvin A

    2013-03-01

    Despite spending an increasing amount on health care and more than every other industrialized country, the U.S. ranks 37th in health outcomes. The implementation of the Patient Protection and Affordable Care Act (ACA) promises to ensure better access to health care for many Americans through expanded public and private insurance coverage, including basic preventive health care. Public health must seize this critical opportunity by taking steps to ensure that prevention, especially primary prevention, is embedded in our health system. This manuscript outlines four areas where public health officials across the U.S. can immediately capitalize on opportunities created by the ACA to ensure that prevention is a key component of health reform: (1) leading the way on community health assessments; (2) linking clinical and community prevention; (3) supporting the development of alternative payment methodologies to pay for prevention; and (4) serving as a community resource for the coordination of care and building the non-traditional health workforce. © 2013 American Society of Law, Medicine & Ethics, Inc.

  1. The Merits of Merit Pay.

    ERIC Educational Resources Information Center

    Cohen, David K.; Murnane, Richard J.

    A study of six selected school districts that had been using merit pay plans successfully for at least 6 years provided insight into administrative strategies associated with merit pay program success. The researchers visited the districts, interviewed teachers and administrators, and studied local documents. Each district used a unique…

  2. Equal Pay for Comparable Work.

    ERIC Educational Resources Information Center

    Von Frank, Jane

    1980-01-01

    Argues that sex discrimination has depressed salaries for jobs filled primarily by women. Shows that under the Equal Pay Act and Title VII, workers in traditionally female occupations can establish equal pay claims. Suggests approaches for developing legal and enforcement standards to deal with discriminatory compensation in traditionally female…

  3. Teacher Pay and Teacher Aptitude

    ERIC Educational Resources Information Center

    Leigh, Andrew

    2012-01-01

    Can changes in teacher pay encourage more able individuals to enter the teaching profession? So far, studies of the impact of pay on the aptitude distribution of teachers have provided mixed evidence on the extent to which altering teacher salaries represents a feasible solution to the teacher quality problem. One possible reason is that these…

  4. Teacher Pay and Teacher Aptitude

    ERIC Educational Resources Information Center

    Leigh, Andrew

    2012-01-01

    Can changes in teacher pay encourage more able individuals to enter the teaching profession? So far, studies of the impact of pay on the aptitude distribution of teachers have provided mixed evidence on the extent to which altering teacher salaries represents a feasible solution to the teacher quality problem. One possible reason is that these…

  5. Paying for water.

    PubMed

    Middleton, J; Saunders, P

    1997-03-01

    Water has been taken for granted as an essential public health need since the Victorian sanitary revolution. Water has come back on to the public health agenda in the United Kingdom because of recent policy changes and their untoward environmental and social impacts; along with water privatization and tough new environmental directives, there have been serious water pollution incidents, water shortages, water debt and disconnection. Along with concern about protecting individual rights to a clean safe water supply, there is concern about the ability of national water resources to meet all our communities' needs, without unacceptable environmental damage. A national plan is needed for the conservation of water and protection of water resources and the environment; adequate central funds are needed to see that this happens. There should be greater emphasis on local water management and a key role for local authorities; there should be fair pricing, protection of water supplies for the poorest and most vulnerable, and a ban on water disconnection to domestic users, on public health grounds. More research is needed into the potential adverse health impact of people on prepayment meters disconnecting themselves. There is a place for water metering as the most rapidly deliverable means of controlling peak demand, reducing overall consumption and avoiding a large-scale environmentally damaging solution to supply more water. However, control of leakage offers the largest potential saving and is the most cost-effective means to protect existing water supply. We question whether private water companies, geared to maximizing profit and share dividends, can deliver a national plan for the protection and management of water resources, for the good of the environment and future generations. The public health lobby must become more actively engaged in the debate about the supply, protection and price of our most precious public health asset-water.

  6. Using School Scholarships to Estimate the Effect of Private Education on the Academic Achievement of Low Income Students in Chile

    ERIC Educational Resources Information Center

    Anand, Priyanka; Mizala, Alejandra; Repetto, Andrea

    2008-01-01

    This paper estimates the impact of private education on the academic achievement of low-income students in Chile. To deal with selection bias, we use propensity score matching to compare the test scores of reduced-fee paying, low-income students in private voucher schools to those of similar students in public schools and free private voucher…

  7. Competition in the Pay Cable Industry.

    ERIC Educational Resources Information Center

    Albarran, Alan B.

    This paper analyzes the state of competition in the pay cable industry. The analysis conceptualizes competition in pay cable and discusses the current structure of the pay cable industry and the competition for subscribers and programming. The competition for audiences that pay cable faces from both pay-per-view services and the video cassette…

  8. 5 CFR 534.502 - Pay range.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Pay range. 534.502 Section 534.502 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.502 Pay range. A pay rate fixed under this subpart shall be— (a) Not less than...

  9. 5 CFR 534.502 - Pay range.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Pay range. 534.502 Section 534.502 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.502 Pay range. A pay rate fixed under...

  10. 5 CFR 534.502 - Pay range.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Pay range. 534.502 Section 534.502 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.502 Pay range. A pay rate fixed under...

  11. 5 CFR 534.502 - Pay range.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Pay range. 534.502 Section 534.502 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.502 Pay range. A pay rate fixed under...

  12. 5 CFR 534.502 - Pay range.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Pay range. 534.502 Section 534.502 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.502 Pay range. A pay rate fixed under...

  13. Monkeys reject unequal pay.

    PubMed

    Brosnan, Sarah F; De Waal, Frans B M

    2003-09-18

    During the evolution of cooperation it may have become critical for individuals to compare their own efforts and pay-offs with those of others. Negative reactions may occur when expectations are violated. One theory proposes that aversion to inequity can explain human cooperation within the bounds of the rational choice model, and may in fact be more inclusive than previous explanations. Although there exists substantial cultural variation in its particulars, this 'sense of fairness' is probably a human universal that has been shown to prevail in a wide variety of circumstances. However, we are not the only cooperative animals, hence inequity aversion may not be uniquely human. Many highly cooperative nonhuman species seem guided by a set of expectations about the outcome of cooperation and the division of resources. Here we demonstrate that a nonhuman primate, the brown capuchin monkey (Cebus apella), responds negatively to unequal reward distribution in exchanges with a human experimenter. Monkeys refused to participate if they witnessed a conspecific obtain a more attractive reward for equal effort, an effect amplified if the partner received such a reward without any effort at all. These reactions support an early evolutionary origin of inequity aversion.

  14. How do patients choose private in vitro fertilization treatment? A customer survey in a tertiary fertility center in the United Kingdom.

    PubMed

    Lass, A; Brinsden, P

    2001-05-01

    To assess the relevant factors affecting patients' decision when choosing a clinic for private, self-funded IVF treatment. Prospective anonymous closed questionnaires. Single tertiary-care private IVF center. New patients attending primary consultation in a period of 7 months from September 1999 to March 2000. None. Primary knowledge about the clinic, source of referral, knowledge of, availability of information pack, and familiarity with the clinic's success rates and treatment's price. The last question assessed the relative importance of each factor in the decision-making process according to the SERVQUAL model, modified version. All items were measured as perceptions on a 5-point Likert scale. 1 = not important, 3 = neutral, and 5 = very important. One hundred seventy-five patients completed the questionnaire. They were well informed and investigated the market before making their final choice. Patients collect information from many sources, including new channels such as the Internet. Up to one third of patients do not consult their doctor before treatment. By far the most relevant factor in decision making is the success rate (i.e., delivery rates) of the clinic, followed by recommendation by general practitioner (GP) or consultant (respectively, Likert scale score, 4.6; 95% confidence interval [CI], 4.5-4.7; and Likert scale score, 4.0; 95% CI, 3.9-4.2; P<.01). Other factors, such as cost of the treatment, friends and relatives' opinions, and distance from home were not relevant. Units that wish to thrive and increase their market share should deliver high-quality service and concentrate their efforts on excelling in performance.

  15. Factors Related to Non-Referral of Patients with Presumptive Pulmonary TB to Designated Microscopy Centers (DMCs) by Registered Private Practitioners in Urban Areas of Punjab, India

    PubMed Central

    Sharma, Shruti; Whig, Jagdeep; Satija, Mahesh; Chaudhary, Anurag

    2015-01-01

    Background Early diagnosis and proper treatment under RNTCP guidelines, forms the mainstay of management of a TB patient. A large proportion of patients with presumptive tuberculosis (TB) visit a Private Practitioner (PP) in the first place. Studies have shown that PPs rely more on X-rays and other diagnostic tools rather than referring the patient to the nearest Designated Microscopy Centre (DMC) for sputum microscopy. Aim The present study was planned to look in to factors responsible for non-referral of patients with presumptive pulmonary TB to the DMCs for diagnosis by PPs. Materials and Methods Present study was a case-control study conducted over a period of one year among registered PPs in urban areas of Punjab. The study was carried out in five major cities which have approximately half of the urban population of Punjab. Forty three Private Practitioners per city for referral group and 43 matched PPs for non-referral group were selected. Results Knowledge regarding RNTCP was low in both the referral (38.1%) as well as non-referral (25.6%) group of PPs. Allopathic doctors had significantly higher knowledge regarding TB as compared to ayurvedic and homeopathy doctors, and Registered Medical Practitioners (RMP). Both the knowledge of PPs regarding nearest DMC as well as perception about accessibility of the nearest DMC for the patients were found to be significantly higher in the referral group. Only 15.3% of practitioners in the non-referral group said that they had been contacted by RNTCP staff. Conclusion The main factors responsible for non-referral of pulmonary TB suspects to DMCs for diagnosis in the present study included low knowledge regarding RNTCP, lack of awareness regarding place and accessibility of nearest DMC, and inadequate sensitization of PPs by the RNTCP staff. PMID:26674553

  16. Privatization and Education

    ERIC Educational Resources Information Center

    Dash, Neena

    2009-01-01

    This paper highlights emerging trends, programmes and policies in privatization of education in Western countries. These trends are educational vouchers, choice of private schools, private school liberalization, private contracting of specific services, tuition tax credits and deductions for parents ,subsidies and assistance grants to private…

  17. A prescription for turning self-pay accounts into revenue.

    PubMed

    Koenig, Scott

    2010-01-01

    The antidote for a healthy bottom line is a streamlined payment recovery process from self-pay patients. Due to the current high unemployment rate and a resulting spike in self-pay patients, CFOs must be proactive and identify self-pay debt recovery solutions to stay in the black. It is vital to design an effective and efficient process that works for the specific needs of the hospital or practice. Utilizing metrics, reconditioning patients to pay at point-of-service, training associates to appropriately request payment, and understanding the limitations of the business office are key elements to financial health. Identifying an accounts receivable management partner could significantly reduce headaches and strain on staff and time.

  18. Pay for performance: will dentistry follow?

    PubMed Central

    2010-01-01

    Background "Pay for performance" is an incentive system that has been gaining acceptance in medicine and is currently being considered for implementation in dentistry. However, it remains unclear whether pay for performance can effect significant and lasting changes in provider behavior and quality of care. Provider acceptance will likely increase if pay for performance programs reward true quality. Therefore, we adopted a quality-oriented approach in reviewing those factors which could influence whether it will be embraced by the dental profession. Discussion The factors contributing to the adoption of value-based purchasing were categorized according to the Donabedian quality of care framework. We identified the dental insurance market, the dental profession position, the organization of dental practice, and the dental patient involvement as structural factors influencing the way dental care is practiced and paid for. After considering variations in dental care and the early stage of development for evidence-based dentistry, the scarcity of outcome indicators, lack of clinical markers, inconsistent use of diagnostic codes and scarcity of electronic dental records, we concluded that, for pay for performance programs to be successfully implemented in dentistry, the dental profession and health services researchers should: 1) expand the knowledge base; 2) increase considerably evidence-based clinical guidelines; and 3) create evidence-based performance measures tied to existing clinical practice guidelines. Summary In this paper, we explored factors that would influence the adoption of value-based purchasing programs in dentistry. Although none of these factors were essential deterrents for the implementation of pay for performance programs in medicine, the aggregate seems to indicate that significant changes are needed before this type of program could be considered a realistic option in dentistry. PMID:20423526

  19. Pay for performance: will dentistry follow?

    PubMed

    Voinea-Griffin, Andreea; Fellows, Jeffrey L; Rindal, Donald B; Barasch, Andrei; Gilbert, Gregg H; Safford, Monika M

    2010-04-28

    "Pay for performance" is an incentive system that has been gaining acceptance in medicine and is currently being considered for implementation in dentistry. However, it remains unclear whether pay for performance can effect significant and lasting changes in provider behavior and quality of care. Provider acceptance will likely increase if pay for performance programs reward true quality. Therefore, we adopted a quality-oriented approach in reviewing those factors which could influence whether it will be embraced by the dental profession. The factors contributing to the adoption of value-based purchasing were categorized according to the Donabedian quality of care framework. We identified the dental insurance market, the dental profession position, the organization of dental practice, and the dental patient involvement as structural factors influencing the way dental care is practiced and paid for. After considering variations in dental care and the early stage of development for evidence-based dentistry, the scarcity of outcome indicators, lack of clinical markers, inconsistent use of diagnostic codes and scarcity of electronic dental records, we concluded that, for pay for performance programs to be successfully implemented in dentistry, the dental profession and health services researchers should: 1) expand the knowledge base; 2) increase considerably evidence-based clinical guidelines; and 3) create evidence-based performance measures tied to existing clinical practice guidelines. In this paper, we explored factors that would influence the adoption of value-based purchasing programs in dentistry. Although none of these factors were essential deterrents for the implementation of pay for performance programs in medicine, the aggregate seems to indicate that significant changes are needed before this type of program could be considered a realistic option in dentistry.

  20. The development of outpatient prospective payment systems and the use of ambulatory patient groups by private insurers.

    PubMed

    Miller, H

    1993-04-01

    Private insurers will likely move to APGs rapidly because of the key advantages that APGs provide. Not only is it necessary to have an outpatient classification system to make utilization review, quality assurance, and customer reporting more meaningful, outpatient prospective payment provides a foundation for the controls on outpatient payments that insurers have been seeking. Because of outpatient volume increases and constraints on inpatient payments that have led hospitals to increase outpatient charges more rapidly, most insurers believe that outpatient payment levels are currently beyond their control. Introduction of an outpatient prospective payment system will shift control over outpatient payment increases from providers to insurers, as has been the case for many insurers who have adopted DRG payment for inpatient services. Once APGs are in place, annual increases in payment amounts will be determined through insurer-provider negotiation or through contractual approaches that limit payment increases to changes in a price index.

  1. Temporal Trends in Use of Biologic DMARDs for Rheumatoid Arthritis in the United States: A Cohort Study of Publicly and Privately Insured Patients.

