A Comparative Study of Students' Access to and Utilization of Learning Resources in Selected Public and Private Universities in Southwest, Nigeria

ERIC Educational Resources Information Center

Lawal, B. O.; Viatonu, Olumuyiwa

2017-01-01

The study investigated students' access to and utilization of some learning resources in selected public and private universities in southwest Nigeria. Stratified random sampling technique was used to select 585 (295 public and 290 private) students from 12 (six public and six private) universities in southwest Nigeria. Two instruments--Cost and…

The Politics of Pipes: The Persistence of Small Water Networks in Post-Privatization Manila

NASA Astrophysics Data System (ADS)

Cheng, Deborah

This project examines the politics of water provision in low-income areas of large, developing cities. In the last two decades, water privatization has become a global paradigm, emerging as a potential means for addressing the urban water crisis. In Manila, the site of the world's largest water privatization project, service to low-income areas has improved significantly in the post-privatization era. But whereas expansion of a water utility typically involves the replacement of informal providers, the experience in Manila demonstrates that the rapid connection of low-income areas actually hinges, in part, on the selective inclusion and exclusion of these smaller actors. Based on an ethnography of the private utilities and community-based providers, I use the persistence of small water networks as a lens for exploring the limits of water privatization in Manila. I focus on what I call micro-networks---community-built infrastructure that extends the formal, private utilities into low-income neighborhoods that the utilities do not wish to serve directly. In such a setup, the utility provides water only as far as the community boundary; beyond that, the micro-network operator constructs internal infrastructure, monitors for leakage and theft, and collects bills. But while these communities may gain access to safer water, they are also subject to higher costs and heightened disciplinary measures. By tracing the ways in which the utilities selectively use micro-networks to manage sub-populations, I show how the utilities make low-income spaces more governable. Delegating localized water management to micro-network operators depoliticizes the utilities' roles, shifting the sociopolitical difficulties of water provision to community organizations, while allowing the utilities to claim that these areas are served. This research leads to three related arguments. First, the persistence of small water networks highlights lingering inequities in access to water, for micro-network consumers are subject to disparities in cost, materials, and personal freedoms. Though Manila's water privatization project has resulted in significant improvements to the centralized system, its success must be tempered by the inequalities that remain. Second, the two utilities are largely able to shape both the geographies of water access and the production of knowledge. For this reason, the utilities typically use micro-networks where cost recovery may be difficult---such as in areas with uncertain land tenure or where higher levels of nonpayment are perceived---while including these areas in their aggregate coverage statistics. Third, the presence of multiple providers of water and other basic services blurs the boundaries between public, private, and community. But that blurriness serves to consolidate the private utilities' power, while increasing the opacity by which citizens navigate processes related to urban water provision. The persistence of micro-networks thus allows us to understand the ways in which low-income spaces are made more governable. By focusing on this peri-urban frontier, this project asserts that differentiation and discipline serve simultaneously as tools of governance and as points of contestation. What emerges is a waterscape consisting not of one type of privatization---where service and access are uniformly provided---but multiple, coexisting, and differentiated privatizations.

The Applicability of Market-Based Solutions to Public Sector Problems.

ERIC Educational Resources Information Center

Kelley, Carolyn

This paper examines the ways in which private- and public-sector location affects organizational structure and functions, and the implications for school reform. It identifies the differences that are often overlooked when policymakers utilize market-based organizational reform models to address public school problems. Two fundamental questions…

Private sector approaches to workforce enhancement.

PubMed

Wendling, Wayne R

2010-06-01

This paper addresses the private practice model of dental care delivery in the US. The great majority of dental care services are delivered through this model and thus changes in the model represent a means to substantially change the supply and availability of dental services. The two main forces that change how private practices function are broad economic factors, which alter the demand for dental care and innovations in practice structure and function which alter the supply and cost of services. Economics has long recognized that although there are private market solutions for many issues, not all problems can be addressed through this model. The private practice of dentistry is a private market solution that works for a substantial share of the market. However, the private market may not work to resolve all issues associated with access and utilization. Solutions for some problems call for creative private - public arrangements - another form of innovation; and market-based solutions may not be feasible for each and every problem. This paper discusses these economic factors and innovation as they relate to the private practice of dentistry, with special emphasis on those elements that have increased the capacity of the dental practice to offer services to those with limited means to access fee-based care. Innovations are frequently described as new care delivery models or new workforce models. However, innovation can occur on an ongoing and regular basis as dental practices examine new ways to combine capital and human resources and to leverage the education and skill of the dentists to a greater number of patients. Innovation occurs within a market context as the current and projected economic returns reward the innovation. Innovation can also occur through private-public arrangements. There are indications of available capacity within the existing delivery system to expand service delivery. The Michigan Medicaid Healthy Kids Dental program is discussed as one example of how dental services to Medicaid insured children were effectively expanded using the private practice model.

Reinforcement Learning for Constrained Energy Trading Games With Incomplete Information.

PubMed

Wang, Huiwei; Huang, Tingwen; Liao, Xiaofeng; Abu-Rub, Haitham; Chen, Guo

2017-10-01

This paper considers the problem of designing adaptive learning algorithms to seek the Nash equilibrium (NE) of the constrained energy trading game among individually strategic players with incomplete information. In this game, each player uses the learning automaton scheme to generate the action probability distribution based on his/her private information for maximizing his own averaged utility. It is shown that if one of admissible mixed-strategies converges to the NE with probability one, then the averaged utility and trading quantity almost surely converge to their expected ones, respectively. For the given discontinuous pricing function, the utility function has already been proved to be upper semicontinuous and payoff secure which guarantee the existence of the mixed-strategy NE. By the strict diagonal concavity of the regularized Lagrange function, the uniqueness of NE is also guaranteed. Finally, an adaptive learning algorithm is provided to generate the strategy probability distribution for seeking the mixed-strategy NE.

Analysis of debt leveraging in private power projects. Revision

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kahn, E.P.; Meal, M.; Doerrer, S.

1992-08-01

As private power (non-utility generation) has grown to become a significant part of the electricity system, increasing concern about its financial implications has arisen. In many cases, the source of this concern has been the substantial reliance of these projects on debt financing. This study examines debt leveraging in private power projects. The policy debate on these issues has typically been conducted at a high level of generality. Critics of the private power industry assert that high debt leveraging confers an unfair competitive advantage by lowering the cost of capital, and that this leveraging is only possible because risks aremore » shifted to the utility. Further, debt leveraging is claimed to be a threat to reliability. On the opposite side, it is argued that debt leveraging imposes costs and obligations not home by utilities, and so there is no financial advantage. The private producers also argue that on balance more risk is shifted away from utilities than to them, and that incentives for reliability are strong. In this study we examine the project finance mechanisms used in private power lending in detail, relying on a sample of actual loan documents. This review and its findings should be relevant to the further evolution of this debate. State regulatory commissions are likely to be interested in it, and Federal legislation to amend the Public Utility Holding Company Act (PUHCA) could require states to consider the implications of debt leveraging in relation to their oversight of utility power purchase programs.« less

Analysis of debt leveraging in private power projects

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kahn, E.P.; Meal, M.; Doerrer, S.

1992-08-01

As private power (non-utility generation) has grown to become a significant part of the electricity system, increasing concern about its financial implications has arisen. In many cases, the source of this concern has been the substantial reliance of these projects on debt financing. This study examines debt leveraging in private power projects. The policy debate on these issues has typically been conducted at a high level of generality. Critics of the private power industry assert that high debt leveraging confers an unfair competitive advantage by lowering the cost of capital, and that this leveraging is only possible because risks aremore » shifted to the utility. Further, debt leveraging is claimed to be a threat to reliability. On the opposite side, it is argued that debt leveraging imposes costs and obligations not home by utilities, and so there is no financial advantage. The private producers also argue that on balance more risk is shifted away from utilities than to them, and that incentives for reliability are strong. In this study we examine the project finance mechanisms used in private power lending in detail, relying on a sample of actual loan documents. This review and its findings should be relevant to the further evolution of this debate. State regulatory commissions are likely to be interested in it, and Federal legislation to amend the Public Utility Holding Company Act (PUHCA) could require states to consider the implications of debt leveraging in relation to their oversight of utility power purchase programs.« less

Do medical doctors respond to economic incentives?

PubMed

Andreassen, Leif; Di Tommaso, Maria Laura; Strøm, Steinar

2013-03-01

A longitudinal analysis of married physicians labor supply is carried out on Norwegian data from 1997 to 1999. The model utilized for estimation implies that physicians can choose among 10 different job packages which are a combination of part time/full time, hospital/primary care, private/public sector, and not working. Their current choice is influenced by past available options due to a habit persistence parameter in the utility function. In the estimation we take into account the budget constraint, including all features of the tax system. Our results imply that an overall wage increase or less progressive taxation moves married physicians toward full time job packages, in particular to full time jobs in the private sector. But the overall and aggregate labor supply elasticities in the population of employed doctors are rather low compared to previous estimates. Copyright © 2012 Elsevier B.V. All rights reserved.

SLA Negotiation for VO Formation

NASA Astrophysics Data System (ADS)

Paurobally, Shamimabi

Resource management systems are changing from localized resources and services towards virtual organizations (VOs) sharing millions of heterogeneous resources across multiple organizations and domains. The virtual organizations and usage models include a variety of owners and consumers with different usage, access policies, cost models, varying loads, requirements and availability. The stakeholders have private utility functions that must be satisfied and possibly maximized.

A Proposal for the use of the Consortium Method in the Design-build system

NASA Astrophysics Data System (ADS)

Miyatake, Ichiro; Kudo, Masataka; Kawamata, Hiroyuki; Fueta, Toshiharu

In view of the necessity for efficient implementation of public works projects, it is expected to utilize advanced technical skills of private firms, for the purpose of reducing project costs, improving performance and functions of construction objects, and reducing work periods, etc. The design-build system is a method to order design and construction as a single contract, including design of structural forms and main specifications of the construction object. This is a system in which high techniques of private firms can be utilized, as a means to ensure qualities of design and construction, rational design, and efficiency of the project. The objective of this study is to examine the use of a method to form a consortium of civil engineering consultants and construction companies, as it is an issue related to the implementation of the design-build method. Furthermore, by studying various forms of consortiums to be introduced in future, it proposes procedural items required to utilize this method, during the bid and after signing a contract, such as the estimate submission from the civil engineering consultants etc.

Managing biotechnology in a network-model health plan: a U.S. private payer perspective.

PubMed

Watkins, John B; Choudhury, Sanchita Roy; Wong, Ed; Sullivan, Sean D

2006-01-01

Emerging biotechnology poses challenges to payers, including access, coverage, reimbursement, patient selection, and affordability. Premera Blue Cross, a private regional health plan, developed an integrated cross-functional approach to managing biologics, built around a robust formulary process that is fast, flexible, fair, and transparent to stakeholders. Results are monitored by cost and use reporting from merged pharmacy and medical claims. Utilization management and case management strategies will integrate with specialty pharmacy programs to improve outcomes and cost-effectiveness. Creative approaches to provider reimbursement can align providers' incentives with those of the plan. Redesign of member benefits can also encourage appropriate use of biotechnology.

Utilization and expenditure at public and private facilities in 39 low-income countries.

PubMed

Saksena, Priyanka; Xu, Ke; Elovainio, Riku; Perrot, Jean

2012-01-01

To document the patterns of health service utilization and health payments at public and private facilities across countries. We used data from the World Health Surveys from 39 low- and low-middle income countries to examine differences between public and private sectors. Utilization of outpatient and inpatient services, out-of-pocket payments (OOP) at public and private facilities, and transportation costs were compared. Utilization and payments to public and private sectors differ widely. Public facilities dominated in most countries for both outpatient and inpatient services. But, whereas use of private facilities is more common among the rich, poor people also use them, to a considerable extent and in almost all the countries in the study. The majority of OOP were incurred at public providers for inpatient services. On average, this was not the case for outpatient services. Medicines accounted for the largest share of OOP for all services except inpatient services at private facilities, where consultation fees did. Transportation costs were considerable. Price competition is certainly not the only factor that guides choice of provider. The results support continued efforts by the governments to engage strategically with the private sector. However, they also highlight the importance of not generalizing conditions across countries. Governments may need to reconsider simplistic user-fee abolition strategies at public providers if they simply focus on consultation fees. Policies to make health services more accessible need to consider a comprehensive benefit package that includes a wider scope of costs related to care such as expenditures on medicines and transportation. © 2011 Blackwell Publishing Ltd.

Analysis of debt leveraging in private power projects

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kahn, E.P.; Meal, M.; Doerrer, S.

1992-08-01

As private power has grown to become a significant part of the electricity system, increasing concern about its financial implications has arisen. In many cases, the source of this concern has been the substantial reliance of these projects on debt financing. This study examines debt leveraging in private power projects. The policy debate on these issues has typically been conducted at a high level of generality. Critics of the private power industry assert that high debt leveraging confers an unfair competitive advantage by lowering the cost of capital. This leveraging is only possible because risks are shifted to the utility.more » Further, debt leveraging is claimed to be a threat to reliability. On the opposite side, it is argued that debt leveraging imposes costs and obligations not borne by utilities, and so there is no financial advantage. The private producers also argue that on balance more risk is shifted away from utilities than to them, and that incentives for reliability are strong. In this study we examine the project finance mechanisms used in private power lending in detail, relying on a sample of actual loan documents. This review and its findings should be relevant to the further evolution of this debate. State regulatory commissions are likely to be interested in it, and Federal legislation to amend the Public Utility Holding Company Act (PUHCA) could require states to consider the implications of debt leveraging in relation to their oversight of utility power purchase programs.« less

Design and implementation of Ada programs to facilitate automated testing

NASA Technical Reports Server (NTRS)

Dean, Jack; Fox, Barry; Oropeza, Michael

1991-01-01

An automated method utilized to test the software components of COMPASS, an interactive computer aided scheduling system, is presented. Each package of this system introduces a private type, and works to construct instances of that type, along with read and write routines for that type. Generic procedures that can generate test drivers for these functions are given and show how the test drivers can read from a test data file the functions to call, the arguments for those functions, what the anticipated result should be, and whether an exception should be raised for the function given the arguments.

Public and private healthcare services utilization by non-institutional elderly in Hong Kong: is the inverse care law operating?

PubMed

Yam, Ho-Kwan; Mercer, Stewart W; Wong, Lai-Yi; Chan, Wan-Kin; Yeoh, Eng-Kiong

2009-08-01

To assess the factors associated with healthcare services utilization by the non-institutional elderly across five types of service utilization (Western medicine doctors in Government clinics, private Western medicine doctors, Chinese medicine practitioners, Emergency Units, and hospitalization). A secondary data analysis of a territory-wide cross-sectional survey collected by the Government among a representative sample of 4812 elderly (aged 60 and above) in Hong Kong. Our analysis, based on Anderson's behavioral framework, shows that need factors (relating to actual or perceived illness and diseases) are significantly related to the healthcare services utilization examined. However, enabling factors, such as monthly household income per capita, play a significant role in determining the utilization. Although the lower-income elderly consult more Government clinics and less private clinics than the more affluent, they have a lower total utilization of healthcare services despite having significantly greater healthcare needs. This suggests a mismatch of need and supply within the mixed economy of private and public healthcare services and suggests the existence of an 'inverse care law' in Hong Kong amongst elderly citizens. The findings raise concerns of inequities in Hong Kong's healthcare system, raising implications for future healthcare reforms.

Turbidity and total suspended solid concentration dynamics in streamflow from California oak woodland watersheds

Treesearch

David J. Lewis; Kenneth W. Tate; Randy A. Dahlgren; Jacob Newell

2002-01-01

Resource agencies, private landowners, and citizen monitoring programs utilize turbidity (water clarity) measurements as a water quality indicator for total suspended solids (TSS – mass of solids per unit volume) and other constituents in streams and rivers. The dynamics and relationships between turbidity and TSS are functions of watershed-specific factors and...

Study of the Interrelationships between Minimum Flow Release Policies and Hydroelectric Power Development in New England.

DTIC Science & Technology

1981-06-01

available information from Public Utilities comaissions responsible for establishing PURPA rates in each state. 1.4 PRINCIPAL FINDINGS The direct effect all... PURPA rates. However, many of those categorized as private and public developers are private and public utilities. This reflects the interest in hydro...The Public Utility Regulatory Policies Act ( PURPA ) of 1978 empowered FERC to prescribe rules requiring utilities to purchase power from and sell power

Comparison of Rate of Utilization of Medicare Services in Private Versus Academic Cardiology Practice.

PubMed

Hovanesyan, Arsen; Rubio, Eduardo; Novak, Eric; Budoff, Matthew; Rich, Michael W

2017-11-15

Cardiovascular services are the third largest source of Medicare spending. We examined the rate of cardiovascular service utilization in the community of Glendale, CA, compared with the nearest academic medical center, the University of Southern California. Publicly available utilization data released by Medicare for the years 2012 and 2013 were used to identify all inpatient and outpatient cardiology services provided in each practice setting. The analysis included 19 private and 17 academic cardiologists. In unadjusted analysis, academic physicians performed half as many services per Medicare beneficiary per year as those in private practice: 2.3 versus 4.8, p <0.001. Other factors associated with higher utilization included male physician, international (vs US) medical school graduate, interventional (vs general) cardiologist, and more years in practice. Factors independently associated with higher utilization rates by multivariable analysis included private practice setting (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.30 to 2.61, p <0.001), male physician (OR 1.64, 95% CI 1.00 to 2.67, p = 0.049), and international medical school graduate (OR 1.37, 95% CI 1.07 to 1.78, p = 0.014). In conclusion, in this analysis of 2 cardiology practice settings in southern California, medical service utilization per Medicare beneficiary was nearly 2-fold higher in private practice than in the academic setting, suggesting that there may be opportunity for substantially reducing costs of cardiology care in the community setting. Copyright © 2017 Elsevier Inc. All rights reserved.

Policy Perspective: School Turnaround in England. Utilizing the Private Sector

ERIC Educational Resources Information Center

Corbett, Julie

2014-01-01

This paper, written by strategic partner of the Center on School Turnaround (CST), Julie Corbett, provides research and examples on England's approach to turning around its lowest performing schools. The English education system utilizes private vendors to support chronically low-performing schools and districts. The introduction is followed by…

NASA's Commercial Space Centers: Bringing Together Government and Industry for "Out of this World" Benefits

NASA Technical Reports Server (NTRS)

Robinson, R. Keith; Henderson, Robin N. (Technical Monitor)

2002-01-01

The National Aeronautics and Space Administration (NASA) is making significant effort to accommodate commercial research in the utilization plans of the International Space Station (ISS)[1]. NASA is providing 30% of the research accommodations in the ISS laboratory modules to support commercial endeavors. However, the availability of resources alone does not necessarily translate into significant private sector participation in NASA's ISS utilization plans. Due to the efforts of NASA's Commercial Space Centers (CSC's), NASA has developed a very robust plan for involving the private sector in ISS utilization activities. Obtaining participation from the private sector requires a demonstrated capability for obtaining commercially significant research results. Since 1985, NASA CSC's have conducted over 200 commercial research activities aboard parabolic aircraft, sounding rockets, the Space Shuttle, and the ISS. The success of these activities has developed substantial investment from private sector companies in commercial space research.

Assessing the community clinic replacement effect on private Medicaid practices in oral health care within rural environments.

PubMed

Squillace, Joe

2013-01-01

Children in Medicaid/CHIP public coverage programs who reside in rural counties have limited access to dental care services. Shortages of dental professionals in rural areas impede utilization of dental care. Public and private initiatives are attempting to address this crisis. Missourians instituted deregulatory policies and invested in community-based initiatives. Using a Medicaid/CHIP claims administrative dataset from 2004 to 2007, this research explored patterns of utilization to assess the impact of these efforts. The number of participating private dental office providers declined over the study period, and the number of children utilizing clinics increased. Trends are being observed within the public health dental care market demonstrating clinics are replacing private dentists as providers of Medicaid/CHIP dental services. Allowing greater market entry through deregulation could provide states with greater improvements to their public dental health infrastructure. © 2012 American Association of Public Health Dentistry.

Mode Choice between Private and Public Transport in Klang Valley, Malaysia

PubMed Central

Karim, Mohamed Rehan; Yusoff, Sumiani

2014-01-01

In 2010, Klang Valley has only 17% trips each day were completed using public transport, with the rest of the 83% trips were made through private transport. The inclination towards private car usage will only get worse if the transport policy continues to be inefficient and ineffective. Under the National Key Economic Area, the priority aimed to stimulate the increase of modal share of public transport in the Klang Valley to 50% by 2020. In the 10th Malaysia Plan, the Klang Valley Mass Rapid Transit was proposed, equipped with 141 km of MRT system, and will integrate with the existing rail networks. Nevertheless, adding kilometers into the rail system will not help, if people do not make the shift from private into public transport. This research would like to assess the possible mode shift of travellers in the Klang Valley towards using public transport, based on the utility function of available transport modes. It intends to identify the criteria that will trigger their willingness to make changes in favour of public transport as targeted by the NKEA. PMID:24701165

Career Education: Collaboration with the Private Sector. Information Series No. 246.

ERIC Educational Resources Information Center

Bhaerman, Robert D.

This paper reviews three aspects of career education-private sector collaboration: (1) the general and specific approaches that have been utilized during the past 10 years by the career education movement and the private sector in developing career education collaboration in the private sector; (2) the major results of these activities, focusing…

Alternative Fuels Data Center: State Alternative Fuel and Advanced Vehicle

Science.gov Websites

2017, the number of new state-level legislative, executive, private, and utility activities related to 2016 (54 total), but in line with previous years. The analysis below provides detail on trends in new (PEVs). Also consistent with recent prior years, new utility and private incentives primarily addressed

Alternative Fuels Data Center: State Alternative Fuel and Advanced Vehicle

Science.gov Websites

2016, the number of new state-level legislative, executive, private, and utility activities related to , new utility and private incentives focused almost entirely on electricity. In previous years, natural gas was also a strong focus area for states. In 2016, however, the volume of new state incentives

Main trends in electricity markets

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pariente-Davied, S.

1998-07-01

Liberalization and restructuring of electricity markets are leading to a globalization of the industry. The electricity sector is moving from state dominance to private participation, from monopoly structures to competition. Greenfield investments in generation capacity are increasingly dominated by private operators; 53% of the 780 GW global capacity additions needed by 2007 will be independent power facilities. Existing power generation assets are changing hands, either through privatization or utility divestitures; 250 GW of capacity is expected to be privatized by 2007 and 310 GW of utility spin-offs are anticipated in the US. The structure of the industry will evolve frommore » fragmentation, with many players operating in national markets, to a few global players operating across borders.« less

Utilization of basic health units of FHS according to private health insurance

PubMed Central

Fontenelle, Leonardo Ferreira; de Camargo, Maria Beatriz Junqueira; Bertoldi, Andréa Dâmaso; Gonçalves, Helen; Maciel, Ethel Leonor Noia; Barros, Aluísio J D

2018-01-01

ABSTRACT OBJECTIVE To describe the utilization of basic health units according to coverage by discount card or private health insurance. METHODS Household survey in the area covered by Family Health Strategy in Pelotas, state of Rio Grande do Sul, Brazil, from December 2007 to February 2008, with persons of all age groups. The frequency of (medical or non-medical) healthcare seeking at the basic health units in the last six months and the prevalence of basic health unit utilization for the last medical consultation (in case it had been performed up to six months before, for a non-routine reason) were analyzed by Poisson regression adjusted for the sampling design. RESULTS Of the 1,423 persons, 75.6% had no discount card or private health insurance. The average frequency of (medical or non-medical) healthcare seeking was 1.6 times in six months (95%CI 1.3-2.0); this frequency was 55.8% lower (p < 0.001) among privately insured persons compared to those with no discount card or private health insurance. Among the last medical consultations, 35.8% (95%CI 25.4-47.7) had been performed at the basic health units; this prevalence was 36.4% lower (p = 0.003) among persons covered by discount card and 87.7% lower (p = 0.007) among privately insured persons compared to those without both coverages. CONCLUSIONS Private health insurance and, to a lesser degree, discount card coverage, are related to lower utilization of basic health units. This can be used to size the population under the accountability of each Family Health Strategy team, to the extent that community health workers are able to differentiate discount card from PHI during family registration. PMID:29791678

48 CFR 252.225-7039 - Contractors performing private security functions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... by Contractors performing private security functions; (A) All armored vehicles, helicopters, and... private security functions. 252.225-7039 Section 252.225-7039 Federal Acquisition Regulations System... security functions. As prescribed in 225.370-6, insert the following clause: CONTRACTORS PERFORMING PRIVATE...

78 FR 37670 - Federal Acquisition Regulation; Contractors Performing Private Security Functions Outside the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-21

...] RIN 9000-AM20 Federal Acquisition Regulation; Contractors Performing Private Security Functions...-181). Section 862, entitled ``Contractors Performing Private Security Functions in Areas of Combat...), as amended, entitled ``Contractors Performing Private Security Functions in Areas of Combat...

Examination of the factors and issues for an environmental technology utilization partnership between the private sector and the Department of Energy. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brouse, P.

1997-05-01

The Department of Energy (DOE) held a meeting on November 12, 1992 to evaluate the DOE relations with industry and university partners concerning environmental technology utilization. The goal of this meeting was to receive feedback from DOE industry and university partners for the identification of opportunities to improve the DOE cooperative work processes with the private sector. The meeting was designed to collect information and to turn that information into action to improve private sector partnerships with DOE.

Maryland Multipayor Patient-centered Medical Home Program

PubMed Central

Marsteller, Jill A.; Hsu, Yea-Jen; Gill, Christine; Kiptanui, Zippora; Fakeye, Oludolapo A.; Engineer, Lilly D.; Perlmutter, Donna; Khanna, Niharika; Rattinger, Gail B.; Nichols, Donald

2018-01-01

Objective: To evaluate impact of the Maryland Multipayor Patient-centered Medical Home Program (MMPP) on: (1) quality, utilization, and costs of care; (2) beneficiaries’ experiences and satisfaction with care; and (3) perceptions of providers. Design: 4-year quasiexperimental design with a difference-in-differences analytic approach to compare changes in outcomes between MMPP practices and propensity score-matched comparisons; pre-post design for patient-reported outcomes among MMPP beneficiaries. Subjects: Beneficiaries (Medicaid-insured and privately insured) and providers in 52 MMPP practices and 104 matched comparisons in Maryland. Intervention: Participating practices received unconditional financial support and coaching to facilitate functioning as medical homes, membership in a learning collaborative to promote education and dissemination of best practices, and performance-based payments. Measures: Sixteen quality, 20 utilization, and 13 cost measures from administrative data; patient-reported outcomes on care delivery, trust in provider, access to care, and chronic illness management; and provider perceptions of team operation, team culture, satisfaction with care provided, and patient-centered medical home transformation. Results: The MMPP had mixed impact on site-level quality and utilization measures. Participation was significantly associated with lower inpatient and outpatient payments in the first year among privately insured beneficiaries, and for the entire duration among Medicaid beneficiaries. There was indication that MMPP practices shifted responsibility for certain administrative tasks from clinicians to medical assistants or care managers. The program had limited effect on measures of patient satisfaction (although response rates were low) and on provider perceptions. Conclusions: The MMPP demonstrated mixed results of its impact and indicated differential program effects for privately insured and Medicaid beneficiaries. PMID:29462077

Acute appendicitis in the public and private sectors in Cape Town, South Africa.

PubMed

Yang, Estin; Cook, Colin; Kahn, Delawir

2015-07-01

South Africa has a low incidence of acute appendicitis, but poor outcomes. However, South African studies on appendicitis focus solely on public hospitals, neglecting those who utilize private facilities. This study aims to compare appendicitis characteristics and outcomes in public and private hospitals in South Africa. A prospective cohort study was conducted among two public and three private hospitals in the Cape Town metropole, from September 2013 to March 2014. Hospital records, operative notes, and histology results were reviewed for patients undergoing appendectomy for acute appendicitis. Patients were interviewed during their hospitalization and followed up at monthly intervals until normal function was attained. A total of 134 patients were enrolled, with 73 in the public and 61 in the private sector. Education and employment were higher among private sector patients. Public sector patients had a higher rupture rate (30.6 vs 13.2 %, p = 0.023). Times to presentation were not statistically different between the two cohorts. Public sector patients had longer hospital stays (5.3 vs 2.9 days, p = 0.036) and longer return to work times (23.0 vs 12.1 days, p < 0.0001). Although complication rates were similar, complications in public hospitals were more severe. Public sector patients in South Africa with appendicitis have higher rupture rates, worse complications, longer hospital stays, and longer recoveries than private sector patients. Patients with perforation had longer delays in presentation than patients without perforation.

Utilization of inpatient care from private hospitals: trends emerging from Kerala, India.

PubMed

Dilip, T R

2010-09-01

There is a gap in knowledge on the overall role and characteristics of private health care providers in India. This research is aimed at understanding changes in the consumption of inpatient care services from private hospitals between 1986 and 2004, with a particular focus on equitable outreach. Secondary analysis of National Sample Survey data on the utilization of inpatient care services in Kerala is performed for the periods 1986-87, 1995-96 and 2004. Household survey data are examined to understand the users of the private health system as there are limitations in obtaining reliable data from unregulated private health care providers. The annual hospitalization rate increased from 69 per 1000 population in 1986-87 to 126 per 1000 population by 2004. The proportion of persons seeking care from private rather than government hospitals increased from 55% in 1986-87 to 65% by 2004. Concentration indices revealed that the year 1995-96 witnessed the highest income inequality in hospitalization rates. A decline both in hospitalization rates and in the relative preference for private hospitals over government hospitals among the poorest two quintiles between 1986-87 and 1995-96 indicates that the poor avoided inpatient treatment. The rich-poor divide in care seeking from private hospitals was moderated by 2004. Improvements in the purchasing power of the population, and the strategy of private hospitals in this highly competitive market to generate revenue from the poorer quintiles by offering different pricing options, have reduced the observed rich-poor divide in the consumption of inpatient treatment from this sector. However, while this gap in utilization has closed, the burden of out-of-pocket expenditure is higher among the poor.

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.