    PubMed

    Desai, Rishi J; Solomon, Daniel H; Jin, Yinzhu; Liu, Jun; Kim, Seoyoung C

    2017-08-01

    Ten biologic disease-modifying antirheumatic drugs (bDMARDs) are available as treatment for rheumatoid arthritis (RA), but relatively little is known about population-level time trends in the use of these agents. To describe time trends in the use of bDMARDs in RA patients with private or public insurance in the United States. Claims data from private (Optum Clinformatics, 2004-2015) and public (Medicaid Analytic eXtract [MAX], 2000-2010) insurance programs were used. Patients with RA diagnosis codes and continuous health plan enrollment for 1-year baseline and 1-year follow-up periods were identified into 2 separate cohorts: (1) patients not using any bDMARD or (2) patients using a single bDMARD during the baseline period. Initiation of the first bDMARD from group 1 and switch to a second bDMARD from group 2 was identified as the outcome of interest during the 1-year follow-up period. Using mixed-effects regression models, we calculated yearly rates of initiation and switch for bDMARDs, adjusted for case-mix. We also described the proportion of all initiations and switches accounted for by each agent. There were 113,031 RA patients with public insurance and 97,751 RA patients with private insurance who were included in the study. The rates of initiation of bDMARDs (per 100 patients) increased significantly over time in Medicaid data for incident RA patients (from 1.1 to 3.1, P = 0.0006) and prevalent RA patients (from 4.6 to 10.9, P = 0.008). In Optum Clinformatics data, the rates were stable, with 7.7 to 8.3 per 100 incident RA patients (P = 0.10) and 11.0 to 11.5 per 100 prevalent RA patients (P = 0.12). The rates of switching (per 100 patients) increased over time from 6.4 to 16.0 (P = 0.04) in Medicaid data and 9.1 to 17.0 (P = 0.00003) in Optum Clinformatics data. Use of etanercept as the most common first-line agent was stable at approximately 50% of all biologic initiations, but use of infliximab decreased and the use of newer agents increased. More RA

  2. Healthy Aging: Paying for Health Care

    MedlinePlus

    ... This information in Spanish ( en español ) Paying for health care More information on paying for health care Better ... Coping without insurance More information on paying for health care Explore other publications and websites Age Page: Choosing ...

  3. Radioguided localisation of non-palpable lesions of the breast in Costa Rica: review of results of our first 800 patients in private practice.

    PubMed

    Aguilar, Marisel; Alfaro, Sabrina; Aguilar, Ricardo

    2017-01-01

    Surgical treatment of non-palpable breast lesions is controversial. At the European Institute of Oncology in Milan, Italy, Prof Umberto Veronesi introduced a new technique called the radioguided occult lesion localisation (ROLL) in 1996 to replace conventional methods and their disadvantages (Zurrida S, Galimberti V, and Monti S et al (1998) Radioguided localization of occult breast lesionsBreast7 11-13 https://doi.org/10.1016/S0960-9776(98)90044-3). Given the success experienced in that institution, the method became the technique of choice for the early diagnosis of breast cancer. In this paper, we will examine the technical aspects of ROLL and the results from a large series of patients treated in our private practice in Costa Rica. We analysed the first 816 patients with different non-palpable breast lesions detected by ultrasound or mammography within our private practice in Costa Rica. In 774 patients, technetium 99m labelled with human serum albumin (7-10 MBq) in 0.2 ml of saline solution was injected into the lesion under mammographic or ultrasound guidance. The excisional biopsy was done by means of a gamma-probe and complete excision of the lesion was verified by X-ray on the specimen in lesions that were visible by mammography and ultrasound 4 months after surgery. In the remaining 42 patients, the localisation of the lesion was carried out by wire. The tracer was correctly positioned in the first attempt in 772/816 (94.6%) of cases and in the second attempt in two other cases. In 42/816 (5.1%) cases, the localisation of the lesion had to be performed with the traditional method. X-rays showed that the lesion was entirely removed in 770/772 (99.74%) of cases. The ROLL is a simple and excellent option for the removal of hidden breast lesions in clinical practice. It offers the advantage of making resections safer and with tumour-free margins, in addition to reducing the number of reinterventions. Since it makes it possible to specify to the pathologist

  4. Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment

    PubMed Central

    Exley, Catherine E; Rousseau, Nikki S; Steele, Jimmy; Finch, Tracy; Field, James; Donaldson, Cam; Thomason, J Mark; May, Carl R; Ellis, Janice S

    2009-01-01

    Background The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments – such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them. Methods/Design Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs) in three Primary Care Trust areas (n = 300) to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs) and 3 (patients) use qualitative focused one to one interviews with a sample of these practitioners (up to 30) and their patients (up to 60) to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made. Discussion Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an unusual treatment in

  5. 5 CFR 1605.13 - Back pay awards and other retroactive pay adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... apply to participants who receive a back pay award or other retroactive pay adjustment for a period... entitled to make up contributions for the period covered by the back pay award or retroactive pay... contributed to the participant's account had the reduction in pay leading to the back pay award or other...

  6. Hospital staffing and local pay: an investigation into the impact of local variations in the competitiveness of nurses' pay on the staffing of hospitals in France.

    PubMed

    Combes, Jean-Baptiste; Delattre, Eric; Elliott, Bob; Skåtun, Diane

    2015-09-01

    Spatial wage theory suggests that employers in different regions may offer different pay rates to reflect local amenities and cost of living. Higher wages may be required to compensate for a less pleasant environment or a higher cost of living. If wages in a competing sector within an area are less flexible and therefore less competitive this may lead to an inability to employ staff. This paper considers the market for nursing staff in France where there is general regulation of wages and public hospitals compete for staff with the private hospital and non-hospital sectors. We consider two types of nursing staff, registered and assistant nurses and first establish the degree of spatial variation in the competitiveness of pay of nurses in public hospitals. We then consider whether these spatial variations are associated with variation in the employment of nursing staff. We find that despite regulation of pay in the public and private sector, there are substantial local variations in the competitiveness of nurses' pay. We find evidence that the spatial variations in the competitiveness of pay are associated with relative numbers of assistant nurses but not registered nurses. While we find the influence of the competitiveness of pay is small, it suggests that nonpay conditions may be an important factor in adjusting the labour market as might be expected in such a regulated market.

  7. Setting Up Private Practice in Psychiatry*

    PubMed Central

    De Sousa, Alan; De Sousa, Avinash

    2015-01-01

    Setting up a private practice in Mumbai is an onerous task. The present paper looks at the difficulties face by young psychiatrists when starting a private practice in psychiatry. It suggests certain guidelines to be followed to ensure the development of a successful practice. It also suggests methods to gain popularity among patients and society along with the ethics to be followed, knowledge base to be garnered, and the role of using multiple therapies and versatility in private practice. PMID:25838718

  8. Finance schemes for funding private orthodontic treatment.

    PubMed

    Perks, S

    1997-02-01

    Over the last ten years there has been a steady increase in the volume of private dental treatment and numerous finance schemes have been developed to help both patients and dentists. Private orthodontic treatment is increasing and the purpose of this article is to summarise the main features of the schemes currently available to fund private orthodontic treatment and to provide a source of reference.

  9. The criteria used by private general practitioners in Bloemfontein for the diagnosis and referral of asthma patients aged 6–15 years

    PubMed Central

    Balt, Monia; Joubert, Caroline; Nel, Michelle; Joubert, Gina

    2010-01-01

    ABSTRACT Background Participants in the study were general practitioners (GPs) in private practice in Bloemfontein, South Africa. Objectives To determine and evaluate the criteria employed by GPs in Bloemfontein to diagnose and refer chronic and acute asthma patients aged 6–15 years and to investigate the actual diagnostic criteria used by GPs, as compared to the theoretical (i.e. textbook) criteria. Method A descriptive study was performed. A questionnaire was designed to investigate which methods of diagnosis were employed by GPs with regard to childhood asthma. The questionnaire was distributed to GPs who fulfilled certain inclusion criteria and were selected by means of simple random sampling. Statistical analysis of data was done by the Department of Biostatistics, University of the Free State, and results were summarised as frequencies and percentages. Results Certain elements were lacking with regard to the patients’ histories taken by GPs. These included severity and frequency of attacks, as well as precipitating factors, such as smoking in the family and allergies. A worrisome number of GPs did not seem to be aware of the exact clinical picture of asthma in children and some failed to use the prescribed guidelines proposed for diagnosis of this condition in young patients. Most GPs indicated that they refer asthmatic children to private specialists, although this practice depended on the medical aid status of the patient's parents/guardian. Conclusion As portrayed by the feedback obtained from these Bloemfontein-based GPs, it could be presumed that the diagnosis of asthma in children did not always meet the standard criteria.

  10. Results from a Patient-Based Health Education Intervention in Reducing Antibiotic Use for Acute Upper Respiratory Tract Infections in the Private Sector Primary Care Setting in Singapore.

    PubMed

    Lee, Magdalene Hui Min; Pan, Darius Shaw Teng; Huang, Joyce Huixin; Chen, Mark I-Cheng; Chong, Joash Wen Chen; Goh, Ee Hui; Jiang, Lili; Leo, Yee Sin; Lee, Tau Hong; Wong, Chia Siong; Loh, Victor Weng Keong; Lim, Fong Seng; Poh, Adrian Zhongxian; Tham, Tat Yean; Wong, Wei Mon; Yu, Yue

    2017-05-01

    We investigated the efficacy of patient-targeted education in reducing antibiotic prescriptions for upper respiratory tract infections (URTIs) among adults in the private primary care setting in Singapore. Our randomized controlled trial enrolled patients aged 21 years and above presenting at general practitioner (GP) clinics with URTI symptoms for 7 days or less. Intervention arm patients were verbally educated via pamphlets about the etiology of URTIs, the role of antibiotics in treating URTIs, and the consequences of inappropriate antibiotic use. Control arm patients were educated on influenza vaccinations. Both arms were compared regarding the proportions prescribed antibiotics and the patients' postconsultation views. A total of 914 patients consulting 35 doctors from 24 clinics completed the study (457 in each arm). The demographics of patients in both arms were similar, and 19.1% were prescribed an antibiotic, but this varied from 0% to 70% for individual GPs. The intervention did not significantly reduce antibiotic prescriptions (odds ratio [OR], 1.20; 95% confidence interval [CI], 0.83-1.73) except in patients of Indian ethnicity (OR, 0.28; 95% CI, 0.09-0.93). Positive associations between the intervention and the view that antibiotics were not needed most of the time for URTIs (P = 0.047) and on being worried about the side effects of antibiotics (P = 0.018) were restricted to the Indian subgroup. GPs in limited liability partnerships or clinic chains prescribed less (OR, 0.36; 95% CI, 0.14 to 0.92), while certain inappropriate patient responses were associated with the receipt of antibiotics. Follow-up studies to investigate differences in responses to educational programs between ethnicities and to explore GP-targeted interventions are recommended. Copyright © 2017 Lee et al.

  11. Presenting Visual Acuity and Ocular Comorbidity in Patients with Primary Open Angle Glaucoma in a Private Tertiary Eye Center in Nigeria.

    PubMed

    Duke, Roseline; Akinye, Ayodele; Ameh, Soter

    2013-01-01

    To determine the presenting visual acuity (VA) of patients with primary open angle glaucoma (POAG) and the relationship to ocular comorbidity. A retrospective case note audit was undertaken in Eye Foundation Hospital, Calabar, between 1st January 2010 and 31st June 2011. The case notes of all newly presenting patients diagnosed with POAG were retrieved and data were extracted for analysis. Inclusion criteria for glaucoma was defined. Out of a total of 320 new patients, 88 patients were diagnosed with POAG, with a prevalence of 27.5% (95% CI: 22.7-32.7). The mean age for males is 57.1 ± 8.8 while that of females is 52.6 ± 11.2 and the total mean of 55.8 ± 9.7. Of the 88 patients, there were 84 self referrals [95.5% (95% CI: 88.8-98.7)], of these, 45, 53.6% (95% CI: 42.4-64.5) were for second opinion. There was no statistical significance between the gender, education and occupation and the level of VA seen on presentation. The best corrected visual acuity (BCVA ) in the right and left eye respectively, was significantly (p < 0.0001) related to the cup disk ratio. Ocular comorbid conditions were seen in 19 (22%) patients in the study. The presenting BCVA was significantly related to the presence of ocular comorbidity in the best eye. Comorbidity was not strongly related to the age of the patients. The course of glaucomatous progression is highly variable, identifying factors that not only predict progression but influence the VA and ocular health of the eye can help to guide clinical practice and patient treatment and monitoring. How to cite this article: Duke R, Akinye A, Ameh S. Presenting Visual Acuity and Ocular Comorbidity in Patients with Primary Open Angle Glaucoma in a Private Tertiary Eye Center in Nigeria. J Current Glau Prac 2013;7(1):6-10.

  12. Results from a Patient-Based Health Education Intervention in Reducing Antibiotic Use for Acute Upper Respiratory Tract Infections in the Private Sector Primary Care Setting in Singapore

    PubMed Central

    Lee, Magdalene Hui Min; Pan, Darius Shaw Teng; Huang, Joyce Huixin; Chong, Joash Wen Chen; Goh, Ee Hui; Jiang, Lili; Leo, Yee Sin; Lee, Tau Hong; Wong, Chia Siong; Loh, Victor Weng Keong; Lim, Fong Seng; Poh, Adrian Zhongxian; Tham, Tat Yean; Wong, Wei Mon; Yu, Yue

    2017-01-01

    ABSTRACT We investigated the efficacy of patient-targeted education in reducing antibiotic prescriptions for upper respiratory tract infections (URTIs) among adults in the private primary care setting in Singapore. Our randomized controlled trial enrolled patients aged 21 years and above presenting at general practitioner (GP) clinics with URTI symptoms for 7 days or less. Intervention arm patients were verbally educated via pamphlets about the etiology of URTIs, the role of antibiotics in treating URTIs, and the consequences of inappropriate antibiotic use. Control arm patients were educated on influenza vaccinations. Both arms were compared regarding the proportions prescribed antibiotics and the patients' postconsultation views. A total of 914 patients consulting 35 doctors from 24 clinics completed the study (457 in each arm). The demographics of patients in both arms were similar, and 19.1% were prescribed an antibiotic, but this varied from 0% to 70% for individual GPs. The intervention did not significantly reduce antibiotic prescriptions (odds ratio [OR], 1.20; 95% confidence interval [CI], 0.83–1.73) except in patients of Indian ethnicity (OR, 0.28; 95% CI, 0.09–0.93). Positive associations between the intervention and the view that antibiotics were not needed most of the time for URTIs (P = 0.047) and on being worried about the side effects of antibiotics (P = 0.018) were restricted to the Indian subgroup. GPs in limited liability partnerships or clinic chains prescribed less (OR, 0.36; 95% CI, 0.14 to 0.92), while certain inappropriate patient responses were associated with the receipt of antibiotics. Follow-up studies to investigate differences in responses to educational programs between ethnicities and to explore GP-targeted interventions are recommended. PMID:28193663

  13. Equity and the Sun Quality Health Private Provider Social Franchise: comparative analysis of patient survey data and a nationally representative TB prevalence survey

    PubMed Central

    2013-01-01

    Introduction Since 2004, the Sun Quality Health (SQH) franchise network has provided TB care in Myanmar through a network of established private medical clinics. This study compares the wealth distribution of the TB patients to non-TB patients to determine if TB is most common among the poor, and compares the wealth of all TB patients to SQH TB patients to assess whether the franchise achieves its goal of serving the poor. Methods The study uses data from two sources: 1) Myanmar’s first nationally representative TB prevalence study conducted in 2009, and 2) client exit interviews from TB patients from SQH clinics. In total, 1,114 TB-positive individuals were included in the study, including 739 from the national sample and 375 from the SQH sample. Results TB patients at SQH clinics were poorer than TB-positive individuals in the overall population, though not at a statistically significant level (p > 0.05). After stratification we found that in urban areas, TB patients at SQH clinics were more likely to be in the poorest quartile compared to general TB positive population (16.8% vs. 8.6%, respectively; p < 0.05). In rural areas, there was no statistically significant difference between the wealth distribution of SQH clinic patients and general TB positive individuals (p > 0.05). Conclusion Franchised clinics in Myanmar are reaching poor populations of TB patients in urban areas; more efforts are needed in order to reach the most vulnerable in rural areas. PMID:23305063

  14. Hematopoietic cell transplantation with autologous cord blood in patients with severe aplastic anemia: an opportunity to revisit the controversy regarding cord blood banking for private use.