48 CFR 52.225-26 - Contractors Performing Private Security Functions Outside the United States.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., helicopters, and other military vehicles operated by Contractors performing private security functions; and... Private Security Functions Outside the United States. 52.225-26 Section 52.225-26 Federal Acquisition... CONTRACT CLAUSES Text of Provisions and Clauses 52.225-26 Contractors Performing Private Security Functions...

48 CFR 52.225-26 - Contractors Performing Private Security Functions Outside the United States.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., helicopters, and other military vehicles operated by Contractors performing private security functions; and... Private Security Functions Outside the United States. 52.225-26 Section 52.225-26 Federal Acquisition... CONTRACT CLAUSES Text of Provisions and Clauses 52.225-26 Contractors Performing Private Security Functions...

Differentially Private Frequent Sequence Mining via Sampling-based Candidate Pruning

PubMed Central

Xu, Shengzhi; Cheng, Xiang; Li, Zhengyi; Xiong, Li

2016-01-01

In this paper, we study the problem of mining frequent sequences under the rigorous differential privacy model. We explore the possibility of designing a differentially private frequent sequence mining (FSM) algorithm which can achieve both high data utility and a high degree of privacy. We found, in differentially private FSM, the amount of required noise is proportionate to the number of candidate sequences. If we could effectively reduce the number of unpromising candidate sequences, the utility and privacy tradeoff can be significantly improved. To this end, by leveraging a sampling-based candidate pruning technique, we propose a novel differentially private FSM algorithm, which is referred to as PFS2. The core of our algorithm is to utilize sample databases to further prune the candidate sequences generated based on the downward closure property. In particular, we use the noisy local support of candidate sequences in the sample databases to estimate which sequences are potentially frequent. To improve the accuracy of such private estimations, a sequence shrinking method is proposed to enforce the length constraint on the sample databases. Moreover, to decrease the probability of misestimating frequent sequences as infrequent, a threshold relaxation method is proposed to relax the user-specified threshold for the sample databases. Through formal privacy analysis, we show that our PFS2 algorithm is ε-differentially private. Extensive experiments on real datasets illustrate that our PFS2 algorithm can privately find frequent sequences with high accuracy. PMID:26973430

Different shades of gray: crafting a regulatory response to private equity buyouts in electricity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vaheesan, Sandeep

2009-01-15

Private equity has made a dramatic entry into the once-staid world of electric utilities. These investors, with their superior management expertise and greater access to capital, have the potential to improve utility operations and increase investment in badly needed generation and transmission facilities. Their acquisitions do not come without their share of risks, however. (author)

77 FR 70780 - Federal Acquisition Regulation; Submission for OMB Review; Contractors Performing Private...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-27

...; Submission for OMB Review; Contractors Performing Private Security Functions Outside the United States... new information collection requirement concerning Contractors Performing Private Security Functions... identified by Information Collection 9000- 0184, Contractors Performing Private Security Functions Outside...

A Real Options Method for Estimating the Adoption Potential of Forestry and Agroforestry Systems on Private Lands in the Lower Mississippi Alluvial Valley, USA

Treesearch

Gregory E. Frey; D. Evan Mercer; Frederick W. Cubbage; Robert C. Abt

2010-01-01

The Lower Mississippi River Alluvial Valley (LMAV), once was the largest forested bottom-land area in the continental United States, but has undergone widespread loss of forest through conversion to farmland. Restoration of forest functions and values has been a key conservation goal in the LMAV since the 1970s. This study utilizes a partial differential real options...

Household utilization and expenditure on private and public health services in Vietnam.

PubMed

Ha, Nguyen Thi Hong; Berman, Peter; Larsen, Ulla

2002-03-01

The private provision of health services in Vietnam was legalized in 1989 as one of the country's means to mobilize resources and improve efficiency in the health system. Ten years after its legalization, the private sector has widely expanded its activities and become an important provider of health services for the Vietnamese people. However, little is known about its contribution to the overall objectives of the health system in Vietnam. This paper assesses the role of the private health care provider by examining utilization patterns and financial burden for households of private, as compared with public, services. We found that the private sector provided 60% of all outpatient contacts in Vietnam. There was no difference by education, sex or place of residence in the use of private ambulatory health care. Although there was evidence suggesting that rich people use private care more than the poor, this finding was not consistent across all income groups. The private sector served young children in particular. Also, people in households with several sick members at the same time relied more on private than public care, while those with severe illnesses tended to use less private care than public. The financial burden for households from private health care services was roughly a half of that imposed by the public providers. Expenditure on drugs accounted for a substantial percentage of household expenditure in general and health care expenditure in particular. These findings call for a prompt recognition of the private sector as a key player in Vietnam's health system. Health system policies should mobilize positive private sector contributions to health system goals where possible and reduce the negative effects of private provision development.

Improving Urban Corridor that Respect to Public Space

NASA Astrophysics Data System (ADS)

Zahrah, W.; Rahmadhani, N.; Nasution, A. D.; Pane, I. F.

2017-03-01

The urban corridor is more than just a linear space to circulation. It is a place for community activities. Since the urban area in Indonesia functionates without guidelines, it is necessary to analyze how this space being used by the community. The objective of the research is to explore the problems in utilization of public space in Dr. Mansur corridor in Medan and to propose some recommendation to improve it. The survey was started by mapping the physical situation that based on urban design aspects and the activities occur. Based on the data, the study identified the problems of the public space utilization. Next, study selected several buildings that significant in generating public life. The study interviewed the building’s owners and users/customers to get their opinion and perception about the using of urban public space utilization in the corridor in relation to their private function. The study analyzed the problems and opportunity to redesign the buildings that respect to public space. Then, the design ideas were presented to the buildings owners to get their response. The result of the observation shows that the fundamental problem in the corridor is the intervention of the private interest to the street as public space. The study indicates that the majority of the buildings owner was not aware that their buildings had distracted the urban public space. However, they gave a positive respond to the design recommendation. The design offered the solution that provided individual needs without intervention to the public realm. The study can contribute to improving urban corridor by educating the community with architecture and urban design.

The potential influence of privatization on quality tourism

Treesearch

Rebecca L. Riedl; Hans Vogelsong

2003-01-01

Increases in travel and tourism are leading to the destruction and degradation of many of our most pristine natural resources. Privatization, if utilized properly, can prevent these tourist generating destinations from mayhem. Privatization will ensure the quality of a travel experience as well as maintain the beauty and preservation of a destination. Traditionally,...

The Impact of Private Insurance Coverage on Prescription Drug Use in Ontario, Canada.

PubMed

Kratzer, Jillian; Cheng, Lucy; Allin, Sara; Law, Michael R

2015-05-01

Canadians obtain prescription drug coverage through a patchwork of public insurance, private benefit plans and out-of-pocket payments. Prior evidence suggests that insurance coverage, in general, leads to higher utilization rates of essential medicines; it is unclear whether individuals with private insurance have better access to medicines. Using data from the 2008 Canadian Community Health Survey, we identified cohorts from Ontario who reported having been diagnosed by a physician with asthma, high blood pressure or diabetes. Using propensity score stratification techniques, we compared drug utilization of individuals holding private insurance with that of individuals holding either public insurance (for those aged over 65 years) or no insurance (aged under 65 years). In five out of six comparisons, individuals with private insurance were more likely to take prescribed drugs than those without. Raw differences in the percentage of patients taking medicines ranged from 0.1 to 8.1%. Ontarians with chronic conditions holding private drug insurance are more likely to use prescription drugs than those who do not. Whether these inequities result in health outcome differences remains unknown. Copyright © 2015 Longwoods Publishing.

The Impact of Private Insurance Coverage on Prescription Drug Use in Ontario, Canada

PubMed Central

Kratzer, Jillian; Cheng, Lucy; Allin, Sara

2015-01-01

Canadians obtain prescription drug coverage through a patchwork of public insurance, private benefit plans and out-of-pocket payments. Prior evidence suggests that insurance coverage, in general, leads to higher utilization rates of essential medicines; it is unclear whether individuals with private insurance have better access to medicines. Using data from the 2008 Canadian Community Health Survey, we identified cohorts from Ontario who reported having been diagnosed by a physician with asthma, high blood pressure or diabetes. Using propensity score stratification techniques, we compared drug utilization of individuals holding private insurance with that of individuals holding either public insurance (for those aged over 65 years) or no insurance (aged under 65 years). In five out of six comparisons, individuals with private insurance were more likely to take prescribed drugs than those without. Raw differences in the percentage of patients taking medicines ranged from 0.1 to 8.1%. Ontarians with chronic conditions holding private drug insurance are more likely to use prescription drugs than those who do not. Whether these inequities result in health outcome differences remains unknown. PMID:26142359

Utilization of Public System for Gastric Bands Placed by Private Providers: a 4-Year Population-Based Analysis in Ontario, Canada.

PubMed

Prabhu, Kristel Lobo; Okrainec, Allan; Maeda, Azusa; Saskin, Refik; Urbach, David; Bell, Chaim M; Jackson, Timothy D

2018-06-16

Laparoscopic adjustable gastric band (LAGB) placement remains a common bariatric procedure. While LAGB procedure is performed within private clinics in most Canadian provinces, public health care is often utilized for LAGB-related reoperations. We identified 642 gastric band removal procedures performed in Ontario from 2011 to 2014 using population-level administrative data. The number of procedures performed increased annually from 101 in 2011 to 220 in 2014. Notably, 54.7% of the patients required laparotomy, and 17.6% of patients underwent a subsequent bariatric surgery. Our findings demonstrated that LAGB placement in private clinics resulted in a large number of band removal procedures performed within the public system. This represents a significant public health concern that may result in significant health care utilization and patient morbidity.

Private sector contribution to childhood immunization: Sri Lankan experience.

PubMed

Agampodi, S B; Amarasinghe, D A C L

2007-04-01

The main service provider for childhood immunization in Sri Lanka is the government sector. However, utilization of private sector for childhood immunization is increasing rapidly. Existing national immunization data does not routinely include statistics on private sector immunization delivery adequately. To estimate the proportion of children immunized in the private sector; describe socio-demographic characteristics of private sector users and compare these with government sector users. A community-based crosssectional descriptive study was conducted using a pre-tested interviewer-administered structured questionnaire. This was done in the Colombo municipal council area using the WHO 30 cluster methodology. The total number of households in the sample was 553. Out of the 5,028 total immunizations reported in the present study, around one-third (2,544) was obtained through the private sector. Nineteen percent (104) of children were exclusively immunized from the private sector. The distribution of usual immunization provider was - government sector 72.3% (400) and private sector 27.7% (153). Significant differences were observed (P < 0.001) between private and government sector users with regard to family income, social class, ethnicity, religion and educational level of the mother. The age-appropriate immunization among the 12- to 23-month age group was 92.3% (144) in the government sector, whereas it was 95% (38) in the private sector. Among the 24- to 35-month age group, it was 91.7% (121) and 92.7% (76) respectively. The age-adjusted immunization coverage rates were almost same among the government and private sector users except for the measles vaccine, where the private sector users had significantly (P = 0.016) higher coverage. Utilization of private sector immunization services is high in the Colombo municipal council area.

Utilization and Perception of Integrative Medicine Among Plastic Surgery Patients.

PubMed

Patel, Nirav; Pierson, Justine; Lee, Timothy; Mast, Bruce; Lee, Bernard T; Estores, Irene; Singhal, Dhruv

2017-05-01

Integrative medicine (IM) is currently used by 40% of Americans. Our objective is to examine the prevalence and perception of IM utilization in patients being evaluated for elective plastic surgery. In July 2014, 402 consecutive patients presenting to plastic surgery clinics at the University of Florida, Veterans Affairs (VA), and Private Practices in Gainesville, Florida were requested to complete a survey regarding utilization of and attitudes towards IM. The survey completion rate was 75.5% (n = 331). The respondents' mean age was 48.5 years, and they were primarily white (75%), married (48%), and educated with at least a college degree (58%). The respondents were distributed between the university (74%), VA (15%), and private practice (11%). There was an equal mix of reconstructive (52%) and cosmetic (48%) visits. Overall IM utilization was 80.0%. Integrative medicine use correlated with having a college degree (P = 0.0002) and being middle age (40-64 years, P < 0.005). A higher utilization rate of IM in the private sector (87.0%) compared with the university (76.1%) and VA (71.0%) was not statistically significant (P = 0.17). Similarly, higher IM utilization in cosmetic patients compared with reconstructive patients (81% vs 74%) was not statistically significant (P = 0.56). The majority of patients stated a strong belief in self-healing techniques (71%, P < 0.005), and they desired (61%) that their physician should be familiar with these techniques (P < 0.005). The IM utilization is highly prevalent among plastic surgery patients regardless of reason for visit (cosmetic versus reconstruction) or practice setting (private versus academic versus VA). Increasing awareness of IM usage and potential impact on outcomes is especially important for academic and VA plastic surgeons. Moreover, an opportunity exists to study how certain aspects of IM can positively impact plastic surgery care.

Contrasting patterns of care for musculoskeletal disorders and injuries of the upper extremity and knee through workers' compensation and private health care insurance among union carpenters in Washington State, 1989 to 2008.

PubMed

Lipscomb, Hester J; Schoenfisch, Ashley L; Cameron, Wilfrid; Kucera, Kristen L; Adams, Darrin; Silverstein, Barbara A

2015-09-01

Musculoskeletal symptoms and disorders (MSDIs) are common reasons for visits to medical providers in the general population and they are common work-related complaints. Prior reports raise concerns as to whether declines in workers' compensation (WC) rates represent true improvement in occupational health and safety or shifting of care to other payment systems. By linking administrative records, we compared patterns of WC claims and private health care utilization for disorders of the upper extremity (UE) and knee among a large cohort of union carpenters over a 20-year period. As WC claim rates declined, private health care utilization increased. The increase was muted somewhat but sustained when adjusting for other patterns of health care utilization. Findings suggest the decline of WC claim rates do not solely represent improved occupational safety in this population, but also a considerable shifting of care to their private insurance coverage over time. © 2015 Wiley Periodicals, Inc.

Team Formation and Communication Restrictions in Collectives

NASA Technical Reports Server (NTRS)

Agogino, Adrian K.; Turner, Kagan

2003-01-01

A collective of agents often needs to maximize a "world utility" function which rates the performance of an entire system, while subject to communication restrictions among the agents. Such communication restrictions make it difficult for agents which try to pursue their own "private" utilities to take actions that also help optimize the world utility. Team formation presents a solution to this problem, where by joining other agents, an agent can significantly increase its knowledge about the environment and improve its chances of both optimizing its own utility and that its doing so will contribute to the world utility. In this article we show how utilities that have been previously shown to be effective in collectives can be modified to be more effective in domains with moderate communication restrictions resulting in performance improvements of up to 75%. Additionally we show that even severe communication constraints can be overcome by forming teams where each agent of a team shares the same utility, increasing performance an additional 25%. We show that utilities and team sizes can be manipulated to form the best compromise between how "aligned" an agent s utility is with the world utility and how easily an agent can learn that utility.

Using Medical Claims for Policy Effectiveness Surveillance: Reimbursement and Utilization of Abdomen/Pelvis Computed Tomography Scans.

PubMed

Horný, Michal; Morgan, Jake R; Merker, Vanessa L

2015-12-01

To quantify changes in private insurance payments for and utilization of abdominal/pelvic computed tomography scans (CTs) after 2011 changes in CPT coding and Medicare reimbursement rates, which were designed to reduce costs stemming from misvalued procedures. TruvenHealth Analytics MarketScan Commercial Claims and Encounters database. We used difference-in-differences models to compare combined CTs of the abdomen/pelvis to CTs of the abdomen or pelvis only. Our main outcomes were inflation-adjusted log payments per procedure, daily utilization rates, and total annual payments. Claims data were extracted for all abdominal/pelvic CTs performed in 2009-2011 within noncapitated, employer-sponsored private plans. Adjusted payments per combined CTs of the abdomen/pelvis dropped by 23.8 percent (p < .0001), and their adjusted daily utilization rate accelerated by 0.36 percent (p = .034) per month after January 2011. Utilization rate of abdominal-only or pelvic-only CTs dropped by 5.0 percent (p < .0001). Total annual payments for combined CTs of the abdomen/pelvis decreased in 2011 despite the increased utilization. Private insurance payments for combined CTs of the abdomen/pelvis declined and utilization accelerated significantly after 2011 policy changes. While growth in total annual payments was contained in 2011, it may not be sustained if 2011 utilization trends persist. © Health Research and Educational Trust.

Out-of-pocket expenses for maternity care in rural Bangladesh: a public-private comparison.

PubMed

Rahman, Moshiur; Rob, Ubaidur; Noor, Forhana Rahman; Bellows, Benjamin

Out-of-pocket expenses incurred by women for availing maternal healthcare services at public and private health facilities in Bangladesh were examined using a baseline household survey evaluating the impact of demand side financing vouchers on utilization and service delivery for maternal healthcare. The survey was conducted in 2010 among 3,300 women who gave birth in the previous 12 months from the start of data collection. Information on costs incurred to receive antenatal, delivery, and postnatal care services was collected. Findings reveal that the majority of women reported paying out-of-pocket expenses for availing maternal healthcare services both at public and private health facilities. Out-of-pocket expenses include registration, consultation, laboratory examination, medicine, transportation, and other associated costs incurred for receiving maternal healthcare services. On average, women paid US$3.60 out-of-pocket expenses for receiving antenatal care at public health facilities and US$12.40 at private health facilities. Similarly, women paid one and half times more for normal (US$42.30) and cesarean deliveries (US$136.20) at private health facilities compared to public health facilities. On the other hand, costs for postnatal care services did not vary significantly between public and private health facilities. Utilization of maternal healthcare services can be improved if out-of-pocket expenses can be minimized. At the same time, effective demand generation strategies are necessary to encourage women to utilize health facilities.

Simulation of Hawaiian Electric Companies Feeder Operations with Advanced Inverters and Analysis of Annual Photovoltaic Energy Curtailment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Giraldez Miner, Julieta I.; Nagarajan, Adarsh; Gotseff, Peter

The Hawaiian Electric Companies achieved a consolidated Renewable Portfolio Standard (RPS) of approximately 26% at the end of 2016. This significant RPS performance was achieved using various renewable energy sources - biomass, geothermal, solar photovoltaic (PV) systems, hydro, wind, and biofuels - and customer-sited, grid-connected technologies (primarily private rooftop solar PV systems). The Hawaiian Electric Companies are preparing grid-modernization plans for the island grids. The plans outline specific near-term actions to accelerate the achievement of Hawai'i's 100% RPS by 2045. A key element of the Companies' grid-modernization strategy is to utilize new technologies - including storage and PV systems withmore » grid-supportive inverters - that will help to more than triple the amount of private rooftop solar PV systems. The Hawaiian Electric Companies collaborated with the Smart Inverter Technical Working Group Hawai'i (SITWG) to partner with the U.S. Department of Energy's National Renewable Energy Laboratory (NREL) to research the implementation of advanced inverter grid support functions (GSF). Together with the technical guidance from the Companies's planning engineers and stakeholder input from the SITWG members, NREL proposed a scope of work that explored different modes of voltage-regulation GSF to better understand the trade-offs of the grid benefits and curtailment impacts from the activation of selected advanced inverter grid support functions. The simulation results presented in this report examine the effectiveness in regulating voltage as well as the impact to the utility and the customers of various inverter-based grid support functions on two Hawaiian Electric distribution substations.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stewart, John; Halbgewachs, Ron; Chavez, Adrian

The manner in which the control systems are being designed and operated in the energy sector is undergoing some of the most significant changes in history due to the evolution of technology and the increasing number of interconnections to other system. With these changes however come two significant challenges that the energy sector must face; 1) Cyber security is more important than ever before, and 2) Cyber security is more complicated than ever before. A key requirement in helping utilities and vendors alike in meeting these challenges is interoperability. While interoperability has been present in much of the discussions relatingmore » to technology utilized within the energy sector and especially the Smart Grid, it has been absent in the context of cyber security. The Lemnos project addresses these challenges by focusing on the interoperability of devices utilized within utility control systems which support critical cyber security functions. In theory, interoperability is possible with many of the cyber security solutions available to utilities today. The reality is that the effort required to achieve cyber security interoperability is often a barrier for utilities. For example, consider IPSec, a widely-used Internet Protocol to define Virtual Private Networks, or tunnels , to communicate securely through untrusted public and private networks. The IPSec protocol suite has a significant number of configuration options and encryption parameters to choose from, which must be agreed upon and adopted by both parties establishing the tunnel. The exercise in getting software or devices from different vendors to interoperate is labor intensive and requires a significant amount of security expertise by the end user. Scale this effort to a significant number of devices operating over a large geographical area and the challenge becomes so overwhelming that it often leads utilities to pursue solutions from a single vendor. These single vendor solutions may inadvertently lock utilities into proprietary and closed systems.« less

The Level of Utilizing Blended Learning in Teaching Science from the Point of View of Science Teachers in Private Schools of Ajman Educational Zone

ERIC Educational Resources Information Center

Al-Derbashi, Khaled Y.; Abed, Osama H.

2017-01-01

This study aims to define the level of utilizing blended learning in teaching science from the point of view of science teachers (85 male and female teachers) who are working in private schools of Ajman Educational Zone. The study also aims to find if there are significant differences according to gender, years of experience, or the fact that…

The past, present, and future of U.S. utility demand-side management programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Eto, J.

Demand-side management or DSM refers to active efforts by electric and gas utilities to modify customers` energy use patterns. The experience in the US shows that utilities, when provided with appropriate incentives, can provide a powerful stimulus to energy efficiency in the private sector. This paper describes the range and history of DSM programs offered by US electric utilities, with a focus on the political, economic, and regulatory events that have shaped their evolution. It also describes the changes these programs are undergoing as a result of US electricity industry restructuring. DSM programs began modestly in the 1970s in responsemore » to growing concerns about dependence on foreign sources of oil and environmental consequences of electricity generation, especially nuclear power. The foundation for the unique US partnership between government and utility interests can be traced first to the private-ownership structure of the vertically integrated electricity industry and second to the monopoly franchise granted by state regulators. Electricity industry restructuring calls into question both of these basic conditions, and thus the future of utility DSM programs for the public interest. Future policies guiding ratepayer-funded energy-efficiency DSM programs will need to pay close attention to the specific market objectives of the programs and to the balance between public and private interests.« less

Overview of ARPA low-cost ceramic composites (LC{sup 3}) program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Adler, P.N.

1996-12-31

Grumman is currently leading an approximate $10M ARPA cost-shared program aimed at developing low-cost fabrication methodology for manufacturing ceramic matrix composite (CMC) structural components. One of the program goals is to demonstrate the effectiveness of an advanced materials partnership. A vertically integrated collaboration now exists that combines the talents of three large private sector organizations, two smaller private sector organizations, three universities, and three federal government laboratories. Work in progress involves preceramic polymer (Blackglas{trademark}) CMC materials technology, RTM and pyrolysis process modeling & simulation, and utilization of low-cost approaches for fabricating a CMC demonstration engine seal component. This paper reviewsmore » the program organization, functioning, and some of the highlights of the technical work, which is of interest to the DoD as well as the commercial sector.« less

77 FR 43039 - Federal Acquisition Regulation; Contractors Performing Private Security Functions Outside the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-23

... Federal Acquisition Regulation; Contractors Performing Private Security Functions Outside the United.... 110-181, enacted January 28, 2008), section 862, entitled ``Contractors Performing Private Security... NDAA required standardization of rules for private security contractors that are performing in...

48 CFR 225.370-4 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... private security functions; (A) All armored vehicles, helicopters, and other military vehicles must be... personnel performing private security functions in designated areas are addressed in Department of Defense... performance of private security functions or other supplies or services. (c) DoD requires contractors...

The Development of Local Private Primary and Secondary Schooling in Hong Kong, 1841-2012

ERIC Educational Resources Information Center

Cheung, Alan C. K.; Randall, E. Vance; Tam, Man Kwan

2016-01-01

Purpose: This paper is a historical review of the development of private primary and secondary education in Hong Kong from 1841-2012. The purpose of this paper is to examine the evolving relationship between the state and private schools in Hong Kong. Design/methodology/approach: This paper utilizes sources from published official documents,…

Constructing a Measure of Private-pay Nursing Home Days.

PubMed

Thomas, Kali S; Silver, Benjamin; Gozalo, Pedro L; Dosa, David; Grabowski, David C; Makineni, Rajesh; Mor, Vincent

2018-05-01

Nursing home (NH) care is financed through multiple sources. Although Medicaid is the predominant payer for NH care, over 20% of residents pay out-of-pocket for their care. Despite this large percentage, an accepted measure of private-pay NH occupancy has not been established and little is known about the types of facilities and the long-term care markets that cater to this population. To describe 2 novel measures of private-pay utilization in the NH setting, including the proportion of privately financed residents and resident days, and examine their construct validity. Retrospective descriptive analysis of US NHs in 2007-2009. We used Medicare claims, Medicare Enrollment records, and the Minimum Data Set to create measures of private-pay resident prevalence and proportion of privately financed NH days. We compared our estimates of private-pay utilization to payer data collected in the NH annual certification survey and evaluated the relationships of our measures with facility characteristics. Our measures of private-pay resident prevalence and private-pay days are highly correlated (r=0.83, P<0.001 and r=0.83, P<0.001, respectively) with the rate of "other payer" reported in the annual certification survey. We also observed a significantly higher proportion of private-pay residents and days in higher quality facilities. This new methodology provides estimates of private-pay resident prevalence and resident days. These measures were correlated with estimates using other data sources and validated against measures of facility quality. These data set the stage for additional work to examine questions related to NH payment, quality of care, and responses to changes in the long-term care market.

When the private sphere goes public: exploring the issues facing family caregiver organizations in the development of long-term care policies.

PubMed

Rozario, Philip A; Palley, Elizabeth

2008-01-01

Though family caregiving forms the backbone of the long-term care system in the United States, long-term care policies have traditionally focused on paid services that frail older people and people with disabilities utilize for their day-to-day functioning. Part of the exclusion of family caregiving from the long-term care discourse stems from the traditional separation of the private sphere, where family caregiving occurs, from the public sphere of policy making. However, the passage of the Family and Medical Leave Act (FMLA), the National Family Caregiver Support Program (NFCSP) and Medicaid waiver legislation may reflect recent changes in the government's position on their role in addressing issues related to the "private spheres." In this article, we explore the nature of family caregiving in the United States, the divide between the public and private spheres and provide an overview of family caregiving-related policies and programs in the U.S. In our review, we examine the provisions in the FMLA, NFCSP, and Medicaid waiver legislation that support family caregiving efforts. We also examine the roles of family caregiver organizations in making family caregiving an important element of long-term care policy and influencing policy-making.

48 CFR 225.370-4 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... personnel performing private security functions in designated areas are addressed in Department of Defense... contract is for the performance of private security functions or other supplies or services. (c) DoD... of the contractor who are responsible for performing private security functions comply with orders...

An evaluation of public, private, and mobile health clinic usage for children under age 5 in Aceh after the tsunami: implications for future disasters

PubMed Central

Rassekh, Bahie Mary; Shu, Winnie; Santosham, Mathuram; Burnham, Gilbert; Doocy, Shannon

2014-01-01

Background: Aceh, Indonesia, was the hardest-hit area in the 26 December 2004 Indian Ocean earthquake and tsunami, with more than 500,000 people displaced, 120,000 people dead, and total damages and losses estimated at $4.5 billion. The relief effort following the tsunami was also immense. Objectives: This study aimed to determine and assess utilization patterns of formal public versus private and mobile health services for children under age 5 with diarrhea, cough and difficulty breathing, fever, or skin disease and to identify determinants of care usage. Methods: A household survey of 962 households was administered to caretakers of children aged 1–5 years. A sample of clusters within Banda Aceh and Aceh Besar were selected and those caretakers within the cluster who fit the inclusion criteria were interviewed. Results: Of those caretakers who utilized formal health services as the first line of care for their sick child, 62% used a public health facility, 30% used a private health facility, and 8% used a mobile clinic. In terms of significant factors associated with public, private, and mobile care utilization, mobile clinics were at one side of the spectrum and private clinics were at the other side overall, with public care somewhere in between. This was true for several variables. Mobile clinic users reported the lowest cost of services and medicine and the highest perceived level of accessibility, and private care users reported the highest perceived level of satisfaction. Conclusions: Utilization of formal health services for children was quite high after the tsunami. The caretaker's perceived satisfaction with public health services could have been improved. Mobile clinics were an accessible source of health care and could be used in future disaster relief efforts to target those populations that seek less care for their sick children, including displaced populations, and those children whose parents have died. PMID:25750788

Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage.

PubMed

Nandi, Sulakshana; Schneider, Helen; Dixit, Priyanka

2017-01-01

Research on impact of publicly financed health insurance has paid relatively little attention to the nature of healthcare provision the schemes engage. India's National Health Insurance Scheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, public and private sectors provide hospital services in a context of extensive gender, social, economic and geographical inequities. This study examined enrolment, utilization (public and private) and out of pocket (OOP) expenditure for the insured and uninsured, in Chhattisgarh. The Chhattisgarh State Central sample (n = 6026 members) of the 2014 National Sample Survey (71st Round) on Health was extracted and analyzed. Variables of enrolment, hospitalization, out of pocket (OOP) expenditure and catastrophic expenditure were descriptively analyzed. Multivariate analyses of factors associated with enrolment, hospitalization (by sector) and OOP expenditure were conducted, taking into account gender, socio-economic status, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalization were 33/1000 population among the insured and 29/1000 among the uninsured. Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents, Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations. Although the insured were less likely to incur out of pocket (OOP) expenditure, 95.1% of insured private sector users and 66.0% of insured public sector users, still incurred costs. Median OOP payments in the private sector were eight times those in the public sector. Of households with at least one member hospitalized, 35.5% experienced catastrophic health expenditures (>10% monthly household consumption expenditure). The study finds that despite insurance coverage, the majority still incurred OOP expenditure. The public sector was nevertheless less expensive, and catered to the more vulnerable groups. It suggests the need to further examine the roles of public and private sectors in financial risk protection through government health insurance.