    PubMed

    Rosenthal, Joseph; Woolfrey, Ann E; Pawlowska, Anna; Thomas, Sandra H; Appelbaum, Frederick; Forman, Stephen

    2011-07-01

    The controversy surrounding private banking of umbilical cord blood units (CBU), as a safeguard against future malignancy or other life-threatening conditions, raises many questions in pediatric clinical practice. Recent favorable experiences with autologous transplantation for severe aplastic anemia using privately stored CBU, suggested a possible utility. While private banking is difficult to justify statistically or empirically, there may exist rare cases where autologous transplant of stored umbilical CBU could be beneficial. The reality of privately banked CBU and the possibility for future discovery of additional indications for autologous cord blood transplant, motivated us to re-examine our attitudes towards private cord blood banking. Copyright © 2011 Wiley-Liss, Inc.

  15. Quantum data locking for high-rate private communication

    NASA Astrophysics Data System (ADS)

    Lupo, Cosmo; Lloyd, Seth

    2015-03-01

    We show that, if the accessible information is used as a security quantifier, quantum channels with a certain symmetry can convey private messages at a tremendously high rate, as high as less than one bit below the rate of non-private classical communication. This result is obtained by exploiting the quantum data locking effect. The price to pay to achieve such a high private communication rate is that accessible information security is in general not composable. However, composable security holds against an eavesdropper who is forced to measure her share of the quantum system within a finite time after she gets it.

  16. Private health insurance: an international overview and considerations for Canada.

    PubMed

    Dhalla, Irfan

    2007-01-01

    Since the passage of the Canada Health Act in 1984 and its prohibition of extra-billing, there has been an extremely limited role for private health insurance in Canada as a mechanism to pay for medically necessary physician or hospital services. In the aftermath of the landmark Supreme Court decision Chaoulli v. Québec, this may change.

  17. Quantifying the Impact of Autism Coverage on Private Insurance Premiums

    ERIC Educational Resources Information Center

    Bouder, James N.; Spielman, Stuart; Mandell, David S.

    2009-01-01

    Many states are considering legislation requiring private insurance companies to pay for autism-related services. Arguments against mandates include that they will result in higher premiums. Using Pennsylvania legislation as an example, which proposed covering services up to $36,000 per year for individuals less than 21 years of age, this paper…

  18. Wage Differentials Between Federal Government and Private Sector Workers.

    ERIC Educational Resources Information Center

    Smith, Sharon Patricia

    This study examined the earnings and wage rate differentials between Federal government and private sector workers in 1960 and 1970 to consider the comparability of these workers and the application of the Comparability Doctrine in Federal pay policy during that period. Two types of earnings and wage rate equations were estimated by ordinary least…

  19. School Privatization's First Big Test: EAI in Baltimore.

    ERIC Educational Resources Information Center

    Williams, Lois C.; Leak, Lawrence E.

    1996-01-01

    An independent study of Baltimore City's Tesseract schools analyzes why the privately managed program failed. Results showed no gains on Comprehensive Test of Basic Skills scores. Baltimore was paying about 11% more per student than in comparison schools. EAI has succeeded in establishing the supremacy of Wednesday afternoons for staff development…

  20. The Compensation and Benefits of Private University Presidents

    ERIC Educational Resources Information Center

    Langbert, Mitchell; Fox, Marc

    2013-01-01

    This study examines the determinants of the salaries of private college and university presidents. Ordinary least squares estimates suggest that institutional size, performance, and prestige are linked to presidents' compensation. Pay is for performance. Externally recruited presidents are paid more than those promoted from inside, which confirms…

  1. Public-Private Partnership in Higher Education: Central Queensland University Meets Campus Management Services

    ERIC Educational Resources Information Center

    Rodan, Paul

    2016-01-01

    Massive growth in the numbers of fee-paying international students and an increasing private sector role are two of the most salient features of Australian higher education in the past quarter century. Both these trends were evident in a little known partnership, involving a public regional university and a private entrepreneur, which had its…

  2. Private Loan Counseling for Undergraduate Students: The Role of College Financial Aid Counselors

    ERIC Educational Resources Information Center

    Jensen, Carol A.

    2008-01-01

    The cost of attending college has surpassed federal financial aid limits and fewer parents are paying the balance. As private lenders have been targeting undergraduate students to obtain private (alternative) loans to fill the financial gap, many students do not have parents or other adults to help them navigate one of the largest financial…

  3. Evaluating recreational hunting as an incentive for habitat conservation on private land in California

    Treesearch

    Luke T. Macaulay

    2015-01-01

    Private land plays a crucial role in the conservation of biodiversity in California, yet these lands are the least protected and most prone to environmental degradation. In 1930, Aldo Leopold recognized the potential to better conserve private land by an incentive scheme where recreational users would pay landowners for access to conserved wildlife habitat. While...

  4. Pay for performance and medical professionalism.

    PubMed

    Hendrickson, Marissa A

    2008-01-01

    Health care delivery systems are widely studying and implementing physician pay for performance (P4P) initiatives to improve quality and control costs. However, the increasing focus on quality-driven financial incentives has some troubling implications for medical professionalism. This article examines the P4P concept in light of a notion of medical fiduciary professionalism that dates back to the 18th-century Scottish physician John Gregory. Gregory's principles serve as a framework to assess the appropriateness of P4P initiatives in disseminating the principles of high-quality care without damage to professionalism, the patient-physician relationship, and access to care for all patients.

  5. Safety-net versus private hospital setting for brain metastasis patients treated with radiosurgery alone: Disparities in follow-up care and outcomes.

    PubMed

    Diao, Kevin; Sun, Yanqing; Yoo, Stella K; Yu, Cheng; Ye, Jason C; Trakul, Nicholas; Jennelle, Richard L; Kim, Paul E; Zada, Gabriel; Gruen, John P; Chang, Eric L

    2017-09-13

    Stereotactic radiosurgery (SRS) alone is an increasingly accepted treatment for brain metastases, but it requires adherence to frequently scheduled follow-up neuroimaging because of the risk of distant brain metastasis. The effect of disparities in access to follow-up care on outcomes after SRS alone is unknown. This retrospective study included 153 brain metastasis patients treated consecutively with SRS alone from 2010 through 2016 at an academic medical center and a safety-net hospital (SNH) located in Los Angeles, California. Outcomes included neurologic symptoms, hospitalization, steroid use and dependency, salvage SRS, salvage whole-brain radiotherapy, salvage neurosurgery, and overall survival. Ninety-three of the 153 patients were private hospital (PH) patients, and 60 were SNH patients. The median follow-up time was 7.7 months. SNH patients received fewer follow-up neuroimaging studies (1.5 vs 3; P = .008). In a multivariate analysis, the SNH setting was a significant risk factor for salvage neurosurgery (hazard ratio [HR], 13.65; P < .001), neurologic symptoms (HR, 3.74; P = .002), and hospitalization due to brain metastases (HR, 6.25; P < .001). More clinical visits were protective against hospitalizations due to brain metastases (HR, 0.75; P = .002), whereas more neuroimaging studies were protective against death (HR, 0.65; P < .001). SNH patients with brain metastases treated with SRS alone had fewer follow-up neuroimaging studies and were at higher risk for neurologic symptoms, hospitalization for brain metastases, and salvage neurosurgery in comparison with PH patients. Clinicians should consider the practice setting and patient access to follow-up care when they are deciding on the optimal strategy for the treatment of brain metastases. Cancer 2017;. © 2017 American Cancer Society. © 2017 American Cancer Society.

  6. Private costs almost equal health care costs when intervening in mild Alzheimer's: a cohort study alongside the DAISY trial.

    PubMed

    Søgaard, Rikke; Sørensen, Jan; Waldorff, Frans B; Eckermann, Ane; Buss, Dorthe V; Waldemar, Gunhild

    2009-11-25

    Alzheimer's disease is the leading cause of dementia and affects about 25 million people worldwide. Recent studies have evaluated the effect of early interventions for dementia, but few studies have considered private time and transportation costs associated with the intervention. This study assessed the total economic costs associated with a multifaceted intervention for mild Alzheimer's disease, including an estimate of the ratio of public to private costs. The study sample comprised 163 dyads of patients and caregivers who received a multifaceted intervention of counselling sessions, courses and informational packages. The typical duration of the intervention was 7 months. A micro-costing approach was applied using prospectively collected data on resource utilisation that included estimates of participant time and transportation. Precision estimates were calculated using a bootstrapping technique and structural uncertainty was assessed with sensitivity analysis. The direct intervention cost was estimated at EUR 1,070 (95% CI 1,029;1,109). The total cost (including private costs) was estimated at EUR 2,020 (95% CI 1,929;2,106) i.e. the ratio of private to public costs was almost 1:1. Intervention for mild Alzheimer's disease can be undertaken at a relatively low cost to public funds. However, policy planners should pay attention to the significant private costs associated with an intervention, which may ultimately pose a threat to equity in access to health care. Current Controlled Trials ISRCTN74848736.

  7. Getting Real Performance Out of Pay-for-Performance

    PubMed Central

    Nicholson, Sean; Pauly, Mark V; Wu, Anita Ya Jung; Murray, James F; Teutsch, Steven M; Berger, Marc L

    2008-01-01

    Context Most private and public health insurers are implementing pay-for-performance (P4P) programs in an effort to improve the quality of medical care. This article offers a paradigm for evaluating how P4P programs should be structured and how effective they are likely to be. Methods This article assesses the current comprehensiveness of evidence-based medicine by estimating the percentage of outpatient medical spending for eighteen medical processes recommended by the Institute of Medicine. Findings Three conditions must be in place for outcomes-based P4P programs to improve the quality of care: (1) health insurers must not fully understand what medical processes improve health (i.e., the health production function); (2) providers must know more about the health production function than insurers do; and (3) health insurers must be able to measure a patient's risk-adjusted health. Only two of these conditions currently exist. Payers appear to have incomplete knowledge of the health production function, and providers appear to know more about the health production function than payers do, but accurate methods of adjusting the risk of a patient's health status are still being developed. Conclusions This article concludes that in three general situations, P4P will have a different impact on quality and costs and so should be structured differently. When information about patients’ health and the health production function is incomplete, as is currently the case, P4P payments should be kept small, should be based on outcomes rather than processes, and should target physicians’ practices and health systems. As information improves, P4P incentive payments could be increased, and P4P may become more powerful. Ironically, once information becomes complete, P4P can be replaced entirely by “optimal fee-for-service.” PMID:18798885

  8. Patient punctuality and clinic performance: observations from an academic-based private practice pain centre: a prospective quality improvement study

    PubMed Central

    Williams, Kayode A; Chambers, Chester G; Dada, Maqbool; McLeod, Julia C; Ulatowski, John A

    2014-01-01

    Objectives The aim of this study was to examine the effects of an intervention to alter patient unpunctuality. The major hypothesis was that the intervention will change the distribution of patient unpunctuality by decreasing patient tardiness and increasing patient earliness. Design Prospective Quality Improvement. Setting Specialty Pain Clinic in suburban Baltimore, Maryland, USA. Participants The patient population ranged in age from 18 to 93 years. All patients presenting to the clinic during the study period were included in the study. The average monthly volume was 86.2 (SD=13) patients. A total of 1500 patient visits were included in this study. Interventions We tracked appointment times and patient arrival times at an ambulatory pain clinic. An intervention was made in which patients were informed that tardy patients would not be seen and would be rescheduled. This policy was enforced over a 12-month period. Primary and secondary outcome measures The distribution of patient unpunctuality was developed preintervention and at 12 months after implementation. Distribution parameters were used as inputs to a discrete event simulation to determine effects of the change in patient unpunctuality on clinic delay. Results Data regarding patient unpunctuality were gathered by direct observation before and after implementation of the intervention. The mean unpunctuality changed from −20.5 min (110 observations, SD=1.7) preintervention to −23.2 (169, 1.2) at 1 month after the intervention, −23.8 min (69, 1.8) at 6 months and −25.0 min (71, 1.2) after 1 year. The unpunctuality 12 months after initiation of the intervention was significantly different from that prior to the intervention (p<0.05). Conclusions Physicians and staff are able to alter patient arrival patterns to reduce patient unpunctuality. Reducing tardiness improves some measures of clinic performance, but may not always improve waiting times. Accommodating early arriving patients

  9. Patient punctuality and clinic performance: observations from an academic-based private practice pain centre: a prospective quality improvement study.