Hospital utilization and out of pocket expenditure in public and private sectors under the universal government health insurance scheme in Chhattisgarh State, India: Lessons for universal health coverage

PubMed Central

Schneider, Helen; Dixit, Priyanka

2017-01-01

Research on impact of publicly financed health insurance has paid relatively little attention to the nature of healthcare provision the schemes engage. India’s National Health Insurance Scheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, public and private sectors provide hospital services in a context of extensive gender, social, economic and geographical inequities. This study examined enrolment, utilization (public and private) and out of pocket (OOP) expenditure for the insured and uninsured, in Chhattisgarh. The Chhattisgarh State Central sample (n = 6026 members) of the 2014 National Sample Survey (71st Round) on Health was extracted and analyzed. Variables of enrolment, hospitalization, out of pocket (OOP) expenditure and catastrophic expenditure were descriptively analyzed. Multivariate analyses of factors associated with enrolment, hospitalization (by sector) and OOP expenditure were conducted, taking into account gender, socio-economic status, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalization were 33/1000 population among the insured and 29/1000 among the uninsured. Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents, Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations. Although the insured were less likely to incur out of pocket (OOP) expenditure, 95.1% of insured private sector users and 66.0% of insured public sector users, still incurred costs. Median OOP payments in the private sector were eight times those in the public sector. Of households with at least one member hospitalized, 35.5% experienced catastrophic health expenditures (>10% monthly household consumption expenditure). The study finds that despite insurance coverage, the majority still incurred OOP expenditure. The public sector was nevertheless less expensive, and catered to the more vulnerable groups. It suggests the need to further examine the roles of public and private sectors in financial risk protection through government health insurance. PMID:29149181

A Literature Survey of Private Sector Methods of Determining Personal Financial Responsibility

DTIC Science & Technology

1988-09-01

private sector methods to the public sector is also discussed. The judgmental and empirical methods are each effective. Their utilization is based upon their respective abilities to minimize cost while achieving the organization’s

Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature.

PubMed

Patouillard, Edith; Goodman, Catherine A; Hanson, Kara G; Mills, Anne J

2007-11-07

There has been a growing interest in the role of the private for-profit sector in health service provision in low- and middle-income countries. The private sector represents an important source of care for all socioeconomic groups, including the poorest and substantial concerns have been raised about the quality of care it provides. Interventions have been developed to address these technical failures and simultaneously take advantage of the potential for involving private providers to achieve public health goals. Limited information is available on the extent to which these interventions have successfully expanded access to quality health services for poor and disadvantaged populations. This paper addresses this knowledge gap by presenting the results of a systematic literature review on the effectiveness of working with private for-profit providers to reach the poor. The search topic of the systematic literature review was the effectiveness of interventions working with the private for-profit sector to improve utilization of quality health services by the poor. Interventions included social marketing, use of vouchers, pre-packaging of drugs, franchising, training, regulation, accreditation and contracting-out. The search for published literature used a series of electronic databases including PubMed, Popline, HMIC and CabHealth Global Health. The search for grey and unpublished literature used documents available on the World Wide Web. We focused on studies which evaluated the impact of interventions on utilization and/or quality of services and which provided information on the socioeconomic status of the beneficiary populations. A total of 2483 references were retrieved, of which 52 qualified as impact evaluations. Data were available on the average socioeconomic status of recipient communities for 5 interventions, and on the distribution of benefits across socioeconomic groups for 5 interventions. Few studies provided evidence on the impact of private sector interventions on quality and/or utilization of care by the poor. It was, however, evident that many interventions have worked successfully in poor communities and positive equity impacts can be inferred from interventions that work with types of providers predominantly used by poor people. Better evidence of the equity impact of interventions working with the private sector is needed for more robust conclusions to be drawn.

Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature

PubMed Central

Patouillard, Edith; Goodman, Catherine A; Hanson, Kara G; Mills, Anne J

2007-01-01

Background There has been a growing interest in the role of the private for-profit sector in health service provision in low- and middle-income countries. The private sector represents an important source of care for all socioeconomic groups, including the poorest and substantial concerns have been raised about the quality of care it provides. Interventions have been developed to address these technical failures and simultaneously take advantage of the potential for involving private providers to achieve public health goals. Limited information is available on the extent to which these interventions have successfully expanded access to quality health services for poor and disadvantaged populations. This paper addresses this knowledge gap by presenting the results of a systematic literature review on the effectiveness of working with private for-profit providers to reach the poor. Methods The search topic of the systematic literature review was the effectiveness of interventions working with the private for-profit sector to improve utilization of quality health services by the poor. Interventions included social marketing, use of vouchers, pre-packaging of drugs, franchising, training, regulation, accreditation and contracting-out. The search for published literature used a series of electronic databases including PubMed, Popline, HMIC and CabHealth Global Health. The search for grey and unpublished literature used documents available on the World Wide Web. We focused on studies which evaluated the impact of interventions on utilization and/or quality of services and which provided information on the socioeconomic status of the beneficiary populations. Results A total of 2483 references were retrieved, of which 52 qualified as impact evaluations. Data were available on the average socioeconomic status of recipient communities for 5 interventions, and on the distribution of benefits across socioeconomic groups for 5 interventions. Conclusion Few studies provided evidence on the impact of private sector interventions on quality and/or utilization of care by the poor. It was, however, evident that many interventions have worked successfully in poor communities and positive equity impacts can be inferred from interventions that work with types of providers predominantly used by poor people. Better evidence of the equity impact of interventions working with the private sector is needed for more robust conclusions to be drawn. PMID:17988396

Differentially Private Frequent Subgraph Mining

PubMed Central

Xu, Shengzhi; Xiong, Li; Cheng, Xiang; Xiao, Ke

2016-01-01

Mining frequent subgraphs from a collection of input graphs is an important topic in data mining research. However, if the input graphs contain sensitive information, releasing frequent subgraphs may pose considerable threats to individual's privacy. In this paper, we study the problem of frequent subgraph mining (FGM) under the rigorous differential privacy model. We introduce a novel differentially private FGM algorithm, which is referred to as DFG. In this algorithm, we first privately identify frequent subgraphs from input graphs, and then compute the noisy support of each identified frequent subgraph. In particular, to privately identify frequent subgraphs, we present a frequent subgraph identification approach which can improve the utility of frequent subgraph identifications through candidates pruning. Moreover, to compute the noisy support of each identified frequent subgraph, we devise a lattice-based noisy support derivation approach, where a series of methods has been proposed to improve the accuracy of the noisy supports. Through formal privacy analysis, we prove that our DFG algorithm satisfies ε-differential privacy. Extensive experimental results on real datasets show that the DFG algorithm can privately find frequent subgraphs with high data utility. PMID:27616876

Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area.

PubMed

Pappa, Evelina; Niakas, Dimitris

2006-11-02

Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Data was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.

The Impact of the Affordable Care Act's Dependent Coverage Mandate on Use of Dental Treatments and Preventive Services.

PubMed

Shane, Dan M; Wehby, George L

2017-09-01

Oral health problems are the leading chronic conditions among children and younger adults. Lack of dental coverage is thought to be an important barrier to care but little empirical evidence exists on the causal effect of private dental coverage on use of dental services. We explore the relationship between dental coverage and dental services utilization with an analysis of a natural experiment of increasing private dental coverage stemming from the Affordable Care Act's (ACA)-dependent coverage mandate. To evaluate whether increased private dental insurance due to the spillover effect of the ACA-dependent coverage health insurance mandate affected utilization of dental services among a group of affected young adults. 2006-2013 Medical Expenditure Panel Surveys. We used a difference-in-difference regression approach comparing changes in dental care utilization for 25-year olds affected by the policy to unaffected 27-year olds. We evaluate effects on dental treatments and preventive services RESULTS:: Compared to 27-year olds, 25-year olds were 8 percentage points more likely to have private dental coverage in the 3 years following the mandate. We do not find compelling evidence that young adults increased their use of preventive dental services in response to gaining insurance. We do find a nearly 5 percentage point increase in the likelihood of dental treatments among 25-year olds following the mandate, an effect that appears concentrated among women. Increases in private dental coverage due to the ACA's-dependent coverage mandate do not appear to be driving significant changes in overall preventive dental services utilization but there is evidence of an increase in restorative care.

Challenges of medicines management in the public and private sector under Ghana's National Health Insurance Scheme - A qualitative study.

PubMed

Ashigbie, Paul G; Azameti, Devine; Wirtz, Veronika J

2016-01-01

Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring more equitable financing of health care to improve access to health services. This qualitative study examines the challenges and consequences of medicines management policies and practices under the NHIS as perceived by public and private service providers. This study was conducted in health facilities in the Eastern, Greater Accra and Volta regions of Ghana between July and August 2014. We interviewed 26 Key Informants (KIs) from a purposively selected sample of public and private sector providers (government and mission hospitals, private hospitals and private standalone pharmacies), pharmaceutical suppliers and NHIS district offices. Data was collected using semi-structured interview guides which covered facility accreditation, reimbursement practices, medicines selection, purchasing and pricing of medicines, and utilization of medicines. Codes for data analysis were developed based on the study questions and also in response to themes that emerged from the transcripts and notes. Most KIs agreed that the introduction of the NHIS has increased access to and utilization of medicines by removing cost barriers for patients; however, some pointed out the increased utilization could also be corollary to moral hazard. Common concerns across all facilities were the delays in receiving NHIS reimbursements, and low reimbursement rates for medicines which result in providers asking patients to pay supplementary fees. KIs reported important differences between private and public sectors including weak separation of prescribing and dispensing and limited use of drugs and therapeutic committees in the private sector, the disproportionate effects of unfavorable reimbursement prices for medicines, and inadequate participation of the private sector providers (especially pharmacies and licensed chemical sellers) in the NHIS. Health providers generally perceive the NHIS to have had a largely positive impact on access to medicines. However, concerns remain about equity in access to medicines and the differences in quality of pharmaceutical care delivered by private and public providers. Routine monitoring of medicines use during the implementation of health insurance schemes is important to identify and address the potential consequences of medicines policies and practices under the scheme.

1977 Nationwide Personal Transportation Study : household vehicle utilization

DOT National Transportation Integrated Search

1981-04-01

This report is part of a series that presents findings from the 1977 Nationwide Personal Transportation Study (NPTS). This report describes patterns of utilization of private vehicles (annual miles driven) in 1977. Utilization is keyed to estimates p...

Utilities Privatization-Is the US Army on the Right Circuit?

DTIC Science & Technology

2009-04-29

is interested, the DoD must use competitive procedures to make the selection. DoD must receive an amount equal to the fair market value (FMV) of the...Aid of Construction versus Fair Market Value Issue and Discussion The first utilities privatization issue existing today centers around the payment of...a 10 percent depreciation rate of the system value so the contract length of the pay-back is 10 years. The contractor’s interest rate or rate of

Michael Jackson, Bin Laden and I: functions of positive and negative, public and private flashbulb memories.

PubMed

Demiray, Burcu; Freund, Alexandra M

2015-01-01

This study examined the perceived psychosocial functions of flashbulb memories: It compared positive and negative public flashbulb memories (positive: Bin Laden's death, negative: Michael Jackson's death) with private ones (positive: pregnancy, negative: death of a loved one). A sample of n = 389 young and n = 176 middle-aged adults answered canonical category questions used to identify flashbulb memories and rated the personal significance, the psychological temporal distance, and the functions of each memory (i.e., self-continuity, social-boding, directive functions). Hierarchical regressions showed that, in general, private memories were rated more functional than public memories. Positive and negative private memories were comparable in self-continuity and directionality, but the positive private memory more strongly served social functions. In line with the positivity bias in autobiographical memory, positive flashbulb memories felt psychologically closer than negative ones. Finally, middle-aged adults rated their memories as less functional regarding self-continuity and social-bonding than young adults. Results are discussed regarding the tripartite model of autobiographical memory functions.

47 CFR 80.507 - Scope of service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... locations. Marine utility stations on ships are operated as ship stations. (d) Each private coast station is... of ships including the transmission of safety communication. (b) In areas where environmental... the ships with which they normally communicate. Private coast stations may provide environmental...

47 CFR 80.507 - Scope of service.

Code of Federal Regulations, 2012 CFR

2012-10-01

... locations. Marine utility stations on ships are operated as ship stations. (d) Each private coast station is... of ships including the transmission of safety communication. (b) In areas where environmental... the ships with which they normally communicate. Private coast stations may provide environmental...

47 CFR 80.507 - Scope of service.

Code of Federal Regulations, 2011 CFR

2011-10-01

... locations. Marine utility stations on ships are operated as ship stations. (d) Each private coast station is... of ships including the transmission of safety communication. (b) In areas where environmental... the ships with which they normally communicate. Private coast stations may provide environmental...

47 CFR 80.507 - Scope of service.

Code of Federal Regulations, 2014 CFR

2014-10-01

... locations. Marine utility stations on ships are operated as ship stations. (d) Each private coast station is... of ships including the transmission of safety communication. (b) In areas where environmental... the ships with which they normally communicate. Private coast stations may provide environmental...

47 CFR 80.507 - Scope of service.

Code of Federal Regulations, 2013 CFR

2013-10-01

... locations. Marine utility stations on ships are operated as ship stations. (d) Each private coast station is... of ships including the transmission of safety communication. (b) In areas where environmental... the ships with which they normally communicate. Private coast stations may provide environmental...

Emergency obstetric and newborn care signal functions in public and private facilities in Bangladesh.

PubMed

Roy, Lumbini; Biswas, Taposh Kumar; Chowdhury, Mahbub Elahi

2017-01-01

Signal functions for emergency obstetric and newborn care (EmONC) are the major interventions for averting maternal and neonatal mortalities. Readiness of the facilities is essential to provide all the basic and comprehensive signal functions for EmONC to ensure emergency services from the designated facilities. The study assessed population coverage and availability of EmONC services in public and private facilities in Bangladesh. An assessment was conducted in all the public and private facilities providing obstetric care in to in-patients 24 districts. Data were collected on the performance of signal functions for EmONC from the study facilities in the last three months prior to the date of assessment. Trained data-collectors interviewed the facility managers and key service providers, along with review of records, using contextualized tools. Population coverage of signal functions was assessed by estimating the number of facilities providing the signal functions for EmONC compared to the United Nations requirements. Availability was assessed in terms of the proportion of facilities providing the services by type of facilities and by district. Caesarean section (CS) delivery and blood transfusion (BT) services (the two major components of comprehensive EmONC) were respectively available in 6.4 (0.9 public and 5.5 private) and 5.6 (1.3 public and 4.3 private) facilities per 500,000 population. The signal functions for basic EmONC, except two (parental anticonvulsants and assisted vaginal delivery), were available in a minimum of 5 facilities (public and private sectors combined) per 500,000 population. A major inter-district variation in the availability of signal functions was observed in each public- and private-sector facility. Among the various types of facilities, only the public medical college hospitals had all the signal functions. The situation was poor in other public facilities at the district and sub-district levels as well as in private facilities. In the public sector, CS delivery and BT services were available in the minimum required number of facilities. However, to ensure basic EmONC services, participation of the private sector is necessary. Public-private partnership should be promoted for nationwide coverage of signal functions for EmONC in Bangladesh.

Models of public-private engagement for health services delivery and financing in Southern Africa: a systematic review.

PubMed

Whyle, Eleanor Beth; Olivier, Jill

2016-12-01

In low- and middle-income countries (LMICs), the private sector-including international donors, non-governmental organizations, for-profit providers and traditional healers-plays a significant role in health financing and delivery. The use of the private sector in furthering public health goals is increasingly common. By working with the private sector through public -: private engagement (PPE), states can harness private sector resources to further public health goals. PPE initiatives can take a variety of forms and understanding of these models is limited. This paper presents the results of a Campbell systematic literature review conducted to establish the types and the prevalence of PPE projects for health service delivery and financing in Southern Africa. PPE initiatives identified through the review were categorized according to a PPE typology. The review reveals that the full range of PPE models, eight distinct models, are utilized in the Southern African context. The distribution of the available evidence-including significant gaps in the literature-is discussed, and key considerations for researchers, implementers, and current and potential PPE partners are presented. It was found that the literature is disproportionately representative of PPE initiatives located in South Africa, and of those that involve for-profit partners and international donors. A significant gap in the literature identified through the study is the scarcity of information regarding the relationship between international donors and national governments. This information is key to strengthening these partnerships, improving partnership outcomes and capacitating recipient countries. The need for research that disaggregates PPE models and investigates PPE functioning in context is demonstrated. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Does Insurance Matter? Implementing Dialectical Behavior Therapy with Two Groups of Youth Engaged in Deliberate Self-Harm

PubMed Central

James, Sigrid; Freeman, Kim; Mayo, Danessa; Riggs, Matt; Morgan, Joshua P.; Schaepper, Mary Ann; Montgomery, Susanne B.

2014-01-01

This paper presents the outcomes of a Dialectical Behavior Treatment (DBT) program, implemented in intensive outpatient care with two groups of adolescents (n=55 and n=45), ages 12–18, who engaged in deliberate self-harm (DSH) but had different insurance/funding sources and risk backgrounds. This pre-post study examined variability in clinical functioning and treatment utilization between the two groups and investigated moderating risk factors. Findings support DBT’s effectiveness in improving clinical functioning for youth with DSH regardless of insurance type. However, lower rates of treatment completion among youth without private insurance call for extra engagement efforts to retain high-risk youth in DBT. PMID:25199812

Review of Reports on Lake Erie-Lake Ontario Waterway, New York. Appendix E. Impact Assessment and Environment Plan.

DTIC Science & Technology

1973-10-01

estate 4.0 1.I 3.5 8.7 Transportation 6. 0 1.8 5.4 .3 (: ommunication and public utilities .).2 1.4 2. 3.5 Services 10. -1.7 10.1 16.1 Government 17.7...tourist directed. Tourism is reduced, in part, because "the poor environmental quality of the waterfront and the lack of comprehensibility and focus in...varied facilities also serve local and regional recreation functions. In addition to the park lands, an extensive private commercial tourism sector

Utilization of the state led public private partnership program "Chiranjeevi Yojana" to promote facility births in Gujarat, India: a cross sectional community based study.

PubMed

Yasobant, Sandul; Vora, Kranti Suresh; Shewade, Hemant Deepak; Annerstedt, Kristi Sidney; Isaakidis, Petros; Mavalankar, Dileep V; Dholakia, Nishith B; De Costa, Ayesha

2016-07-15

"Chiranjeevi Yojana (CY)", a state-led large-scale demand-side financing scheme (DSF) under public-private partnership to increase institutional delivery, has been implemented across Gujarat state, India since 2005. The scheme aims to provide free institutional childbirth services in accredited private health facilities to women from socially disadvantaged groups (eligible women). These services are paid for by the state to the private facility with the intention of service being free to the user. This community-based study estimates CY uptake among eligible women and explores factors associated with non-utilization of the CY program. This was a community-based cross sectional survey of eligible women who gave birth between January and July 2013 in 142 selected villages of three districts in Gujarat. A structured questionnaire was administered by trained research assistant to collect information on socio-demographic details, pregnancy details, details of childbirth and out-of-pocket (OOP) expenses incurred. A multivariable inferential analysis was done to explore the factors associated with non-utilization of the CY program. Out of 2,143 eligible women, 559 (26 %) gave birth under the CY program. A further 436(20 %) delivered at free public facilities, 713(33 %) at private facilities (OOP payment) and 435(20 %) at home. Eligible women who belonged to either scheduled tribe or poor [aOR = 3.1, 95 % CI:2.4 - 3.8] or having no formal education [aOR = 1.6, 95 % CI:1.1, 2.2] and who delivered by C-section [aOR = 2.1,95 % CI: 1.2, 3.8] had higher odds of not utilizing CY program. Of births at CY accredited facilities (n = 924), non-utilization was 40 % (n = 365) mostly because of lack of required official documentation that proved eligibility (72 % of eligible non-users). Women who utilized the CY program overall paid more than women who delivered in the free public facilities. Uptake of the CY among eligible women was low after almost a decade of implementation. Community level awareness programs are needed to increase participation among eligible women. OOP expense was incurred among who utilized CY program; this may be a factor associated with non-utilization in next pregnancy which needs to be studied. There is also a need to ensure financial protection of women who have C-section.

17 CFR 275.205-3 - Exemption from the compensation prohibition of section 205(a)(1) for investment advisers.

Code of Federal Regulations, 2012 CFR

2012-04-01

... to private funds with non-qualified investors. If you are an investment adviser to a private... private funds with non-qualified clients. If you are an investment adviser to a private investment company... functions with regard to the investment adviser) who, in connection with his or her regular functions or...

Are tax subsidies for private medical insurance self-financing? Evidence from a microsimulation model.

PubMed

López Nicolás, Angel; Vera-Hernández, Marcos

2008-09-01

This paper develops an empirical strategy to estimate whether subsidies to private medical insurance are self-financing in countries where public and private insurance coexist and the latter covers the same treatments as the former. We construct a simulation routine based on a micro-econometric discrete choice model that allows us to evaluate the impact of premium changes on the utilization of outpatient and inpatient health care services. As an application, we estimate the budgetary effects of scrapping a subsidy from the purchase of individual private policies, using micro-data from Catalonia. Our results suggest that the subsidy is not self-financing. This result is driven by the fact that private medical insurance holders make concurrent use of public and private services, and by the price inelasticity of the demand for private policies.

The rules implementing sections 201 and 210 of the Public Utility Regulatory Policies Act of 1978: A regulatory history

NASA Technical Reports Server (NTRS)

Danziger, R. N.

1980-01-01

The act provides that utilities must purchase power for qualifying producers of electricity at nondiscriminatory rates. It exempts private generators from virtually all state and federal utility regulation. Pertinent reference material is provided.

Analysis of the private market for LANDSAT products and applications

NASA Technical Reports Server (NTRS)

1981-01-01

The private sector was examined and evaluated to develop base line strategies and mechanisms for its increased utilization of LANDSAT (and future satellite) technologies as both consumer and producer of products and services. Methodologies used to assess the digital analysis service and national mapping industries are described. Private sector users in business and industry are identified and the potential U.S. industry role in the foreign LANDSAT market is considered.

The perceived impact of privatization on local health departments.

PubMed

Keane, Christopher; Marx, John; Ricci, Edmund; Barron, Gerald

2002-07-01

This article presents nationally representative data on the effects of privatization on local health departments (LHDs). A stratified representative national sample of 380 LHDs was drawn from a national list of 2488 departments. Telephone interviews were conducted with 347 LHD directors. One half of the directors of LHDs with privatized services reported that privatization helped the performance of core functions. Privatization often resulted in increased time needed for management and administration. More than a third of LHD directors reported concern about loss of control over the performance of privatized functions and services. Privatization is part of a broader shift toward "managing" rather than directly providing public health services, yet privatization often reduces LHDs' control over the performance of services.

48 CFR 25.302-4 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... performing private security functions in designated areas are addressed at 32 CFR part 159, entitled “Private... for weapons; registering and identifying armored vehicles, helicopters, and other military vehicles; and reporting specified incidents in which personnel performing private security functions under a...

Utilities Privatization in the United States Air Force

DTIC Science & Technology

2007-01-01

75 3.2.6. Independent Review............................................................................ 77 3.2.7. Fair Market Value ...101 3.5.15. Fair Market Value ............................................................................. 106 3.5.16. Recommendations by the GAO...Private Competition Decisions for FY 1995-2005... 125 4.3. Fair Market Value and Use of Should Cost .......................................... 125

Planning for patient privacy and hospitability: a must do in oncology care.

PubMed

Easter, James G

2003-01-01

The number one design challenge in the healthcare environment is the patient room. This space is one of the primary functional areas impacting hospital design and, quite often, the place of greatest controversy. This controversy is due to the length of time the patient spends in the room (compared to other areas), the amount of overall space required and the time dedicated to patient room utilization, maintenance, general arrangement and overall efficiency. In addition, there is a growing list of room types to be considered, many are of the ambulatory care, short stay and observation category. Other room types beyond the routine medical/surgical room include Intensive Care, Coronary Care, Surgical Intensive Care, Skilled Nursing, Rehabilitation and Oncology Care as well as more intensive Bone Marrow Transplantation, for example. Major features of the traditional acute care patient room require the space to be flexible, convertible, expandable and, most importantly, hospitable. For many, many years the patient room was considered a shared space with multiple beds and multiple users. The term semi-private has been used to describe the traditional two-bed and, sometimes 4-bed patient room. This article will address the programmatic elements of an inpatient area, the room and its functional components along with some examples for comparative purposes. For the oncology patient, the development of a family-focused, private room is mandatory. The private room is more flexible, less expensive to operate, safer and environmentally more appealing for the patient, family and staff.

Emergency obstetric and newborn care signal functions in public and private facilities in Bangladesh

PubMed Central

2017-01-01

Background Signal functions for emergency obstetric and newborn care (EmONC) are the major interventions for averting maternal and neonatal mortalities. Readiness of the facilities is essential to provide all the basic and comprehensive signal functions for EmONC to ensure emergency services from the designated facilities. The study assessed population coverage and availability of EmONC services in public and private facilities in Bangladesh. Methods An assessment was conducted in all the public and private facilities providing obstetric care in to in-patients 24 districts. Data were collected on the performance of signal functions for EmONC from the study facilities in the last three months prior to the date of assessment. Trained data-collectors interviewed the facility managers and key service providers, along with review of records, using contextualized tools. Population coverage of signal functions was assessed by estimating the number of facilities providing the signal functions for EmONC compared to the United Nations requirements. Availability was assessed in terms of the proportion of facilities providing the services by type of facilities and by district. Results Caesarean section (CS) delivery and blood transfusion (BT) services (the two major components of comprehensive EmONC) were respectively available in 6.4 (0.9 public and 5.5 private) and 5.6 (1.3 public and 4.3 private) facilities per 500,000 population. The signal functions for basic EmONC, except two (parental anticonvulsants and assisted vaginal delivery), were available in a minimum of 5 facilities (public and private sectors combined) per 500,000 population. A major inter-district variation in the availability of signal functions was observed in each public- and private-sector facility. Among the various types of facilities, only the public medical college hospitals had all the signal functions. The situation was poor in other public facilities at the district and sub-district levels as well as in private facilities. Conclusions In the public sector, CS delivery and BT services were available in the minimum required number of facilities. However, to ensure basic EmONC services, participation of the private sector is necessary. Public-private partnership should be promoted for nationwide coverage of signal functions for EmONC in Bangladesh. PMID:29091965

Survey Says: Using Teacher Feedback to Bolster Evaluation

ERIC Educational Resources Information Center

Wiener, Ross; Lundy, Kasia

2014-01-01

Many of the leading private sector organizations have for years embraced a survey approach to improving products, services, and internal policies and processes. Like these successful private sector businesses, school systems can utilize a similar survey-based approach to improving teacher evaluation. Here, the authors provide and outline some…

Timber and Amenities on Nonindustrial Private Forest Land

Treesearch

Subhrendu K. Pattanayak; Karen Lee Abt; Thomas P. Holmes

2003-01-01

Economic analyses of the joint production timber and amenities from nonindustrial private forest lands (NIPF) have been conducted for several decades. Binkley (1981) summarized this strand of research and elegantly articulated a microeconomic household model in which NIPF owners maximize utility by choosing optimal combinations of timber income and amenities. Most...

Teacher Perceptions of the Use of a Public-Private Partnership for School Facility Provision

ERIC Educational Resources Information Center

Bradley-Levine, Jill

2008-01-01

This article considers how the private finance initiative, a contract for infrastructure, affected teachers' perceptions of efficacy, job satisfaction, and morale at an urban secondary school in the United Kingdom. Qualitative data collection techniques, including unstructured observation and semistructured personal interviews, were utilized to…

Academic Leadership in a Private University: An Iranian Case Study

ERIC Educational Resources Information Center

Hamidifar, Fatemeh; Ebrahimi, Mansoureh

2016-01-01

This study explores effective academic leadership as well as hindrances within Iran's private higher educational institutions. The author employed a qualitative approach that utilized purposive sampling to collect and analyze data. Findings were categorized into three classes comprising the (i) setting of direction, (ii) organizational and (iii)…

Organizational Commitment among Employees at a Private Nonprofit University in Virginia

ERIC Educational Resources Information Center

Calland, David R.

2012-01-01

The purpose of this quantitative study was to investigate the similarity between the human resource strategies (benefits, due process, employee participation, employee skill level, general training, job enrichment, social interactions, wages) currently utilized at a private, nonprofit university in Virginia, and those reported in the research…

Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance.

PubMed

Sarkar, Madhurima; Earley, Elizabeth R; Asti, Lindsey; Chisolm, Deena J

This study explores comparative differentials in health care needs, health care utilization, and health status between Medicaid and private/employer-sponsored insurance (ESI) among a statewide population of children with special health care needs (CSHCN) in Ohio. We used data from the 2012 Ohio Medicaid Assessment Survey to examine CSHCN's health care needs, utilization, status, and health outcomes by insurance type. Adjusted multivariable logistic regression models were used to explore associations between public and private health insurance, as well as the utilization and health outcome variables. Bivariate analyses indicate that the Medicaid population had higher care coordination needs (odds ratio [OR] = 1.6; 95% confidence interval [CI], 1.1-2.2) as well as need for mental/educational health care services (OR = 1.5; 95% CI; 1.1-2.0). They also reported higher unmet dental care needs (OR = 2.2; 95% CI, 1.2-4.0), higher emergency department (ED) utilization (OR = 2.3; 95% CI, 1.7-3.2), and worse overall health (OR = 0.6; 95% CI, 0.4-0.7), oral health (OR = 0.4; 95% CI, 0.3-0.5), and vision health (OR = 0.4; 95% CI, 0.2-0.6). After controlling for demographic variables, CSHCN with Medicaid insurance coverage were more likely to need mental health and education services (adjusted odds ratio [AOR] = 1.8; 95% CI; 1.2-2.6), had significantly more ED visits (AOR = 2.3; 95% CI, 1.5-3.5), and were less likely to have excellent overall health (AOR = 0.64; 95% CI, 0.4-0.9), oral health (AOR = 0.43; 95% CI, 0.3-0.7), and vision health (AOR = 0.38; 95% CI, 0.2-0.6) than those with private insurance/ESI. The CSHCN population is a highly vulnerable population. While Ohio's Medicaid provides greater coverage to CSHCN, disparities continue to exist within access and services that Medicaid provides versus the ones provided by private insurance/ESI.