    PubMed

    Williams, Kayode A; Chambers, Chester G; Dada, Maqbool; McLeod, Julia C; Ulatowski, John A

    2014-05-15

    The aim of this study was to examine the effects of an intervention to alter patient unpunctuality. The major hypothesis was that the intervention will change the distribution of patient unpunctuality by decreasing patient tardiness and increasing patient earliness. Prospective Quality Improvement. Specialty Pain Clinic in suburban Baltimore, Maryland, USA. The patient population ranged in age from 18 to 93 years. All patients presenting to the clinic during the study period were included in the study. The average monthly volume was 86.2 (SD=13) patients. A total of 1500 patient visits were included in this study. We tracked appointment times and patient arrival times at an ambulatory pain clinic. An intervention was made in which patients were informed that tardy patients would not be seen and would be rescheduled. This policy was enforced over a 12-month period. The distribution of patient unpunctuality was developed preintervention and at 12 months after implementation. Distribution parameters were used as inputs to a discrete event simulation to determine effects of the change in patient unpunctuality on clinic delay. Data regarding patient unpunctuality were gathered by direct observation before and after implementation of the intervention. The mean unpunctuality changed from -20.5 min (110 observations, SD=1.7) preintervention to -23.2 (169, 1.2) at 1 month after the intervention, -23.8 min (69, 1.8) at 6 months and -25.0 min (71, 1.2) after 1 year. The unpunctuality 12 months after initiation of the intervention was significantly different from that prior to the intervention (p<0.05). Physicians and staff are able to alter patient arrival patterns to reduce patient unpunctuality. Reducing tardiness improves some measures of clinic performance, but may not always improve waiting times. Accommodating early arriving patients does serve to improve clinic performance. Published by the BMJ Publishing Group Limited. For permission to use (where

  10. Prescription for antibiotics at drug shops and strategies to improve quality of care and patient safety: a cross-sectional survey in the private sector in Uganda

    PubMed Central

    Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus; Clarke, Siân E; Lal, Sham; Hansen, Kristian S; Magnussen, Pascal; LaRussa, Philip

    2016-01-01

    Objectives The main objective of this study was to assess practices of antibiotic prescription at registered drug shops with a focus on upper respiratory tract infections among children in order to provide data for policy discussions aimed at improving quality of care and patient safety in the private health sector in Uganda. Methods A survey was conducted within 57 parishes from August to October 2014 in Mukono District, Uganda. Data was captured on the following variables: drug shop characteristics, training of staff in management of pneumonia, availability of guidelines and basic equipment, available antibiotics, knowledge on treatment of pneumonia in children aged <5 years. The main study outcome was the proportion of private health facilities prescribing an antibiotic. Results A total of 170 registered drug shops were surveyed between August and October 2014. The majority of drug shops, 93.5% were prescribing antibiotics, especially amoxicillin and trimethoprim-sulfamethoxazole (septrin). The professional qualification of a provider was significantly associated with this practice, p=0.04; where lower cadre staff (nursing assistants and enrolled nurses) overprescribed antibiotics. A third, 29.4% of drug shop providers reported that antibiotics were the first-line treatment for children with diarrhoea; yet the standard guideline is to give oral rehydration salts and zinc tablets. Only few providers, 8.2%, had training on antibiotics, with 10.6% on pneumonia case management. Further to this, 7.1% drug shops had WHO-Integrated Management of Childhood Illness guidelines, and a negligible proportion (<1%) had respiratory timers and baby weighing scales. Although the majority of providers, 82.4%, knew severe signs and symptoms of pneumonia, few, 17.6%, knew that amoxicillin was the first-line drug for treatment of pneumonia in children according to the guidelines. Conclusions There is urgent need to regulate drug shop practices of prescribing and selling

  11. Adoption of Radiation Technology Among Privately Insured Nonelderly Patients With Cancer in the United States, 2008 to 2014: A Claims-Based Analysis.

    PubMed

    Pan, Hubert Y; Jiang, Jing; Shih, Ya-Chen Tina; Smith, Benjamin D

    2017-04-10

    Despite enthusiasm for advanced radiation technologies, understanding of their adoption in recent years is limited. The aim of this study was to elucidate utilization trends of conventional radiation, intensity-modulated radiotherapy (IMRT), brachytherapy, proton radiotherapy, stereotactic body radiotherapy (SBRT), and stereotactic radiosurgery (SRS) using a large convenience sample of irradiated patients with cancer identified from private insurance claims in the United States. The unit of analysis was a claim corresponding to a fraction of delivered radiotherapy from 2008 to 2014. Each claim was assigned a disease site on the basis of the diagnosis code and a radiation technology on the basis of the procedure code. In 2014, conventional radiation and IMRT constituted 56% and 39% of all radiation treatment claims, respectively, while brachytherapy constituted 2%, proton radiotherapy 1%, SBRT 1%, and SRS <1%. Compared with the first quarter of 2008, the proportional contribution of conventional radiation and brachytherapy to all radiation claims each decreased by 16% in the fourth quarter of 2014. In contrast, proportional contribution increased by 32% for IMRT, 83% for proton radiotherapy, 124% for SRS, and 309% for SBRT. Prostate cancer constituted 60% of all proton claims in 2008 but declined to 37% by 2014. SBRT was used to treat a variety of disease sites, most commonly primary lung (25%), prostate (12%), secondary bone (9%), and secondary lung (9%), in 2014. In this claims-based analysis of younger patients with private insurance, conventional radiation and IMRT were the most commonly used technologies from 2008 to 2014, while SBRT showed the most robust growth over the study period.

  12. P2Y12 receptor inhibition and effect of morphine in patients undergoing primary PCI for ST-segment elevation myocardial infarction. The PRIVATE-ATLANTIC study.

    PubMed

    Silvain, Johanne; Storey, Robert F; Cayla, Guillaume; Esteve, Jean-Baptiste; Dillinger, Jean-Guillaume; Rousseau, Hélène; Tsatsaris, Anne; Baradat, Caroline; Salhi, Néjoua; Hamm, Christian W; Lapostolle, Frédéric; Lassen, Jens Flensted; Collet, Jean-Philippe; Ten Berg, Jurriën M; Van't Hof, Arnoud W; Montalescot, Gilles

    2016-08-01

    PRIVATE-ATLANTIC (P2Y12 Receptor Inhibition with VASP Testing using Elisa kit during the ATLANTIC study) is a pre-specified substudy of the randomised, double-blind ATLANTIC trial in patients with ST-segment elevation myocardial infarction, designed to help interpret the main trial results. The primary objective of ATLANTIC was to assess coronary reperfusion prior to percutaneous coronary intervention (PCI) with pre- vs in-hospital ticagrelor 180 mg loading dose (LD). PRIVATE-ATLANTIC assessed platelet inhibition in 37 patients by measurement of vasodilator-associated stimulated phosphoprotein (VASP) platelet reactivity index (PRI) and VerifyNow platelet reactivity units (PRU) before angiogram (T1), immediately after PCI (T2), 1 (T3), and 6 (T4) hours (h) after PCI, and before next study drug administration (T5). The median time difference between the two ticagrelor LD was 41 minutes. Platelet reactivity was unaffected at T1 when measured by VASP-PRI (89.8 vs 93.9 % for pre- and in-hospital ticagrelor, respectively; p = 0.18) or PRU (239 vs 241; p = 0.82). Numerical differences were apparent at T2 and maximal at T3. Morphine administration significantly delayed onset of platelet inhibition at T3 (VASP-PRI 78.2 vs 23.4 % without morphine; p = 0.0116) and T4 (33.1 vs 11.0 %; p = 0.0057). In conclusion, platelet inhibition in ATLANTIC was unaffected by pre-hospital ticagrelor administration at the time of initial angiogram due to the short transfer delay. The maximum difference in platelet inhibition was detected 1 h after PCI (T3). Morphine administration was associated with delayed onset of action of ticagrelor and appeared more important than timing of ticagrelor administration.

  13. The Private Language Argument.

    ERIC Educational Resources Information Center

    Baker, Gordon

    1998-01-01

    Discusses the private language argument (PLA)--the argument against the possibility of a private language. Raises questions about the PLA, suggesting there are a number of problems that PLA interpretation generates and fails to resolve. (Author/JL)

  14. Implant placement with or without simultaneous tooth extraction in patients taking oral bisphosphonates: postoperative healing, early follow-up, and the incidence of complications in two private practices.

    PubMed

    Fugazzotto, Paul A; Lightfoot, W Scott; Jaffin, Robert; Kumar, Ashkay

    2007-09-01

    The development of bisphosphonate-associated osteonecrosis in patients with a history of intravenous bisphosphonate therapy is a significant cause of concern in clinical periodontal practice. The role of oral bisphosphonates in the development of bisphosphonate-associated osteonecrosis is less clear. This article documents the results of treatment of patients with a history of oral bisphosphonate therapy in two private periodontal practices. The study was a retrospective analysis of case records of patients treated as part of routine periodontal and implant treatment. Patients with a history of oral bisphosphonate therapy of various durations were treated with implant placement and restoration or tooth extraction, immediate placement, and restoration. These patients were followed for 12 to 24 months after implant placement. The incidence of hard and soft tissue complications, including the development of osteonecrosis, was noted. No osteonecrosis was noted immediately postoperatively or during the follow-up period in 61 patients. One patient demonstrated a small tissue dehiscence at the 1-week postoperative examination following extraction of a mandibular first molar and simultaneous implant placement in the area of a prominent torus. No other postoperative complications were noted. All implants were functioning successfully by the Albrektsson criteria 12 to 24 months post-insertion. A history of oral bisphosphonate use for a mean period of 3.3 years (range, 1 to 5 years) was not found to be a contributing factor to the development of osteonecrosis following implant placement in intact ridges or tooth extraction with immediate implant placement. However, there is no doubt that larger controlled studies and retrospective reports are needed.

  15. Public and private sector interactions: an economic perspective.

    PubMed

    Maynard, A

    1986-01-01

    The debate about the public-private mix for health care has been dominated by rhetoric and the failure to evaluate the characteristics of the outcomes of public and private health care systems and to relate these to policy targets. After a brief analysis of the competing, liberal (conservative) and collectivist (socialist), objectives, the nature of the private health care sector in Britain is described and it is shown that growth has faltered due to cost containment problems. This outcome is the product of characteristics of the private health care system, paralleled precisely in the NHS: asymmetry information, monopoly power, moral hazard and third party pays. The final section discusses briefly some remedies for the inefficient and inequitable outcomes which are seen in all health care markets and it is argued that competition within public and private health care systems may enable each system type to achieve its own particular objectives more efficiently.

  16. 75 FR 18133 - Pay for Sunday Work

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-09

    ... OF PERSONNEL MANAGEMENT 5 CFR Part 550 RIN 3206-AM08 Pay for Sunday Work AGENCY: Office of Personnel... of Sunday premium pay for work performed on Sundays. The revised Sunday premium pay regulations would... are regularly scheduled to perform work on a Sunday are entitled to Sunday premium pay for the non...

  17. 5 CFR 551.501 - Overtime pay.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Overtime pay. 551.501 Section 551.501 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION UNDER THE FAIR LABOR STANDARDS ACT Overtime Pay Provisions Basic Provisions § 551.501 Overtime pay. (a) An agency...

  18. 28 CFR 345.60 - Training pay.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Training pay. 345.60 Section 345.60... (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.60 Training pay. Inmates directed by the SOI to take a particular type of training in connection with a FPI job are to receive FPI pay if...

  19. 5 CFR 9701.356 - Pay retention.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Pay Administration § 9701.356 Pay retention. (a) Subject to...

  20. 28 CFR 345.52 - Premium pay.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Premium pay. 345.52 Section 345.52 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.52 Premium pay. Payment of premium pay to...

  1. 28 CFR 345.52 - Premium pay.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Premium pay. 345.52 Section 345.52 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.52 Premium pay. Payment of premium pay to...

  2. 28 CFR 345.52 - Premium pay.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Premium pay. 345.52 Section 345.52 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.52 Premium pay. Payment of premium pay to...

  3. 28 CFR 345.52 - Premium pay.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Premium pay. 345.52 Section 345.52 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.52 Premium pay. Payment of premium pay to...

  4. 28 CFR 345.52 - Premium pay.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Premium pay. 345.52 Section 345.52 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.52 Premium pay. Payment of premium pay to...

  5. A Primer on Privatization.

    ERIC Educational Resources Information Center

    Menell, Seth J.; Phelps, Richard P.

    This paper provides a detailed examination of "contracting," a type of privatization, and is intended to clarify the issues surrounding decisions to privatize public services. Privatization introduces competition among market participants as a means of generating revenue, spurring development of an industry, and/or improving the quality of…

  6. Privatization in Education.

    ERIC Educational Resources Information Center

    Rehfuss, John

    1995-01-01

    Privatization calls for substantially trimming the scope and breadth of government services, replacing them with private or other nongovernmental operators. The attraction of privatization is reduced costs and increased management flexibility. To date, the arrangement has received substantial support from students and parents in situations that…

  7. Long-term care: The public role and private initiatives

    PubMed Central

    Burke, Thomas R.

    1988-01-01

    The ongoing effort of the U.S. Department of Health and Human Services to identify private financing mechanisms that can effectively assist the rapidly growing population of older persons in paying for long-term care expenses is discussed in this article. The focus on private strategies stems from the recognition that Federal and State sectors already pay almost one-half of all long-term care expenses, the proclivity of liberalized financing structures to raise total costs, and the tendency of public financing to dampen choice, flexibility, and access to care. In view of the improved economic situation of most older persons in our Nation today, the potential for market development of private financing options is thought to be excellent, particularly the market for long-term care insurance. PMID:10312961

  8. Social and private benefits of assisted reproductive technology: a national survey-based evaluation in Israel.

    PubMed

    Gonen, Limor Dina

    2016-01-01

    The objective of this paper was to measure the private and social benefits resulting from technological advances in fertility treatment. An empirical model investigates the willingness-to-pay (WTP) for advances in the medical technology of in vitro fertilization (IVF) among the general public and among IVF patients in Israel. The empirical model's findings demonstrate that IVF patients and the general public value medical technology advances and have a positive WTP for it. The average WTP for IVF technology advances, among IVF patients, is US $3116.9 whereas for the general public it is US$2284.4. Available evidence suggests that advances in medical technology have delivered substantial benefits and appear to have contributed to improved wellbeing.

  9. 29 CFR 778.219 - Pay for foregoing holidays and vacations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... he is owed an additional $25 as overtime premium (additional half-time) for the 10 hours in excess of... sum as vacation pay. This is a matter of private contract between the parties who may agree that... additional $25 as overtime premium (additional half-time) for the 10 hours in excess of 40. His regular...

  10. How much is a child worth? Providers' and patients' views and responses concerning ethical and policy challenges in paying for ART.

    PubMed

    Klitzman, Robert

    2017-01-01

    Infertility treatments remain expensive and in many countries are covered by little, if any, insurance, raising critical questions concerning how patients and providers view and make decisions regarding these challenges. In-depth semi-structured interviews of approximately 1 hour were conducted with 37 IVF providers and 10 patients (17 physicians, 10 other providers and 10 patients), and were systematically analyzed. These data suggest current insurance policies and legislation pose critical ethical and logistical challenges for both patients and providers. These individuals face multiple uncertainties about costs and insurance, related to unclear causes of fertility, treatment length, costs and outcomes, and odds that insurers will cover expenses. Insurers frequently decline to agree to reimbursement beforehand, and decide only afterwards, case-by-case, generating stress. Patients and providers thus may not be able to predict how best to allocate limited resources. Providers may advocate for patients, but are usually unsuccessful. Patients may adopt several strategies: e.g., moving/seeking treatment elsewhere, switching or feeling "stuck" in jobs because of insurance, seeking "free" medications, going into debt, or using funds intended for other purposes. Patients do not perceive and respond to resource limitations as fixed phenomena-i.e., patients do not see treatment simply as "affordable" or not. Rather, patients face quandaries of how much to keep spending-how much a child is worth-and are forced to make complex risk/benefit calculations. Couples can disagree, straining relationships. In sum, these data, the first to explore how providers and patients struggle, view, and make decisions regarding limited insurance and resources for infertility, raise several critical ethical and policy issues. These data suggest that individuals have difficulty translating profoundly life-altering, deeply personal quests for meaning and fulfillment into purely economic terms

  11. HIGH BODY MASS INDEX AMONG PATIENTS UNDERGOING HEMATOPOIETIC STEM CELL TRANSPLANTATION: RESULTS OF A CROSS-SECTIONAL EVALUATION OF NUTRITIONAL STATUS IN A PRIVATE HOSPITAL.