Hydro development in Costa Rica

DOE Office of Scientific and Technical Information (OSTI.GOV)

Young, C.F.

The initial foreign thrust of private power activities was quite naturally by large companies acquiring existing government-owned facilities in relatively large countries. Only recently, it seems, people have discovered that there are countries in Latin America other than Argentina, Brazil, and Mexico, and that there is interest in having the private sector construct new (and often smaller) facilities, with an increasing emphasis on renewable energy. Costa Rica passed its private power law in 1991 and has clearly been the most progressive country in Central America in promoting greenfield development of private power projects. The country has not been exempt, however,more » from the cyclical nature of the support that governments, utilities and regulatory agencies give to private power producers. The initial enthusiasm and willingness to encourage private power producers inevitably give way to requirements and procedures which impair if not thwart the initial intentions of the private power laws.« less

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.

Performance of fully private and concessionary water and sewerage companies: a metafrontier approach.

PubMed

Molinos-Senante, María; Sala-Garrido, Ramon

2016-06-01

As many countries have privatized their water industries, there is increasing interest in comparing the efficiency of public and private water and sewerage companies (WaSCs). However, previous studies have not considered that privatization can be carried out following two main approaches: fully private WaSCs, which involve the sale of utilities to the private sector, and concessionary WaSCs, in which only the operation of the services is privatized. This paper investigates, for the first time, the impact of both privatization approaches on the efficiency of WaSCs. In doing so, data envelopment analysis (DEA) was applied. However, unlike traditional models, the metafrontier concept was used in this research as it cannot be assumed that fully private and concessionary WaSCs share the same production frontier. The empirical application focused on the Chilean water industry as it was privatized from 1998 to 2004 following the two approaches described. The results suggest that the performance of fully private WaSCs is better than that of concessionary WaSCs. The conclusions of this study will be of great interest to water authorities worldwide facing the challenge of water industry privatization.

A Model for NASA-KSC's Privatization Transition

NASA Technical Reports Server (NTRS)

Lavelle, Jerome P.; Krumwiede, Dennis W.; Flowers, Jean

1996-01-01

This paper describes a model for government agencies that are considering privatization of all or part of their functions. Privatization encompasses the transitioning of government functions from government run to contractor run. The model developed in this paper is used to analyze the National Aeronautics and Space Administration's (NASA) decision to privatize space shuttle operations at the Kennedy Space Center (KSC). Several specific recommendations are given to KSC as they attempt to operationalize this privatization decision at the Center and to transition to a new relationship with their contractors.

Assessing public and private sector contributions in reproductive health financing and utilization for six sub-Saharan African countries.

PubMed

Nguyen, Ha; Snider, Jeremy; Ravishankar, Nirmala; Magvanjav, Oyunbileg

2011-05-01

The present study provides evidence to support enhanced attention to reproductive health and comprehensive measures to increase access to quality reproductive health services. We compare and contrast the financing and utilization of reproductive health services in six sub-Saharan African countries using data from National Health Accounts and Demographic and Health Surveys. Spending on reproductive health in 2006 ranged from US$4 per woman of reproductive age in Ethiopia to US$17 in Uganda. These are below the necessary level for assuring adequate services given that an internationally recommended spending level for family planning alone was US$16 for 2006. Moreover, reproductive health spending shows signs of decline in tandem with insufficient improvement in service utilization. Public providers played a predominant role in antenatal and delivery care for institutional births, but home deliveries with unqualified attendants dominated. The private sector was a major supplier of condoms, oral pills and IUDs. Private clinics, pharmacies and drug vendors were important sources of STI treatment. The findings highlight the need to commit greatly increased funding for reproductive health services as well as more policy attention to the contribution of public, private and informal providers and the role of collaboration among them to expand access to services for under-served populations. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Context-Aware Generative Adversarial Privacy

NASA Astrophysics Data System (ADS)

Huang, Chong; Kairouz, Peter; Chen, Xiao; Sankar, Lalitha; Rajagopal, Ram

2017-12-01

Preserving the utility of published datasets while simultaneously providing provable privacy guarantees is a well-known challenge. On the one hand, context-free privacy solutions, such as differential privacy, provide strong privacy guarantees, but often lead to a significant reduction in utility. On the other hand, context-aware privacy solutions, such as information theoretic privacy, achieve an improved privacy-utility tradeoff, but assume that the data holder has access to dataset statistics. We circumvent these limitations by introducing a novel context-aware privacy framework called generative adversarial privacy (GAP). GAP leverages recent advancements in generative adversarial networks (GANs) to allow the data holder to learn privatization schemes from the dataset itself. Under GAP, learning the privacy mechanism is formulated as a constrained minimax game between two players: a privatizer that sanitizes the dataset in a way that limits the risk of inference attacks on the individuals' private variables, and an adversary that tries to infer the private variables from the sanitized dataset. To evaluate GAP's performance, we investigate two simple (yet canonical) statistical dataset models: (a) the binary data model, and (b) the binary Gaussian mixture model. For both models, we derive game-theoretically optimal minimax privacy mechanisms, and show that the privacy mechanisms learned from data (in a generative adversarial fashion) match the theoretically optimal ones. This demonstrates that our framework can be easily applied in practice, even in the absence of dataset statistics.

Variation in inpatient hospital prices and outpatient service quantities drive geographic differences in private spending in Texas.

PubMed

Franzini, Luisa; White, Chapin; Taychakhoonavudh, Suthira; Parikh, Rohan; Zezza, Mark; Mikhail, Osama

2014-12-01

To measure the contribution of market-level prices, utilization, and health risk to medical spending variation among the Blue Cross Blue Shield of Texas (BCBSTX) privately insured population and the Texas Medicare population. Claims data for all BCBSTX members and publicly available CMS data for Texas in 2011. We used observational data and decomposed overall and service-specific spending into health status and health status adjusted utilization and input prices and input prices adjusted for the BCBSTX and Medicare populations. Variation in overall BCBSTX spending across HRRs appeared driven by price variation, whereas utilization variation factored more prominently in Medicare. The contribution of price to spending variation differed by service category. Price drove inpatient spending variation, while utilization drove outpatient and professional spending variation in BCBSTX. The context in which negotiations occur may help explain the patterns across services. The conventional wisdom that Medicare does a better job of controlling prices and private plans do a better job of controlling volume is an oversimplification. BCBSTX does a good job of controlling outpatient and professional prices, but not at controlling inpatient prices. Strategies to manage the variation in spending may need to differ substantially depending on the service and payer. © Health Research and Educational Trust.

Variation in Inpatient Hospital Prices and Outpatient Service Quantities Drive Geographic Differences in Private Spending in Texas

PubMed Central

Franzini, Luisa; White, Chapin; Taychakhoonavudh, Suthira; Parikh, Rohan; Zezza, Mark; Mikhail, Osama

2014-01-01

Objective To measure the contribution of market-level prices, utilization, and health risk to medical spending variation among the Blue Cross Blue Shield of Texas (BCBSTX) privately insured population and the Texas Medicare population. Data Sources Claims data for all BCBSTX members and publicly available CMS data for Texas in 2011. Study Design We used observational data and decomposed overall and service-specific spending into health status and health status adjusted utilization and input prices and input prices adjusted for the BCBSTX and Medicare populations. Principal Findings Variation in overall BCBSTX spending across HRRs appeared driven by price variation, whereas utilization variation factored more prominently in Medicare. The contribution of price to spending variation differed by service category. Price drove inpatient spending variation, while utilization drove outpatient and professional spending variation in BCBSTX. The context in which negotiations occur may help explain the patterns across services. Conclusions The conventional wisdom that Medicare does a better job of controlling prices and private plans do a better job of controlling volume is an oversimplification. BCBSTX does a good job of controlling outpatient and professional prices, but not at controlling inpatient prices. Strategies to manage the variation in spending may need to differ substantially depending on the service and payer. PMID:24919408

The Perceived Impact of Privatization on Local Health Departments

PubMed Central

Keane, Christopher; Marx, John; Ricci, Edmund; Barron, Gerald

2002-01-01

Objectives. This article presents nationally representative data on the effects of privatization on local health departments (LHDs). Methods. A stratified representative national sample of 380 LHDs was drawn from a national list of 2488 departments. Telephone interviews were conducted with 347 LHD directors. Results. One half of the directors of LHDs with privatized services reported that privatization helped the performance of core functions. Privatization often resulted in increased time needed for management and administration. More than a third of LHD directors reported concern about loss of control over the performance of privatized functions and services. Conclusions. Privatization is part of a broader shift toward “managing” rather than directly providing public health services, yet privatization often reduces LHDs' control over the performance of services. (Am J Public Health. 2002;92:1178–1180) PMID:12084705

Partitioning-based mechanisms under personalized differential privacy.

PubMed

Li, Haoran; Xiong, Li; Ji, Zhanglong; Jiang, Xiaoqian

2017-05-01

Differential privacy has recently emerged in private statistical aggregate analysis as one of the strongest privacy guarantees. A limitation of the model is that it provides the same privacy protection for all individuals in the database. However, it is common that data owners may have different privacy preferences for their data. Consequently, a global differential privacy parameter may provide excessive privacy protection for some users, while insufficient for others. In this paper, we propose two partitioning-based mechanisms, privacy-aware and utility-based partitioning, to handle personalized differential privacy parameters for each individual in a dataset while maximizing utility of the differentially private computation. The privacy-aware partitioning is to minimize the privacy budget waste, while utility-based partitioning is to maximize the utility for a given aggregate analysis. We also develop a t -round partitioning to take full advantage of remaining privacy budgets. Extensive experiments using real datasets show the effectiveness of our partitioning mechanisms.

Partitioning-based mechanisms under personalized differential privacy

PubMed Central

Li, Haoran; Xiong, Li; Ji, Zhanglong; Jiang, Xiaoqian

2017-01-01

Differential privacy has recently emerged in private statistical aggregate analysis as one of the strongest privacy guarantees. A limitation of the model is that it provides the same privacy protection for all individuals in the database. However, it is common that data owners may have different privacy preferences for their data. Consequently, a global differential privacy parameter may provide excessive privacy protection for some users, while insufficient for others. In this paper, we propose two partitioning-based mechanisms, privacy-aware and utility-based partitioning, to handle personalized differential privacy parameters for each individual in a dataset while maximizing utility of the differentially private computation. The privacy-aware partitioning is to minimize the privacy budget waste, while utility-based partitioning is to maximize the utility for a given aggregate analysis. We also develop a t-round partitioning to take full advantage of remaining privacy budgets. Extensive experiments using real datasets show the effectiveness of our partitioning mechanisms. PMID:28932827

Philippines: Small-scale renewable energy update

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1997-12-01

This paper gives an overview of the application of small scale renewable energy sources in the Philippines. Sources looked at include solar, biomass, micro-hydroelectric, mini-hydroelectric, wind, mini-geothermal, and hybrid. A small power utilities group is being spun off the major utility, to provide a structure for developing rural electrification programs. In some instances, private companies have stepped forward, avoiding what is perceived as overwhelming beaurocracy, and installed systems with private financing. The paper provides information on survey work which has been done on resources, and the status of cooperative programs to develop renewable systems in the nation.

Examining Factors Influencing Attrition at a Small, Private, Selective Liberal Arts College

ERIC Educational Resources Information Center

Gansemer-Topf, Ann M.; Zhang, Yi; Beatty, Cameron C.; Paja, Scott

2014-01-01

Despite a diverse body of literature on college student retention, studies focusing on small, private, selective liberal arts colleges are limited. This study utilized a mixed methodology beginning with logistic regression analyses and followed with a qualitative inquiry that included interviews with students who had not persisted. While variables…

Supply of Private Acreage for Recreational Deer Hunting in Georgia

Treesearch

Neelam C. Poudyal; J. M. Bowker; Gary T. Green; Michael A. Tarrant

2012-01-01

Understanding factors that influence the supply of private acreage for lease hunting has become increasingly important to sustaining hunting. Improving on existing studies that mostly utilized landowners’ responses from contingent surveys, we adopted a different approach to this question by analyzing 2009 market data from Georgia counties. Results from multivariate...

Comparison of Ethical Dilemmas across Public and Private Sectors in Rehabilitation Counseling Practice

ERIC Educational Resources Information Center

Beveridge, Scott; Garcia, Jorge; Siblo, Matt

2015-01-01

Purpose: To examine the nature of ethical dilemmas most frequently reported by rehabilitation counselors in the private and public sectors and determine if significant differences exist in how practitioners experience ethical dilemmas in these two settings. Method: A mixed-methods internet-based survey design was utilized and included descriptive,…

Reproductive Health-Care Utilization of Young Adults Insured as Dependents.

PubMed

Andrasfay, Theresa

2018-05-01

The common practice of sending an explanation of benefits to policyholders may inadvertently disclose sensitive services to the parents of dependents, making confidentiality a potential barrier to reproductive health care. This study compares the reproductive health-care utilization of young adult dependents and young adult policyholders using nationally representative data collected after full implementation of the Affordable Care Act. Data from 2,108 young adults aged 18-25 years in the 2015 National Health Interview Survey were analyzed. Logistic regressions predicted utilization of two preventive services (general doctor visit and flu vaccination) and four reproductive health services (HIV testing, obstetrician/gynecologist visit, hormonal contraceptive use, and Pap testing) from the insurance type of the young adult (dependent, privately insured policyholder, or Medicaid). In unadjusted analyses, young adult dependents had lower utilization of HIV tests than their peers who were privately insured or Medicaid policyholders. Young women dependents had lower utilization of Pap tests than young women on Medicaid. Once controls were included, young adult dependents did not have significantly lower odds of obtaining reproductive health care than privately insured policyholders. Dependent young men still had marginally lower odds of ever having an HIV test (adjusted odds ratio = .65, p = .08) and dependent young women still had marginally lower odds of ever having a Pap test (adjusted odds ratio = .58, p = .06) than comparable Medicaid policyholders. Despite confidentiality concerns, young adults insured as dependents have utilization of several reproductive health services similar to that of comparable young adult policyholders. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Assessment of management approaches in a public water utility: A case study of the Namibia water corporation (NAMWATER)

NASA Astrophysics Data System (ADS)

Ndokosho, Johnson; Hoko, Zvikomborero; Makurira, Hodson

More than 90% of urban water supply and sanitation services in developing countries are provided by public organizations. However, public provision of services has been inherently inefficient. As a result a number of initiatives have emerged in recent years with a common goal to improve service delivery. In Namibia, the water sector reform resulted in the creation of a public utility called the Namibia Water Corporation (NAMWATER) which is responsible for bulk water supply countrywide. Since its inception in 1998, NAMWATER has been experiencing poor financial performance. This paper presents the findings of a case study that compared the management approaches of NAMWATER to the New Public Management (NPM) paradigm. The focus of the NPM approach is for the public water sector to mirror private sector methods of management so that public utilities can accrue the benefits of effectiveness, efficiency and flexibility often associated with private sector. The study tools used were a combination of literature review, interviews and questionnaires. It was found out that NAMWATER has a high degree of autonomy in its operations, albeit government approved tariffs and sourcing of external financing. The utility reports to government annually to account for results. The utility embraces a notion of good corporate culture and adheres to sound management practices. NAMWATER demonstrated a strong market-orientation indicated by the outsourcing of non-core functions but benchmarking was poorly done. NAMWATER’s customer-orientation is poor as evidenced by the lack of customer care facilities. NAMWATER’s senior management delegated operational authority to lower management to facilitate flexibility and eliminate bottlenecks. The lower management is in turn held accountable for performance by the senior management. There are no robust methods of ensuring sufficient accountability indicated by absence of performance contracts or service level agreements. It was concluded that NAMWATER’s management approaches adhere to the NPM paradigm but some NPM core-ideas such as customer orientation and external accountability (performance contracts) were visibly missing.