    PubMed

    Pereira, Andrea Z; Victor, Elivane S; Vidal Campregher, Paulo; Piovacari, Silvia M F; Bernardo Barban, Juliana S; Pedreira, Wilson L; Hamerschlak, Nelson

    2015-12-01

    nutritional status before hematopoietic stem cell transplantation (HSCT) affects prognosis: better nourished patients have shorter time to engraftment, while malnutrition is associated with increase of mortality rates, complications, medical costs, poor quality of life and hospitalization stay. Furthermore, underweight patients have increased risk of death in the early post- HSCT period, and non-relapse mortality is greater for those who are extremely underweight, overweight and obese. Obesity is associated with treatment-related toxicity, higher incidence of grade II-IV acute graft-versus- host disease (GVHD), infections and mortality. The objective of this study was to investigate the nutritional status of patients undergoing HSCT between 2007-2013 in a private hospital, by calculating the body mass index (BMI), to verify the prevalence of any nutritional imbalances, especially obesity. in this retrospective study, based on medical records, we analyzed data from all patients with malignant and nonmalignant diseases who underwent HSCT from January 2007 to February 2014 in the Hematology- Oncology and Bone Marrow Transplantation Center at a large, tertiary referral center in Brazil. a total of 257 cases were treated in the period and analyzed, of which 79% were aged up to 65 years old. Among these, 56% were overweight or obese. We observed a higher prevalence of obesity in elderly patients (P < 0.001). The mean BMI of the total sample was 26.4 kg/m2. BMI was significantly different between genders, with higher prevalence of overweight among men (P < 0.001). differently from other studies, our investigation has shown low rates of underweight and more overweight and obesity rates in men and elderly patients undergoing HSCT. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  12. Clinical characteristics of molluscum contagiosum in children in a private dermatology practice in the greater Paris area, France: a prospective study in 661 patients.

    PubMed

    Osio, A; Deslandes, E; Saada, V; Morel, P; Guibal, F

    2011-01-01

    Series regarding the clinical characteristics of molluscum contagiosum (MC) are retrospective and concern small defined populations seen in a hospital setting. We prospectively studied patients under 15 years of age with MC seen in 25 private dermatology practices in the greater Paris area during 1 year. Six hundred fifty patients were included. The mean age was 6 years. Of the patients, 30.5% had had MC in the past, 53% had 5-20 MC, 43% had a history of atopic dermatitis (AD), 5% were using topical steroids, 25.5% had coexistent AD, 13% had giant MC (>5 mm), 21% had inflammatory MC, and 19% had MC surrounded by eczema. Bathing with siblings was associated with a higher number of MC. A history of AD was associated with the presence of MC surrounded by eczema. The use of topical steroids was associated with a higher risk of relapse. There was no relation between environmental factors (MC in surrounding people, going to the swimming pool, sports practice) and the number of lesions or between environmental factors and the number of recurrences. Atypical lesions are frequent. Bathing with siblings is associated with a higher number of MC. Topical steroid use increases the risk of relapses. AD prevalence is higher than in the general population. Copyright © 2011 S. Karger AG, Basel.

  13. Patient Insurance Profiles: A Tertiary Care Compared to Three Freestanding Emergency Departments.

    PubMed

    Simon, Erin L; Griffin, Gregory; Orlik, Kseniya; Jia, Zhenyu; Hayslip, Dave; Kobe, Daniel; Jouriles, Nicholas

    2016-10-01

    It has been speculated that freestanding emergency departments (FEDs) draw more affluent, better-insured patients away from urban hospital EDs. It is believed that this leaves urban hospital-based EDs less financially secure. We examined whether the distribution of patients with four types of insurance (self-pay, Medicaid, Medicare, and private) at the main ED changed after opening three affiliated FEDs, and whether the insurance type distribution was different between main ED and FEDs and between individual FEDs. A retrospective analysis of insurance status of all patients presenting to our EDs from July 2006 through August 2013. Insurance was divided into self-pay, Medicare, Medicaid, and private insurance across three time periods, which reflect the sequential opening of each FED. Insurance types for each facility were compared for individual time periods and across time periods. χ(2) was used to analyze the data. In the three studied time frames (periods B, C, and D), there were less privately insured patients and more self-pay, Medicaid, and Medicare patients at the main than at each FED (p < 0.001). Insurance types were significantly different between each of the three FEDs and the main ED (p < 0.001) and between each of the three FEDs (p < 0.001). There were less privately insured patients and more self-pay, Medicaid, and Medicare patients at the main ED compared to the FEDs. Privately insured patients decreased at both the FEDs and main ED during the study. Insurance distribution was significantly different between the main ED, and three FEDs, and between individual FEDs. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Audiology Assistants in Private Practice.

    PubMed

    Hamill, Teri A; Andrews, Julia P

    2016-11-01

    Using audiology assistants allows a practice to meet the expected increase in patient demand in a cost-effective manner, without compromise to quality of patient care. Assistants are particularly valuable in private practice settings that have an emphasis in amplification, as many of the tasks involved do not require the unique skills of the doctor of audiology. Regulatory considerations, methods of training, and scope of practice of the assistant are discussed.

  15. Trends of Anti-Vascular Endothelial Growth Factor Use in Ophthalmology Among Privately Insured and Medicare Advantage Patients.

    PubMed

    Parikh, Ravi; Ross, Joseph S; Sangaralingham, Lindsey R; Adelman, Ron A; Shah, Nilay D; Barkmeier, Andrew J

    2017-03-01

    To characterize the first 10 years of intravitreal anti-vascular endothelial growth factor (VEGF) medication use for ophthalmic disease, including bevacizumab, ranibizumab, and aflibercept. A retrospective cohort study using administrative claims data from January 1, 2006 to December 31, 2015. Total of 124 835 patients 18 years of age or over in the United States. OptumLabs Data Warehouse, which includes administrative claims data for over 100 million commercially insured and Medicare Advantage individuals, was used to identify patients receiving intravitreal anti-VEGF injections based on Current Procedural Terminology codes. Total and annual numbers of intravitreal anti-VEGF injections, as well as injections per 1000 enrolled patients per general category of ophthalmic disease, overall and for each available medication. There were 959 945 anti-VEGF injections among 124 835 patients from 2006 to 2015. Among all injections, 64.6% were of bevacizumab, 22.0% ranibizumab, and 13.4% aflibercept; 62.7% were performed to treat age-related macular degeneration (AMD), 16.1% to treat diabetic retinal diseases (including 0.9% of all injections that were for proliferative diabetic retinopathy), 8.3% to treat retinal vein occlusions, and 12.9% for all other uses. Use of bevacizumab and ranibizumab for AMD plateaued as of 2011/2012 and decreased thereafter (in 2006, 58.8 and 35.3 injections/1000 AMD patients, respectively; in 2015, 294.4 and 100.7 injections/1000), whereas use of aflibercept increased (1.1 injections/1000 AMD patients in 2011 to 183.0 injections/1000 in 2015). Bevacizumab use increased each year for diabetic retinal disease (2.4 injections/1000 patients with diabetic retinal disease in 2009 to 13.6 per 1000 in 2015) while that of ranibizumab initially increased significantly and then declined after 2014 (0.1 in 2009 to 4.0 in 2015). Aflibercept use increased each year in patients with diabetic retinal diseases and retinal vein occlusions (both <0.1 per 1000

  16. Pay modernisation and healthcare governance.

    PubMed

    Benton, David C

    Policies interact and have direct and indirect consequences resulting in both short-term and longer-term effects on the working lives of professionals, the care they offer and the education needed by future generations of staff. This article explores how pay modernisation could result in benefits and risks for corporate, clinical and staff governance. It is argued that if pay modernisation as a major enabler of service redesign is to succeed then far greater understanding of how various policies interact and their potential consequences is required.

  17. The Monetary Cost of Sexual Assault to Privately Insured US Women in 2013.

    PubMed

    Tennessee, Ashley M; Bradham, Tamala S; White, Brandi M; Simpson, Kit N

    2017-06-01

    To determine whether privately insured female rape victims were billed for charges associated with a specific rape in the United States. We examined 2013 de-identified patient data from Truven Analytics Health MarketScan database for an assault that occurred by using International Classification of Diseases, Ninth Revision, code E960.1. Analysis of insurance providers' payment patterns for 1355 incident events to female victims aged between 16 and 61 years revealed that victims remit, on average, 14% or $948 of the rape cost, whereas insurance providers pay 86% or $5789 of the total cost. Hospital billing procedures for privately insured victims of rape across the United States are not separate from billing procedures for privately insured nonrape patients. This standardized procedure leads hospitals to bill victims directly for services not paid under the victims' insurance policy. Public Health Implications. The Violence Against Women Act (passed in 1994, reauthorized in 2000, 2005, and 2013) must be amended to mandate that all costs incurred because of rape are not passed on to the victim.

  18. Hermeneutic phenomenological interpretations of patients with head and neck neoplasm experiences living with radiation-induced xerostomia: the price to pay?

    PubMed

    Charalambous, Andreas

    2014-10-01

    Patients with head and neck neoplasms often experience a number of persistent treatment related symptoms including xerostomia. The impact of xerostomia can be profound and wearing on the patients, hence negatively influencing their quality of life. The purpose of this study was to explore the in-depth experiences of the patients living with radiation-induced xerostomia. This was a hermeneutic phenomenological study inspired by the Philosophy of Paul Ricoeur. Research data were retrieved with individual narratives from 15 patients diagnosed with head and neck neoplasm that underwent radiotherapy. Interpretation proceeded through three phases: naïve reading, structural analysis and comprehensive understanding. Five themes consisting of ten sub-themes emerged from the narratives reflecting on the patients' lived experiences. The themes were "suffering of the body", "suffering of the person's world", "being helpless against xerostomia", "suffering of the mind" and "being alone". The comprehensive understanding disclosed new possibilities for being-in-the world in relation to living with xerostomia. The precedent consideration of xerostomia mainly as a physical side-effect of radiotherapy was outweighed by the social and psychological effects revealed by this study. These xerostomia's effects are inflicted on the patients with an obvious reflection on their perceived quality of life. The findings call upon a shift towards acknowledging the severity of xerostomia and the need to care for these patients holistically. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. 1997 JEMS salary survey. Long hours, modest pay.

    PubMed

    Mayfield, T Y

    1997-11-01

    As in years past, the 1997 Jems salary survey tracks trends in compensation and career development in both the public and private sectors. This year, we've included some information about volunteer agencies as well. While the survey serves as a barometer for EMS wages and benefits, relying solely on the absolute numbers may create an incomplete picture because of changes in the number of respondents, organizational characteristics and other variables. However, combined with other industry data, the annual salary survey is a useful tool for comparing your pay with that of your peers. The survey should also prove useful to organizations and labor groups planning and preparing competitive compensation packages.

  20. Willingness to pay for obesity pharmacotherapy.

    PubMed

    Doyle, Scott; Lloyd, Andrew; Birt, Julie; Curtis, Bradley; Ali, Shehzad; Godbey, Kecia; Sierra-Johnson, Justo; Halford, Jason C G

    2012-10-01

    Several treatments for obesity have received regulatory approval, but health insurers and other payers typically refuse to support access to them. Thus, patients are left to bear significant out-of-pocket costs for obesity pharmacotherapy. This study aimed to assess preferences and willingness to pay (WTP) for obesity medications among people seeking weight loss in the United States and United Kingdom. An online survey was developed based on literature review, clinician interviews, and profiles of available therapies. Participants indicated their preference for hypothetical treatments which varied by seven attributes: percentage of weight loss, long-term health risk reduction, time to noticeable weight loss, delivery mode, side effects, lifestyle modification, and cost; 502 obese participants completed the survey (mean BMI 37.12 kg/m(2) (±4.63); 73.5% female; 47.7 (±12.9) years of age). The participants deemed weight loss of >21 kg (United Kingdom) and >28 kg (United State) as "acceptable". All treatment attributes were important (P < 0.001) except "time to noticeable weight loss." The survey found that percentage weight loss was the most important factor for patients and a reduction in long-term health risk was relatively less important. Patients were willing to pay £6.51/$10.49 per month per percentage point of weight loss that a pharmacotherapy could provide. Participants also highly valued therapies that did not require substantial lifestyle modifications and were willing to pay £17.78/$30.77 more per month for a one-pill-per-day treatment vs. a weekly injectable. Participants placed a high value on weight loss and avoiding changes to their lifestyle, and less value on reducing long-term risks to health.

  1. Disaster preparedness pays off.

    PubMed

    Reed, M K

    1998-06-01

    Last spring, the Red River Valley of North Dakota and Minnesota was devastated by an unprecedented flood. Flooding caused foundations to collapse and houses to float away or become severely damaged by the raging, sewage-filled water. The river displaced people from their homes, and caused significant disruption of services including water, power, and medical care for 18 days. Find out how a medical contingency plan enabled staff members at the only trauma center and the largest clinic in the region to evacuate safely and effectively nearly 1,000 patients and senior residents in 36 hours, while setting up critical services across the region to care for the 50,000 displaced residents of the flood disaster.

  2. Automating The Work at The Skin and Allergy Private Clinic : A Case Study on Using an Imaging Database to Manage Patients Records

    NASA Astrophysics Data System (ADS)

    Alghalayini, Mohammad Abdulrahman

    Today, many institutions and organizations are facing serious problem due to the tremendously increasing size of documents, and this problem is further triggering the storage and retrieval problems due to the continuously growing space and efficiency requirements. This problem is becoming more complex with time and the increase in the size and number of documents in an organization; therefore, there is a world wide growing demand to address this problem. This demand and challenge can be met by converting the tremendous amount of paper documents to images using a process to enable specialized document imaging people to select the most suitable image type and scanning resolution to use when there is a need for storing documents images. This documents management process, if applied, attempts to solve the problem of the image storage type and size to some extent. In this paper, we present a case study resembling an applied process to manage the registration of new patients in a private clinic and to optimize following up the registered patients after having their information records stored in an imaging database system; therefore, through this automation approach, we optimize the work process and maximize the efficiency of the Skin and Allergy Clinic tasks.

  3. 5 CFR 550.1409 - Inapplicability of premium pay and aggregate pay caps.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Compensatory Time Off for Travel § 550.1409 Inapplicability of premium pay and aggregate pay caps. Accrued compensatory time off under this subpart is...

  4. 5 CFR 550.1409 - Inapplicability of premium pay and aggregate pay caps.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Compensatory Time Off for Travel § 550.1409 Inapplicability of premium pay and aggregate pay caps. Accrued compensatory time off under this subpart is...

  5. 5 CFR 550.1409 - Inapplicability of premium pay and aggregate pay caps.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Compensatory Time Off for Travel § 550.1409 Inapplicability of premium pay and aggregate pay caps. Accrued compensatory time off under this subpart is...

  6. 5 CFR 550.1409 - Inapplicability of premium pay and aggregate pay caps.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Compensatory Time Off for Travel § 550.1409 Inapplicability of premium pay and aggregate pay caps. Accrued compensatory time off under this subpart is...

  7. 5 CFR 550.1409 - Inapplicability of premium pay and aggregate pay caps.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Compensatory Time Off for Travel § 550.1409 Inapplicability of premium pay and aggregate pay caps. Accrued compensatory time off under this subpart is...

  8. Merit Pay: The Federal Government’s Pay-for-Performance Experience

    DTIC Science & Technology

    1983-06-01

    Government’s experience with pay- for-performance, discusses the probable effectiveness of ’merit pay’ as it now stands, and recommends specific actions for more effective performance-based pay management in the public sector.

  9. The Problem with Performance Pay

    ERIC Educational Resources Information Center

    Gratz, Donald B.

    2009-01-01

    Although today's performance pay plans take many forms, the most commonly proposed version--in which teachers are rewarded on the basis of their students' standardized test scores--flows from flawed logic and several troublesome assumptions: that teachers lack motivation and supposedly need financial awards to give students what they need; that…

  10. The Problem with Performance Pay

    ERIC Educational Resources Information Center

    Gratz, Donald B.

    2009-01-01

    Although today's performance pay plans take many forms, the most commonly proposed version--in which teachers are rewarded on the basis of their students' standardized test scores--flows from flawed logic and several troublesome assumptions: that teachers lack motivation and supposedly need financial awards to give students what they need; that…

  11. Performance Pay Path to Improvement

    ERIC Educational Resources Information Center

    Gratz, Donald B.

    2011-01-01

    The primary goal of performance pay for the past decade has been higher test scores, and the most prominent strategy has been to increase teacher performance through financial incentives. If teachers are rewarded for success, according to this logic, they will try harder. If they try harder, more children will achieve higher test scores. The…

  12. How Universities Pay Their Presidents

    ERIC Educational Resources Information Center

    Langbert, Mitchell

    2006-01-01

    Statistics show that university presidents at nondenominational and public institutions in the north make a lot more money. Presidents generally also seem to be rewarded for increasing the spending per student. Such indices of quality as "U.S. News" ranking and high SAT scores do relate to presidential pay, but not robustly, and Mitchell Langbert…

  13. Pay for Performance: Whose Performance?

    ERIC Educational Resources Information Center

    Tienken, Christopher H.

    2011-01-01

    Education reform proposals are not in short supply. Recent issues of the "Kappa Delta Pi Record" examined two of these: Common Core State Standards (Winter 2011) and Charter Schools (Spring 2011). Teacher pay for performance is another policy gaining traction in state legislatures and at the federal level. The Race to the Top (RTTT)…

  14. Performance Pay Path to Improvement

    ERIC Educational Resources Information Center

    Gratz, Donald B.

    2011-01-01

    The primary goal of performance pay for the past decade has been higher test scores, and the most prominent strategy has been to increase teacher performance through financial incentives. If teachers are rewarded for success, according to this logic, they will try harder. If they try harder, more children will achieve higher test scores. The…

  15. History of Pay Equity Studies.

    ERIC Educational Resources Information Center

    Barbezat, Debra A.

    2002-01-01

    Traces the evolution of salary-equity studies over time, and how the findings have changed with regard to pay differences by gender and race/ethnicity. Reviews the literature on salary equity for both faculty and nonfaculty academic employees. (EV)

  16. Pay for Performance: Whose Performance?

    ERIC Educational Resources Information Center

    Tienken, Christopher H.

    2011-01-01

    Education reform proposals are not in short supply. Recent issues of the "Kappa Delta Pi Record" examined two of these: Common Core State Standards (Winter 2011) and Charter Schools (Spring 2011). Teacher pay for performance is another policy gaining traction in state legislatures and at the federal level. The Race to the Top (RTTT)…

  17. Paying for health.

    PubMed Central

    Black, D

    1991-01-01

    Health care systems, irrespective of how they are financed, present the paradox that to some observers they appear as a major component of social benefits, while to other observers they seem both excessively costly and limited in their effectiveness. These differing perceptions may be explained in part by the diversity of the determinants of health and disease, only some of which are amenable to those preventive or therapeutic measures encompassed in a health care system--the majority of determinants being genetic, societal, or else uninfluenced by those interventions at present available within a health service. The share of national resources which should be devoted to health care, and the method of raising resources, are primarily matters for political decision; but a national system has advantages both of economy and of comprehensiveness. But when it comes to allocation of resources within the established health budget, the knowledge and skills of health professionals are essential to informed decision-making. The possibilities depend critically on the 'state of the art' at a given time, as is illustrated by the radical changes over time in what could be done for patients with renal failure; and health professionals are likely to be most aware of current options, and of how to choose between them. More speculatively, they are also less likely to confuse the attitudes appropriate to providing a service with those required to run a business. PMID:1941951

  18. 38 CFR 1.514a - Disclosure to private psychologists.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... psychologists. 1.514a Section 1.514a Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... Disclosure to private psychologists. When a beneficiary elects to obtain therapy or analysis as a private patient from a private psychologist, such information in the medical record as may be pertinent may...

  19. Pay Equity Act (No. 34 of 1987), 29 June 1987.

    PubMed

    1987-01-01

    This document contains major provisions of Ontario, Canada's 1987 Pay Equity Act. The Act seeks to redress systemic gender discrimination in compensation for work performed by employees in "female job classes" and applies to all private sector employers in Ontario with 10 or more employees, all public sector employers, and the employees of applicable employers. The Act continues to apply even if an employer subsequently reduces the number of employees below 10. The Act calls for identification of systemic gender discrimination in compensation through comparisons between female job classes and male job classes in terms of compensation and value of work performed, which is a composite of skill, effort, and responsibility normally required. Pay equity is deemed achieved when the job rate for the female job class is at least equal to the rate for a male job class in the same establishment. If there is no male job class to use for comparison, pay equity is achieved when the female job rate is at least equal to the job rate of a male job class in the same establishment that, at the time of comparison, had a higher job rate while performing work of lower value than the female job class. Differences in compensation between a female and a male job class are allowed if they result from a formal seniority system that does not discriminate on basis of gender, a temporary training or development assignment equally available to males and females, a specified merit compensation plan, actions taken as the result of a gender-neutral reevaluation process, or a skills shortage leading to a temporary inflation in compensation. Pay equity will not be achieved by reducing any employee's compensation. The Act establishes a Pay Equity Commission to oversee implementation.

  20. Future Of Privatized Warfare

    DTIC Science & Technology

    2016-05-26

    explanations for the recent growth of private military companies (PMCs). This study fills this void by defining the logic of privatized warfare, those... Companies , PMCs, State-Society Relationship, Evolution of the Nation- State and Warfare 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18...future in the United States. Current literature is nearly devoid of theoretical explanations for the recent growth of private military companies

  1. Les manifestations cutanées chez les patients hémodialysés chroniques dans un pays en voie de développement

    PubMed Central

    Coulibaly, Gérard; Korsaga-Somé, Nina; Fomena, Dorisse Fernade Yongué; Nagalo, Yacouba; Karambiri, Adama Roger; Bassolet, Alban; Kafando, Hyacinthe; Traoré, Adama; Lengani, Adama

    2016-01-01

    Le but de cette étude était deconnaître les affections cutanées les plus fréquentes chez les patients hémodialysés chroniques du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO) de Ouagadougou. L’étude, de type transversal descriptif, menée du 15 Septembre au 31 Décembre 2014, s'estdéroulée au CHU-YO. Elle concernait les patients qui avaient au moins trois mois d'ancienneté en hémodialyse chronique. La fréquence des séances d'hémodialyse était d'une tous les cinq jours. Le seuil de signification des tests statistiques était défini pour une probabilité p ≤ 0,05. Quatre-vingt-quinze patients (61,1% d'hommes et 38,9% de femmes), de moyenne d’âge 42,1 ans participaient à l’étude. La durée moyenne en hémodialyse était de 31,9 mois. Le taux de réalisation des analyses biologiques variait de 7,4 à 85,3%. Quatre-vingt patients (85,3%) avaient au moins une manifestation cutanée. La xérose cutanée (67,4%), le prurit (45,3%), et l'hyperpigmentation (23,2%) étaient les plus fréquentes des manifestations cutanées pouvant être spécifiques de l'hémodialyse. L'hypomélanose en gouttes (11,6%), le prurigo (11,6%) et la folliculite (8,4%) étaient les principales manifestations cutanées non spécifiques. L'atteinte cutanée était fréquente mais ne semblait pas liée à l'ancienneté en hémodialyse. Les mauvaises conditions d'hémodialyse et l'environnement sec et chaud à Ouagadougou, ont pu favoriser ces atteintes, en particulier la xérose et le prurit. Une meilleure subvention des soins de santé contribuerait à réduire la prévalence des maladies cutanées et à améliorer la qualité de vie de nos patients hémodialysés chroniques. PMID:27642449

  2. Merit Pay: Challenge of the Decade.

    ERIC Educational Resources Information Center

    Cramer, Jerome

    1983-01-01

    Discusses the issue of merit pay, its becoming a political issue for national politicians, and reactions of teacher union leaders. Examples illustrating individual merit pay systems in five school districts are presented. (MBR)

  3. Merit Pay: Challenge of the Decade.

    ERIC Educational Resources Information Center

    Cramer, Jerome

    1983-01-01

    Discusses the issue of merit pay, its becoming a political issue for national politicians, and reactions of teacher union leaders. Examples illustrating individual merit pay systems in five school districts are presented. (MBR)

  4. Patient outcomes and evidence-based medicine in a preferred provider organization setting: a six-year evaluation of a physician pay-for-performance program.

    PubMed

    Gilmore, Amanda S; Zhao, Yingxu; Kang, Ning; Ryskina, Kira L; Legorreta, Antonio P; Taira, Deborah A; Chung, Richard S

    2007-12-01

    To determine whether health plan members who saw physicians participating in a quality-based incentive program in a preferred provider organization (PPO) setting received recommended care over time compared with patients who saw physicians who did not participate in the incentive program, as per 11 evidence-based quality indicators. Administrative claims data for PPO members of a large nonprofit health plan in Hawaii collected over a 6-year period after the program was first implemented. An observational study allowing for multiple member records within and across years. Levels of recommended care received by members who visited physicians who did or did not participate in a quality incentive program were compared, after controlling for other member characteristics and the member's total number of annual office visits. Data for all PPO enrollees eligible for at least one of the 11 quality indicators in at least 1 year were collected. We found a consistent, positive association between having seen only program-participating providers and receiving recommended care for all 6 years with odds ratios ranging from 1.06 to 1.27 (95 percent confidence interval: 1.03-1.08, 1.09-1.40). Physician reimbursement models built upon evidence-based quality of care metrics may positively affect whether or not a patient receives high quality, recommended care.

  5. Patient Outcomes and Evidence-Based Medicine in a Preferred Provider Organization Setting: A Six-Year Evaluation of a Physician Pay-for-Performance Program

    PubMed Central

    Gilmore, Amanda S; Zhao, Yingxu; Kang, Ning; Ryskina, Kira L; Legorreta, Antonio P; Taira, Deborah A; Chung, Richard S

    2007-01-01

    Objective To determine whether health plan members who saw physicians participating in a quality-based incentive program in a preferred provider organization (PPO) setting received recommended care over time compared with patients who saw physicians who did not participate in the incentive program, as per 11 evidence-based quality indicators. Data Sources/Study Setting Administrative claims data for PPO members of a large nonprofit health plan in Hawaii collected over a 6-year period after the program was first implemented. Study Design An observational study allowing for multiple member records within and across years. Levels of recommended care received by members who visited physicians who did or did not participate in a quality incentive program were compared, after controlling for other member characteristics and the member's total number of annual office visits. Data Collection Data for all PPO enrollees eligible for at least one of the 11 quality indicators in at least 1 year were collected. Principal Findings We found a consistent, positive association between having seen only program-participating providers and receiving recommended care for all 6 years with odds ratios ranging from 1.06 to 1.27 (95 percent confidence interval: 1.03–1.08, 1.09–1.40). Conclusions Physician reimbursement models built upon evidence-based quality of care metrics may positively affect whether or not a patient receives high quality, recommended care. PMID:17995557

  6. Private expenditure and the role of private health insurance in Greece: status quo and future trends.

    PubMed

    Siskou, Olga; Kaitelidou, Daphne; Economou, Charalampos; Kostagiolas, Peter; Liaropoulos, Lycourgos

    2009-10-01

    The health care system in Greece is financed in almost equal proportions by public and private sources. Private expenditure, consists mostly of out-of-pocket and under-the-table payments. Such payments strongly suggest dissatisfaction with the public system, due to under financing during the last 25 years. This gap has been filled rapidly by the private sector. From this point of view, one might suggest that the flourishing development of private provision may lead in turn to a corresponding growth in private health insurance (PHI). This paper aims to examine the role of PHI in Greece, to identify the factors influencing its development, and to make some suggestions about future policies and trends. In the decade of 1985-1995 PHI show increasing activity, reflecting the intention of some citizens to seek health insurance solutions in the form of supplementary cover in order to ensure faster access, better quality of services, and increased consumer choice. The benefits include programs covering hospital expenses, cash benefits, outpatient care expenses, disability income insurance, as well as limited managed care programs. However, despite recent interest, PHI coverage remains low in Greece compared to other EU countries. Economic, social and cultural factors such as low average household income, high unemployment, obligatory and full coverage by social insurance, lead to reluctance to pay for second-tier insurance. Instead, there is a preference to pay a doctor or hospital directly even in the form of under-the-table payments (which are remarkably high in Greece), when the need arises. There are also factors endogenous to the PHI industry, related to market policies, low organisational capacity, cream skimming, and the absence of insurance products meeting consumer requirements, which explain the relatively low state of development of PHI in Greece.

  7. Health care rationing: doing it better in public and private health care systems.

    PubMed

    Maynard, Alan

    2013-12-01

    All public and private health care systems ration patient access to care. The private sector rations access to consumers who are willing and able to pay. The poor and disadvantaged have limited access to care and inadequate income protection. In public health systems, care is provided on the basis of "need," that is, the comparative cost-effectiveness of competing treatments. This results in patients being deprived of care if treatments are clinically effective but not cost-effective. Rationing health care is ubiquitous. In both types of systems physicians have discretion to deviate from these rationing principles. This has created inefficient variations in clinical practice. These are difficult to resolve because of the lack of transparency of costs and patient outcomes and perverse incentives. The failure to remove universal inefficiency in a period of economic austerity sharpens awareness of rationing. Hopes of greater efficiency are largely faith based. Competing ideologues from the left and the right continue to offer evidence for free solutions to long-established problems. Inefficiency is unethical, as it deprives potential patients of care from which they could benefit. Reducing inefficiency is essential but difficult. The universal challenge is to decide who shall live when all will die in a world of scarce resources.

  8. 5 CFR 534.503 - Pay setting.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.503 Pay setting. (a) Each agency with... (5) The management controls that will be applied to assure compliance with the procedures and a...

  9. Social Comparison of Pay and Inequity Theory.

    ERIC Educational Resources Information Center

    Judd, Ben

    Inequity theory differs from social exchange theory in its analysis of a worker's reaction to pay by asserting that effects on work performance caused by high or low pay are due to social comparison of fairness rather than principles of direct exchange, such as reciprocity and power. The present experiment held piece-rate pay constant at two…

  10. Why doesn't performance pay work?

    PubMed

    Griffin, R P

    1992-01-01

    The NHS is about to embark on the widescale introduction of performance-related pay. A number of recent studies have seriously questioned the efficacy of merit pay. Utilizing the expectancy theory of motivation, explains why performance pay is unlike to motivate NHS staff.

  11. Fisherman expectations and pay-lake profits

    Treesearch

    George H. Moeller; John Engelken; John Engelken

    1973-01-01

    Personal interviews with licensed fishermen in Central New York State were used to determine characteristics of fishermen who are willing to pay to fish. Willingness to pay was related to aspects of the fishing experience that most strongly influenced fishing enjoyment. Sixty-two percent of the respondents expressed a willingness to pay for a quality fishing experience...

  12. 20 CFR 218.27 - Vacation pay.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Vacation pay. 218.27 Section 218.27 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT ANNUITY BEGINNING AND... Beginning Date § 218.27 Vacation pay. (a) From railroad employer. Vacation pay may be credited to...

  13. Equal Pay for Work of Comparable Value.

    ERIC Educational Resources Information Center

    Mutari, Ellen; And Others

    1982-01-01

    Discusses occupational segregation and other barriers to equal job opportunities for women and examines two approaches toward correcting pay inequities: equal pay for equal work and equal pay for work of comparable value. Legal cases, job evaluation studies, and other steps toward comparable worth are described. A 64-item reference list is…

  14. 4 CFR 5.1 - Pay.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... fixed by the Comptroller General consistent with the principles that— (1) There be equal pay for work of substantially equal value. (2) Pay distinctions be maintained in keeping with work and performance distinctions... 4 Accounts 1 2010-01-01 2010-01-01 false Pay. 5.1 Section 5.1 Accounts GOVERNMENT...

  15. 5 CFR 534.503 - Pay setting.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Pay setting. 534.503 Section 534.503... Senior-Level and Scientific and Professional Positions § 534.503 Pay setting. (a) Each agency with positions subject to this subpart shall establish written procedures for setting the pay of incumbents...

  16. 5 CFR 534.503 - Pay setting.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Pay setting. 534.503 Section 534.503... Senior-Level and Scientific and Professional Positions § 534.503 Pay setting. (a) Each agency with positions subject to this subpart shall establish written procedures for setting the pay of incumbents...

  17. 5 CFR 534.503 - Pay setting.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Pay setting. 534.503 Section 534.503... Senior-Level and Scientific and Professional Positions § 534.503 Pay setting. (a) Each agency with positions subject to this subpart shall establish written procedures for setting the pay of incumbents...

  18. 5 CFR 534.503 - Pay setting.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Pay setting. 534.503 Section 534.503... Senior-Level and Scientific and Professional Positions § 534.503 Pay setting. (a) Each agency with positions subject to this subpart shall establish written procedures for setting the pay of incumbents...

  19. 28 CFR 345.51 - Inmate pay.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Inmate pay. 345.51 Section 345.51 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.51 Inmate pay. (a) Grade levels. Inmate...

  20. 28 CFR 345.56 - Vacation pay.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Vacation pay. 345.56 Section 345.56 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.56 Vacation pay. Inmate workers are granted...

  1. 28 CFR 345.57 - Administrative pay.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Administrative pay. 345.57 Section 345.57 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.57 Administrative pay. An inmate excused from...

  2. 28 CFR 345.56 - Vacation pay.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Vacation pay. 345.56 Section 345.56 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.56 Vacation pay. Inmate workers are granted...

  3. 28 CFR 345.51 - Inmate pay.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Inmate pay. 345.51 Section 345.51 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.51 Inmate pay. (a) Grade levels. Inmate...

  4. 28 CFR 345.55 - Longevity pay.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Longevity pay. 345.55 Section 345.55 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.55 Longevity pay. (a) Except as provided in...

  5. 28 CFR 345.58 - Holiday pay.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Holiday pay. 345.58 Section 345.58 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.58 Holiday pay. An inmate worker in FPI work...

  6. 28 CFR 345.55 - Longevity pay.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Longevity pay. 345.55 Section 345.55 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.55 Longevity pay. (a) Except as provided in...

  7. 28 CFR 345.51 - Inmate pay.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Inmate pay. 345.51 Section 345.51 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.51 Inmate pay. (a) Grade levels. Inmate...

  8. 28 CFR 345.60 - Training pay.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Training pay. 345.60 Section 345.60 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.60 Training pay. Inmates directed by the SOI...

  9. 28 CFR 345.51 - Inmate pay.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Inmate pay. 345.51 Section 345.51 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.51 Inmate pay. (a) Grade levels. Inmate...

  10. 28 CFR 345.56 - Vacation pay.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Vacation pay. 345.56 Section 345.56 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.56 Vacation pay. Inmate workers are granted...

  11. 28 CFR 345.58 - Holiday pay.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Holiday pay. 345.58 Section 345.58 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.58 Holiday pay. An inmate worker in FPI work...

  12. 28 CFR 345.57 - Administrative pay.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Administrative pay. 345.57 Section 345.57 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.57 Administrative pay. An inmate excused from...

  13. 28 CFR 345.57 - Administrative pay.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Administrative pay. 345.57 Section 345.57 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.57 Administrative pay. An inmate excused from...

  14. 28 CFR 345.56 - Vacation pay.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Vacation pay. 345.56 Section 345.56 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.56 Vacation pay. Inmate workers are granted...

  15. 28 CFR 345.55 - Longevity pay.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Longevity pay. 345.55 Section 345.55 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.55 Longevity pay. (a) Except as provided in...

  16. 28 CFR 345.57 - Administrative pay.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Administrative pay. 345.57 Section 345.57 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.57 Administrative pay. An inmate excused from...

  17. 28 CFR 345.60 - Training pay.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Training pay. 345.60 Section 345.60 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.60 Training pay. Inmates directed by the SOI...

  18. 28 CFR 345.58 - Holiday pay.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Holiday pay. 345.58 Section 345.58 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.58 Holiday pay. An inmate worker in FPI work...

  19. 28 CFR 345.51 - Inmate pay.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Inmate pay. 345.51 Section 345.51 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.51 Inmate pay. (a) Grade levels. Inmate...

  20. 28 CFR 345.58 - Holiday pay.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Holiday pay. 345.58 Section 345.58 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.58 Holiday pay. An inmate worker in FPI work...

  1. 28 CFR 345.55 - Longevity pay.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Longevity pay. 345.55 Section 345.55 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.55 Longevity pay. (a) Except as provided in...

  2. 28 CFR 345.58 - Holiday pay.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Holiday pay. 345.58 Section 345.58 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.58 Holiday pay. An inmate worker in FPI work...

  3. 28 CFR 345.57 - Administrative pay.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Administrative pay. 345.57 Section 345.57 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.57 Administrative pay. An inmate excused from...

  4. 28 CFR 345.56 - Vacation pay.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Vacation pay. 345.56 Section 345.56 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.56 Vacation pay. Inmate workers are granted...

  5. 28 CFR 345.60 - Training pay.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Training pay. 345.60 Section 345.60 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.60 Training pay. Inmates directed by the SOI...

  6. 28 CFR 345.60 - Training pay.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Training pay. 345.60 Section 345.60 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.60 Training pay. Inmates directed by the SOI...

  7. 28 CFR 345.55 - Longevity pay.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Longevity pay. 345.55 Section 345.55 Judicial Administration FEDERAL PRISON INDUSTRIES, INC., DEPARTMENT OF JUSTICE FEDERAL PRISON INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.55 Longevity pay. (a) Except as provided in...

  8. Public Values, Private Schools.

    ERIC Educational Resources Information Center

    Devins, Neal E.

    Controversy surrounding private education involves questions of compulsory education's role in inculcating values, how much alike public and private schools should be, and the duty of educational institutions to conform to constitutional norms. This book examines government regulation and resistance, legislative and judicial approaches, and issues…

  9. The Limits of Privatization.

    ERIC Educational Resources Information Center

    Starr, Paul

    Transferring public services and public assets to private ownership is not an entirely new idea. Governments at all levels in the United States have for years contracted out many services. However, under the recently coined label "privatization," such policies now come recommended as a more comprehensive approach to the problems of…

  10. Private Speech in Ballet

    ERIC Educational Resources Information Center

    Johnston, Dale

    2006-01-01

    Authoritarian teaching practices in ballet inhibit the use of private speech. This paper highlights the critical importance of private speech in the cognitive development of young ballet students, within what is largely a non-verbal art form. It draws upon research by Russian psychologist Lev Vygotsky and contemporary socioculturalists, to…

  11. Public Values, Private Schools.

    ERIC Educational Resources Information Center

    Devins, Neal E.

    Controversy surrounding private education involves questions of compulsory education's role in inculcating values, how much alike public and private schools should be, and the duty of educational institutions to conform to constitutional norms. This book examines government regulation and resistance, legislative and judicial approaches, and issues…

  12. Laboring through Privatization.

    ERIC Educational Resources Information Center

    Bushweller, Kevin

    1994-01-01

    Hiring private contractors to manage school support services, such as food, maintenance, and busing, is a growing trend. Companies such as Marriott Corp., ServiceMaster, ARA Services, and Laidlaw Transit report that school business is steadily increasing. Unions staunchly oppose privatization. This article balances advantages and disadvantages,…

  13. Women and Private Pensions.

    ERIC Educational Resources Information Center

    Benson, Helene A.

    This speech focuses on women and private pension plans, such as private pension coverage and smaller benefit amounts. Pension issues affecting women as employees include participation in plans, vesting, break-in service, benefit accruals, integration with Social Security, sex-based actuarial tables, portability, inflation, and individual…

  14. Private Speech in Ballet

    ERIC Educational Resources Information Center

    Johnston, Dale

    2006-01-01

    Authoritarian teaching practices in ballet inhibit the use of private speech. This paper highlights the critical importance of private speech in the cognitive development of young ballet students, within what is largely a non-verbal art form. It draws upon research by Russian psychologist Lev Vygotsky and contemporary socioculturalists, to…

  15. The Limits of Privatization.

    ERIC Educational Resources Information Center

    Starr, Paul

    Transferring public services and public assets to private ownership is not an entirely new idea. Governments at all levels in the United States have for years contracted out many services. However, under the recently coined label "privatization," such policies now come recommended as a more comprehensive approach to the problems of…

  16. Donating the Voucher: An Alternative Tax Treatment of Private School Enrollment. Research Briefs in Economic Policy, Number 1

    ERIC Educational Resources Information Center

    Samwick, Andrew

    2014-01-01

    In the United States, parents send about 10 percent of elementary and secondary school-age children to private schools, which through their accreditation meet the requirement that students receive an adequate education. By paying out of pocket for their children's private education, these families relieve a financial burden on local, state, and…

  17. Dialogue on private events

    PubMed Central

    Palmer, David C.; Eshleman, John; Brandon, Paul; Layng, T. V. Joe; McDonough, Christopher; Michael, Jack; Schoneberger, Ted; Stemmer, Nathan; Weitzman, Ray; Normand, Matthew

    2004-01-01

    In the fall of 2003, the authors corresponded on the topic of private events on the listserv of the Verbal Behavior Special Interest Group. Extracts from that correspondence raised questions about the role of response amplitude in determining units of analysis, whether private events can be investigated directly, and whether covert behavior differs from other behavior except in amplitude. Most participants took a cautious stance, noting not only conceptual pitfalls and empirical difficulties in the study of private events, but doubting the value of interpretive exercises about them. Others argued that despite such obstacles, in domains where experimental analyses cannot be done, interpretation of private events in the light of laboratory principles is the best that science can offer. One participant suggested that the notion that private events can be behavioral in nature be abandoned entirely; as an alternative, the phenomena should be reinterpreted only as physiological events. PMID:22477293

  18. Early Adoption of lnjectable Naltrexone for Alcohol-Use Disorders: Findings in the Private-Treatment Sector*

    PubMed Central

    Abraham, Amanda J.; Roman, Paul M.

    2010-01-01

    Objective: The U.S. substance-abuse treatment system has been slow to adopt medications for the treatment of alcohol-use disorders (AUDs). The objectives of this study are to (a) determine how the inherent characteristics of injectable naltrexone (i.e., relative advantage, complexity, trialability, observability, compatibility) shape organizational-level decisions to adopt the medication and (b) identify key predictors of adoption and barriers that impede adoption. Method: This study uses data from a nationally representative sample of 345 privately funded U.S. substance-abuse treatment programs to examine adoption (current use) of injectable naltrexone. Results: Sixteen percent of private treatment programs are early adopters of injectable naltrexone. Multivariate logistic regression models reveal that organizational size and percentage of patients paying with private insurance are significant predictors of adoption. The most salient predictor of adoption is innovation compatibility, measured by program use of other AUD pharmacotherapies. Barriers to adoption include cost, lack of access to prescribing physicians, and lack of knowledge about the medication. Injectable naltrexone, however, is addressing the patient compliance barrier, demonstrated by 70% of patients receiving at least 2 months of medication Conclusions: The adoption of AUD pharmacotherapies remains low, with only half of the sampled programs prescribing any AUD pharmacotherapies. Patterns of early adoption of injectable naltrexone are, however, promising. Results highlight innovation compatibility and relative advantage as explanations of organizational decisions to adopt injectable naltrexone. Future research will move beyond issues of adoption and provide a more detailed examination of the implementation process. PMID:20409441

  19. [The national union for private hospital oncology].

    PubMed

    Parmentier, Gérard

    2013-06-01

    In the French health system, social security is the same for both public and private hospitals regardless of their status. In terms of number of patients screened, diagnosed, or treated, independant medicine is the most important sector in the French oncology. The multitude of organizations representing private hospitals or independant oncologists, physicians, radiologists or pathologists have a common organization, the National Union for Private Hospital Oncology (UNHPC). It bases its action on two founding postulates to ensure the quality of the oncology practice : the medical and managerial cultures are complementary and should be articulated ; the quality of organizations is as important as professional competence.

  20. Self-pay markets in health care: consumer Nirvana or caveat emptor?

    PubMed

    Tu, Ha T; May, Jessica H

    2007-01-01

    As consumers face more incentives to make cost-conscious medical care decisions, some policymakers cite self-pay markets as models for consumer shopping. An analysis of the LASIK market revealed limited shopping overall, despite the fact that patients pay the full cost. For other self-pay procedures, consumers shop even less, for reasons ranging from urgency, to costs of obtaining price quotes, to quality concerns that prompt many consumers to rely on word-of-mouth recommendations. Given that consumer shopping is not prevalent in most self-pay markets, we expect the extent of shopping to be even more limited for many services covered by insurance.

  1. The spectrum of HIV infection in patients seen at a private hospital in Mexico City: 115 patients seen from 1984 to 1990.

    PubMed

    del Río-Chiriboga, C; Tellez-Gómez, I; Orzechowski-Rallo, A; Alanis-Ortega, A

    1996-01-01

    The objective of this study was to describe the epidemiology and clinical presentation of HIV infection among upper middle class patients in Mexico City. A retrospective review of outpatient and hospital records of all HIV-infected patients was accomplished by one of the authors between 1984 and 1990. A total of 115 patients were seen during the study period, 109 men and 6 women. One hundred and seven patients acquired HIV infection through sexual contact, six patients had HIV infection associated with blood transfusion and two were homosexual men who also had a history of intravenous drug use. The mean age of the patients was 36.2 years (range 13 - 65 years). CDC classification at presentation was predominantly stage IV (65%) with the most common AIDS associated diseases at presentation being wasting syndrome in 30 (42.2%), P. carinii pneumonia in 22 (30.9%), cytomegalovirus infection in 11 (15.5%), Cryptosporidium parvum diarrhea in 7 (9.8%), and Kaposi's sarcoma in 6 (8.4%). CD4+ T-lymphocyte cell counts at the time of HIV diagnosis were available in 87 patients (median = 150 cells/microliters; mean = 224 cells/microliters, SD +/- 219). Zidovudine was used in 37 patients after 1988 when it first became available in Mexico, in six patients the drug had to be discontinued because of serious hematologic toxicity. The average follow-up on zidovudine was 8.5 months. Similar age, gender, age distribution, risk categories and CDC classification at presentation was seen compared to other series reported from Mexico. However, the spectrum of opportunistic infections found were similar to that seen in the United States.

  2. Medicare Pays for End-of-Life Consults.

    PubMed

    Sorrel, Amy Lynn

    2016-06-01

    As of January, Medicare pays physicians for advance care planning as a separate service, a long-sought victory that promotes educating patients and physicians on the issue. The Centers for Medicare & Medicaid Services created two new payment codes that cover it as a separate service in physician practices and facilities, including hospitals.

  3. New activity-based funding model for Australian private sector overnight rehabilitation cases: the rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model.

    PubMed

    Hanning, Brian; Predl, Nicolle

    2015-09-01

    Traditional overnight rehabilitation payment models in the private sector are not based on a rigorous classification system and vary greatly between contracts with no consideration of patient complexity. The payment rates are not based on relative cost and the length-of-stay (LOS) point at which a reduced rate applies (step downs) varies markedly. The rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model (RAM), which has been in place for over 2 years in some private hospitals, bases payment on a rigorous classification system, relative cost and industry LOS. RAM is in the process of being rolled out more widely. This paper compares and contrasts RAM with traditional overnight rehabilitation payment models. It considers the advantages of RAM for hospitals and Australian Health Service Alliance. It also considers payment model changes in the context of maintaining industry consistency with Electronic Claims Lodgement and Information Processing System Environment (ECLIPSE) and health reform generally.

  4. Continuous interscalene analgesia for rotator cuff repair: a retrospective comparison of effectiveness and cost in 205 patients from a multi-provider private practice setting.

    PubMed

    Fredrickson, M J; Stewart, A W

    2008-11-01

    Several barriers exist to the routine use of continuous interscalene block (CISB) for postoperative analgesia following rotator cuff repair There is a perception that the technique is feasible only for single operators exposed to a high volume case load. The aim of this retrospective review was to compare the three commonly employed analgesic techniques following rotator cuff repair in a multi-provider setting. The techniques studied were CISB, combined single injection interscalene block with postoperative intermittent intra-articular local anaesthetic infiltration (SSISB/IA) and intermittent intra-articular only local anaesthetic infiltration (IA). The clinical records of 205 consecutive patients having open rotator cuff repair over an 18-month period in two private care facilities were reviewed. The primary outcome endpoint was total opioid/tramadol consumption during the period of an overnight hospital stay. The median total opioid and tramadol consumption (in intravenous mg equivalents of morphine) from admission to the post anaesthesia care unit until discharge from hospital was 5 mg in the CISB group and 10 mg for the SSISB/IA and IA groups (P < 0.0001). The proportion of subjects requiring more than one antiemetic for the same period was 1.9% in the CISB group, 16.4% for the SSISB/IA group and 36.1% for the IA group (P < 0.0001). Costs related to the analgesic technique were similar in each group. CISB following rotator cuff repair in a multi-provider setting was associated with reduced total opioid/tramadol and antiemetic consumption, and occurred without a significant increase in the monetary cost.

  5. Public private partnership in vascular surgery

    PubMed Central

    Mendes, Cynthia de Almeida; Martins, Alexandre de Arruda; Teivelis, Marcelo Passos; Kuzniec, Sérgio; Wolosker, Nelson

    2014-01-01

    Objective To describe and analyze the results of a public-private partnership between the Ministry of Health and a private hospital in a project of assistance and scientific research in the field of endovascular surgery. Methods: The flows, costs and clinical outcomes of patients treated in a the public-private partnership between April 2012 and July 2013 were analyzed. All patients underwent surgery and stayed at least one day at the intensive care unit of the private hospital. They also participated in a research protocol to compare two intravenous contrast media used in endovascular surgery (iodinated contrast and carbon dioxide). Results A total of 62 endovascular procedures were performed in 57 patients from the public healthcare system. Hospital and endovascular supplies expenses were significantly higher as compared to the amount paid by the Unified Health System (SUS - Sistema Único de Saúde) in two out of three disease groups studied. Among outpatients, the average interval between appointment and surgery was 15 days and, in hospitalized patients 7 days. All procedures were successful with no conversion to open surgery. The new contrast medium studied - carbon dioxide – was effective and cheaper. Conclusion The waiting time for patients between indication and accomplishment of surgery was significantly reduced. Public-private partnerships can speed up care of patients from public health services, and generate and improve scientific knowledge. PMID:25295457

  6. Payún Volcanic Field

    NASA Image and Video Library

    2017-09-27

    Situated in the southern Andes Mountains, the Payún volcanic field of Argentina is a complex landscape that formed over hundreds of thousands of years. Sprawling over 5,200 square kilometers (2,000 square miles), Payún is a massive shield volcano—a broad formation resembling an ancient warrior shield. This false-color image is a composite of observations acquired on February 7 and March 20, 2001 by the Enhanced Thematic Mapper Plus on the Landsat 7 satellite. It was made from a combination of visible and infrared light, where green indicates vegetation, black indicates lava flows, and orange is bare rock rich in iron oxides. Part of the back-arc volcanism of the Andes, Payún lies about 530 kilometers (330 miles) east from where the Nazca plate subducts below the South America plate. Not surprisingly, a volcanic zone extends over some 1,000 kilometers (600 miles) north-to-south in this region. According to a study published in 2010, the regional geology and chemical composition of the rocks indicate that the volcanic field likely formed within the past 300,000 years. The dominant feature of the volcanic field is Payún Matru, an elliptical caldera measuring roughly 9 by 7 kilometers (6 by 4 miles). Geologists surmise that the caldera formed after the old magma chamber emptied and the summit collapsed. Southwest of the caldera is a stratovolcano composed of alternating layers of compacted ash, hardened lava, and rocks ejected during previous eruptions. This stratovolcano, Payún, rises to 3,680 meters (12,073 feet) above sea level. (The entire volcanic field sits at 2,000 meters, or 6,600 feet.) The stratovolcano may be the most prominent feature in the volcanic field but it is by no means the only one. More than 300 eruptive features litter the shield volcano, most of them occupying an east-west line. West of Payún Matru is an area known as Los Volcanes, a mass of strombolian cones and basaltic lava flows. Image courtesy Michael P. Taylor, Landsat Data

  7. Consumer cost sharing in private health insurance: on the threshold of change.

    PubMed

    Goff, Veronica

    2004-05-14

    Employers are asking employees to pay more for health care through higher premium contributions, share of contribution, and out-of-pocket maximums, along with variations in deductibles, co-pays, and coinsurance based on choice of providers, networks, drugs, and other services. This issue brief examines consumer cost-sharing trends in private insurance, discusses the outlook for cost sharing in employment-based benefits, and considers public policies to support health care markets for consumers.

  8. Estimating rural households' willingness to pay for health insurance.

    PubMed

    Asgary, Ali; Willis, Ken; Taghvaei, Ali Akbar; Rafeian, Mojtaba

    2004-10-01

    In many developing countries limited health budgets are a serious problem. Innovative ways to raise funds for the provision of health services, for example, through health care insurance, have a high priority. Health care insurance for rural households shields such patients from unexpected high costs of care. However, there are questions about whether, and how much, rural households are willing to pay to purchase such insurance, as well as the factors determining willingness to pay. In recent years the Iranian government has tried to improve health and medical services to rural areas through a health insurance program. This study was conducted to estimate rural households' demand and willingness to pay for health insurance. A contingent valuation method (CVM) was applied using an iterative bidding game technique. Data has been collected from a sample of 2,139 households across the country.

  9. Paying your marketers--properly.

    PubMed

    Pearson, Elizabeth Zink

    2003-09-01

    Home health agencies have more freedom to market their services since the implementation of the prospective payment system. In order to do that, a number of agencies have turned to marketing professionals for help. A common method of compensating marketers in the business world, however, is through payment for referrals--something expressly forbidden by federal statute. Home health agencies need to know what they can and can't do to pay marketers and must train their marketers on the federal anti-kickback regulations to assure their compliance.

  10. Paying for Forest Ecosystem Services: Voluntary Versus Mandatory Payments

    NASA Astrophysics Data System (ADS)

    Roesch-McNally, Gabrielle E.; Rabotyagov, Sergey S.

    2016-03-01

    The emergence of new markets for forest ecosystem services can be a compelling opportunity for market diversification for private forest landowners, while increasing the provision of public goods from private lands. However, there is limited information available on the willingness-to-pay (WTP) for specific forest ecosystem services, particularly across different ecosystem market mechanisms. We utilize survey data from Oregon and Washington households to compare marginal WTP for forest ecosystem services and the total WTP for cost-effective bundles of forest ecosystem services obtained from a typical Pacific Northwest forest across two value elicitation formats representing two different ecosystem market mechanisms: an incentive-compatible choice experiment involving mandatory tax payments and a hypothetical private provision scenario modeled as eliciting contributions to the preferred forest management alternative via a provision point mechanism with a refund. A representative household's total WTP for the average forest management program was estimated at 217.59 per household/year under a mandatory tax mechanism and 160.44 per household/per year under a voluntary, crowdfunding-style, contribution mechanism; however, these estimates are not statistically different. Marginal WTP estimates were assessed for particular forest ecosystem service attributes including water quality, carbon storage, mature forest habitat, and public recreational access. This study finds that survey respondents place significant economic value on forest ecosystem services in both elicitation formats and that the distributions of the marginal WTP are not statistically significantly different.

  11. Paying for Forest Ecosystem Services: Voluntary Versus Mandatory Payments.

    PubMed

    Roesch-McNally, Gabrielle E; Rabotyagov, Sergey S

    2016-03-01

    The emergence of new markets for forest ecosystem services can be a compelling opportunity for market diversification for private forest landowners, while increasing the provision of public goods from private lands. However, there is limited information available on the willingness-to-pay (WTP) for specific forest ecosystem services, particularly across different ecosystem market mechanisms. We utilize survey data from Oregon and Washington households to compare marginal WTP for forest ecosystem services and the total WTP for cost-effective bundles of forest ecosystem services obtained from a typical Pacific Northwest forest across two value elicitation formats representing two different ecosystem market mechanisms: an incentive-compatible choice experiment involving mandatory tax payments and a hypothetical private provision scenario modeled as eliciting contributions to the preferred forest management alternative via a provision point mechanism with a refund. A representative household's total WTP for the average forest management program was estimated at $217.59 per household/year under a mandatory tax mechanism and $160.44 per household/per year under a voluntary, crowdfunding-style, contribution mechanism; however, these estimates are not statistically different. Marginal WTP estimates were assessed for particular forest ecosystem service attributes including water quality, carbon storage, mature forest habitat, and public recreational access. This study finds that survey respondents place significant economic value on forest ecosystem services in both elicitation formats and that the distributions of the marginal WTP are not statistically significantly different.

  12. 38 CFR 17.53 - Limitations on use of public or private hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... public or private hospitals. 17.53 Section 17.53 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.53 Limitations on use of public or private hospitals. The admission of any patient to a private or public hospital at Department of Veterans Affairs...

  13. 38 CFR 17.53 - Limitations on use of public or private hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... public or private hospitals. 17.53 Section 17.53 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.53 Limitations on use of public or private hospitals. The admission of any patient to a private or public hospital at Department of Veterans Affairs...

  14. 38 CFR 17.53 - Limitations on use of public or private hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... public or private hospitals. 17.53 Section 17.53 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.53 Limitations on use of public or private hospitals. The admission of any patient to a private or public hospital at Department of Veterans Affairs...

  15. Preferences for policy attributes and willingness to pay for water quality improvements under uncertainty

    NASA Astrophysics Data System (ADS)

    Mullen, Jeffrey D.; Calhoun, Kayla C.; Colson, Gregory J.

    2017-04-01

    When exploring environmental policy options, sometimes neither the current state of the environmental good being analyzed nor the effectiveness of the proposed policy is known with certainty. This is the case with privately owned, residential, onsite wastewater treatment systems (septic systems)—there is ample evidence that they can contribute to water quality impairment, but their contribution is generally stochastic in nature and the efficacy of technological solutions is uncertain. Furthermore, the benefits of ameliorating water quality impairments are public in nature. Septic system owners are legally responsible for maintaining their systems, but requiring them to upgrade otherwise properly functioning tanks is outside the scope of water quality regulations. An incentive structure is necessary to induce private homeowners to invest in septic upgrades that deliver both private benefits in addition to the positive externality for the wider public and environment. The question for policy makers is how these private incentives should be financed, and whether public support can be garnered. Results of a choice experiment in Gwinnett County, Georgia, accounting for both sources of uncertainty—the current state of water quality and the efficacy of the intervention—in the design of water quality policy are presented. We find baseline water quality conditions and policy efficacy significantly affect public support for a policy transferring public funds to private homeowners, in terms of both sentiment and willingness to pay. The manner in which costs are shared across stakeholders also affects the selection of a policy option, but not willingness to pay for it.

  16. 5 CFR 9701.354 - Setting pay upon demotion.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Setting pay upon demotion. 9701.354... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Pay Administration § 9701.354 Setting pay upon demotion. DHS will issue implementing directives regarding how to set an employee's pay when he...

  17. 5 CFR 9701.354 - Setting pay upon demotion.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Setting pay upon demotion. 9701.354... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Pay Administration § 9701.354 Setting pay upon demotion. DHS will issue implementing directives regarding how to set an employee's pay when he...

  18. 5 CFR 550.122 - Computation of night pay differential.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Computation of night pay differential... REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Night Pay § 550.122 Computation of night pay differential. (a) Absence on holidays or in travel status. An employee is entitled to a night pay differential for...

  19. 5 CFR 550.905 - Payment of hazard pay differential.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Payment of hazard pay differential. 550... hazard pay differential. (a) When an employee performs duty for which a hazard pay differential is authorized, the agency must pay the hazard pay differential for the hours in a pay status on the day (a...

  20. 5 CFR 550.905 - Payment of hazard pay differential.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Payment of hazard pay differential. 550... hazard pay differential. (a) When an employee performs duty for which a hazard pay differential is authorized, the agency must pay the hazard pay differential for the hours in a pay status on the day (a...