Symposium reports progress in utilization of off-site hardwoods

Treesearch

P. Koch

1975-01-01

On March 10 of this year, 240 industrialists and researchers from both private and public sectors gathered for three and a half days in Alexandria, Louisiana, for intensive discussions aimed at increasing utilization of small hardwoods. The symposium, "Utilization of Hardwoods Growing on Southern Pine Sites", was jointly sponsored by the Southern Forest...

Perceptions and utilization of primary health care services in Iraq: findings from a national household survey

PubMed Central

2011-01-01

Background After many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services. A network exists of public sector hospitals and clinics, as well as private clinics and a few private hospitals. Little data are available about the approximately 1400 Primary Health Care clinics (PHCCs) staffed with doctors. How do Iraqis utilize primary health care services? What are their preferences and perceptions of public primary health care clinics and private primary care services in general? How does household wealth affect choice of services? Methods A 1256 household national survey was conducted in the catchment areas of randomly selected PHCCs in Iraq. A cluster of 10 households, beginning with a randomly selected start household, were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq's 18 governorates. A questionnaire was developed using key informants. Teams of interviewers, including both males and females, were recruited and provided a week of training which included field practice. Teams then gathered data from households in the service areas of randomly selected clinics. Results Iraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector. Private clinics are generally the most popular source of primary care, however the PHCCs are utilized more by poorer households. In spite of free services available at PHCCs many households expressed difficulty in affording health care, especially in the purchase of medications. There is no evidence of informal payments to secure health services in the public sector. Conclusions There is widespread satisfaction reported with primary health care services, and levels did not differ appreciably between public and private sectors. The public sector PHCCs are preferentially used by poorer populations where they are important providers. PHCC services are indeed free, with little evidence of informal payments to providers. PMID:22176866

Health insurance and health services utilization in Ireland.

PubMed

Harmon, C; Nolan, B

2001-03-01

The numbers buying private health insurance in Ireland have continued to grow, despite a broadening in entitlement to public care. About 40% of the population now have insurance, although everyone has entitlement to public hospital care. In this paper, we examine in detail the growth in insurance coverage and the factors underlying the demand for insurance. Attitudinal responses reveal the importance of perceptions about waiting times for public care, as well as some concerns about the quality of that care. Individual characteristics, such as education, age, gender, marital status, family composition and income all influence the probability of purchasing private insurance. We also examine the relationship between insurance and utilization of hospital in-patient services. The positive effect of private insurance appears less than that of entitlement to full free health care from the state, although the latter is means-tested, and may partly represent health status. Copyright 2001 John Wiley & Sons, Ltd.

Why not? Understanding the spatial clustering of private facility-based delivery and financial reasons for homebirths in Nigeria.

PubMed

Wong, Kerry L M; Radovich, Emma; Owolabi, Onikepe O; Campbell, Oona M R; Brady, Oliver J; Lynch, Caroline A; Benova, Lenka

2018-06-01

In Nigeria, the provision of public and private healthcare vary geographically, contributing to variations in one's healthcare surroundings across space. Facility-based delivery (FBD) is also spatially heterogeneous. Levels of FBD and private FBD are significantly lower for women in certain south-eastern and northern regions. The potential influence of childbirth services frequented by the community on individual's barriers to healthcare utilization is under-studied, possibly due to the lack of suitable data. Using individual-level data, we present a novel analytical approach to examine the relationship between women's reasons for homebirth and community-level, health-seeking surroundings. We aim to assess the extent to which cost or finance acts as a barrier for FBD across geographic areas with varying levels of private FBD in Nigeria. The most recent live births of 20,467 women were georeferenced to 889 locations in the 2013 Nigeria Demographic and Health Survey. Using these locations as the analytical unit, spatial clusters of high/low private FBD were detected with Kulldorff statistics in the SatScan software package. We then obtained the predicted percentages of women who self-reported financial reasons for homebirth from an adjusted generalized linear model for these clusters. Overall private FBD was 13.6% (95%CI = 11.9,15.5). We found ten clusters of low private FBD (average level: 0.8, 95%CI = 0.8,0.8) and seven clusters of high private FBD (average level: 37.9, 95%CI = 37.6,38.2). Clusters of low private FBD were primarily located in the north, and the Bayelsa and Cross River States. Financial barrier was associated with high private FBD at the cluster level - 10% increase in private FBD was associated with + 1.94% (95%CI = 1.69,2.18) in nonusers citing cost as a reason for homebirth. In communities where private FBD is common, women who stay home for childbirth might have mild increased difficulties in gaining effective access to public care, or face an overriding preference to use private services, among other potential factors. The analytical approach presented in this study enables further research of the differentials in individuals' reasons for service non-uptake across varying contexts of healthcare surroundings. This will help better devise context-specific strategies to improve health service utilization in resource-scarce settings.

Utilization of Space Station for industrial thermophysical property measurements

NASA Astrophysics Data System (ADS)

Overfelt, Tony; Watkins, John

1996-03-01

The International Space Station represents the largest cooperative space project in history and will be industry's only reasonable access to the low-g environment for long duration R&D. Such access will provide unique and competitive capabilities to industry if private sector entities can commercially utilize the Space Station for their industrial research programs. The metal casting industry has identified the need for accurate thermophysical properties of molten alloys as a priority need. Research over the last decade has demonstrated that experimental techniques exist to containerlessly measure critical thermophysical and related properties of molten metals for improved process design. This paper describes the ``VULCAN'' concept, a proposed commercial instrument for thermophysical properties measurements on the Space Station. Finally, several issues regarding private sector utilization of the Space Station are also discussed.

Three empirical essays on energy and labor economics

NASA Astrophysics Data System (ADS)

Chow, Melissa

This dissertation analyzes the differences between private and non-private firms in two contexts. Chapters 1 and 2 examine the electricity industry in the United States and the motivation behind electric utilities' usage of demand side management programs. The first chapter focuses on load management programs, which decrease electricity demand during the peak hours of the day. It looks into the impact of a plausibly exogenous decrease in natural gas prices on the utilization and capacity of these programs. The second chapter analyzes the relationship between electricity market deregulation and electric utilities' energy efficiency activity. The third chapter investigates the impact of Chinese enterprise restructuring on employment, wage bills, and productivity. All three chapters show that different objectives due to ownership type lead to differences in firm behavior.

Social class inequalities in the use of and access to health services in Catalonia, Spain: what is the influence of supplemental private health insurance?

PubMed

Borrell, C; Fernandez, E; Schiaffino, A; Benach, J; Rajmil, L; Villalbi, J R; Segura, A

2001-04-01

To analyse social class inequalities in the access to and utilization of health services in Catalonia (Spain), and the influence of having private health insurance supplementing the National Health System (NHS) coverage. 1994 Catalan Health Interview Survey, a cross-sectional survey conducted in 1994. Catalonia (Spain). The participants were a representative sample of people aged over 14 years from the non-institutionalized population of Catalonia (n = 12,245). Health services utilization, perceived health, having only NHS or NHS plus a private health insurance, and social class. Although one-quarter of the population of Catalonia had a supplemental private health insurance, percentages were very different according to social class, ranging from almost 50% for classes I and II to 16% for classes IV and V in both sexes. No inequalities by social class were observed for the utilization of non-preventive health care services (consultation with a health professional in the last 2 weeks and hospitalization in the last year) among persons with poor self-perceived health status, i.e. those in most need. However, social inequalities still remain in the use of health services provided only partially by the NHS, and when characteristics of last consultation are taken into account. Subjects who paid for a private service waited an average of 18.8 minutes less than those attending the NHS. Within the NHS, social classes IV and V waited longer (35.5 minutes) than social classes I and II (28.4 minutes). The NHS in Catalonia, Spain, has reduced inequalities in the use of health services. Social inequalities remain in the use of those health services provided only partially by the NHS.

An equity analysis of utilization of health services in Afghanistan using a national household survey.

PubMed

Kim, Christine; Saeed, Khwaja Mir Ahad; Salehi, Ahmad Shah; Zeng, Wu

2016-12-05

Afghanistan has made great strides in the coverage of health services across the country but coverage of key indicators remains low nationally and whether the poorest households are accessing these services is not well understood. We analyzed the Afghanistan Mortality Survey 2010 on utilization of inpatient and outpatient care, institutional delivery and antenatal care by wealth quintiles. Concentration indexes (CIs) were generated to measure the inequality of using the four services. Additional analyses were conducted to examine factors that explain the health inequalities (e.g. age, gender, education and residence). Among households reporting utilization of health services, public health facilities were used more often for inpatient care, while they were used less for outpatient care. Overall, the utilization of inpatient and outpatient care, and antenatal care was equally distributed among income groups, with CIs of 0.04, 0.03 and 0.08, respectively. However, the poor used more public facilities while the wealthy used more private facilities. There was a substantial inequality in the use of institutional delivery services, with a CI of 0.31. Poorer women had a lower rate of institutional deliveries overall, in both public and private facilities, compared to the wealthy. Location was an important factor in explaining the inequality in the use of health services. The large gap between the rich and poor in access to and utilization of key maternal services, such as institutional delivery, may be a central factor to the high rates of maternal mortality and morbidity and impedes efforts to make progress toward universal health coverage. While poorer households use public health services more often, the use of public facilities for outpatient visits remains half that of private facilities. Pro-poor targeting as well as a better understanding of the private sector's role in increasing equitable coverage of maternal health services is needed. Equity-oriented approaches in health should be prioritized to promote more inclusive health system reforms.

Differentially private distributed logistic regression using private and public data.

PubMed

Ji, Zhanglong; Jiang, Xiaoqian; Wang, Shuang; Xiong, Li; Ohno-Machado, Lucila

2014-01-01

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. 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. 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. 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.

An economic analysis of harvest behavior: integrating forest and ownership characteristics

Treesearch

Donald F. Dennis

1989-01-01

This study provides insight into the determinants of timber supply from private forests through development of both theoretical and empirical models of harvest behavior. A microeconomic model encompasses the multiple objective nature of private ownership by examining the harvest decision for landowners who derive utility from forest amenities and from income used for...

Comparing Public and Private Institutions That Have and Have Not Implemented Enterprise Resource Planning (ERP) Systems: A Resource Dependence Perspective

ERIC Educational Resources Information Center

Sendhil, Geetha R.

2012-01-01

The purpose of this national study was to utilize quantitative methods to examine institutional characteristics, financial resource variables, personnel variables, and customer variables of public and private institutions that have and have not implemented enterprise resource planning (ERP) systems, from a resource dependence perspective.…

The Reproduction of Privilege: Young Women, the Family and Private Education

ERIC Educational Resources Information Center

Maxwell, Claire; Aggleton, Peter

2014-01-01

The paper examines processes of cultural production and reproduction among members of the elite and upper-middle classes. Drawing on findings from a study of private education in England, it explores the utility of a conceptual framework to examine how practices in and across different sites may be reproductive of various forms of…

Descriptive epidemiology and prior healthcare utilization of patients in the Spine Patient Outcomes Research Trial's (SPORT) three observational cohorts: disc herniation, spinal stenosis, and degenerative spondylolisthesis.

PubMed

Cummins, Justin; Lurie, Jon D; Tosteson, Tor D; Hanscom, Brett; Abdu, William A; Birkmeyer, Nancy J O; Herkowitz, Harry; Weinstein, James

2006-04-01

Prospective observational cohorts. To describe sociodemographic and clinical features, and nonoperative (medical) resource utilization before enrollment, in patients who are candidates for surgical intervention for intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS) according to SPORT criteria. Intervertebral disc herniation, spinal stenosis, and degenerative spondylolisthesis with stenosis are the three most common diagnoses of low back and leg symptoms for which surgery is performed. There is a paucity of descriptive literature examining large patient cohorts for the relationships among baseline characteristics and medical resource utilization with these three diagnoses. The Spine Patient Outcomes Research Trial (SPORT) conducts three randomized and three observational cohort studies of surgical and nonsurgical treatments for patients with IDH, SpS, and DS. Baseline data include demographic information, prior treatments received, and functional status measured by SF-36 and the Oswestry Disability Index (ODI-AAOS/Modems version). The data presented represent all 1,411 patients (743 IDH, 365 SpS, 303 DS) enrolled in the SPORT observational cohorts. Multiple logistic regression was used to generate independent predictors of utilization adjusted for sociodemographic variables, diagnosis, and duration of symptoms. The average age was 41 years for the IDH group, 64 years for the SpS group, and 66 years for the DS group. At enrollment, IDH patients presented with the most pain as reported on the SF-36 (BP 26.3 vs. 33.2 SpS and 33.8 DS) and were the most impaired (ODI 51 vs. 42.3 SpS and 41.5 DS). IDH patients used more chiropractic treatment (42% vs. 33% SpS and 26% DS), had more Emergency Department (ED) visits (21% vs. 7% SpS and 4% DS), and used more opiate analgesics (49% vs. 29% SpS and 27% DS). After adjusting for age, gender, diagnosis, education, race, duration of symptoms, and compensation, Medicaid patients used significantly more opiate analgesics (58% Medicaid vs. 41% no insurance, 42% employer, 33% Medicare, and 32% private) and had more ED visits compared with other insurance types (31% Medicaid vs. 22% no insurance, 16% employer, 3% Medicare, and 11% private). IDH patients appear to have differences in sociodemographics, resource utilization, and functional impairment when compared with the SpS/DS patients. In addition, the differences in resource utilization for Medicaid patients may reflect differences in access to care. The data provided from these observational cohorts will serve as an important comparison to the SPORT randomized cohorts in the future.

Trends in Alcohol Services Utilization from 1991-1992 to 2001-2002: Ethnic Group Differences in the U.S. Population

PubMed Central

Chartier, Karen G.; Caetano, Raul

2011-01-01

Background During the early 1990s in the U.S., changes to the provision and financing of alcohol treatment services included reductions in inpatient treatment services and in private sector spending for treatment. We investigated trends in alcohol services utilization over the 10-year period from 1991-1992 to 2001-2002 among U.S. Whites, Blacks and Hispanics. Method Data come from two household surveys of the U.S. adult population. The 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES) and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) conducted face-to-face interviews with a multistage cluster sample of individuals 18 years of age and older in the continental United States. Treatment utilization represented both total utilization and the use of alcohol services. Data analyses were prevalence rates and multivariate logistic regressions for lifetime utilization with drinkers and individuals with alcohol use disorders (AUD). Results From 1991-1992 to 2001-2002, drinking-related emergency room and human services use increased for drinkers, while total utilization and the use of private health professional services and mutual aid decreased for individuals with AUDs. In drinkers and individuals with AUDs, Blacks and Hispanics were less likely than Whites to use private health professional care. Hispanics with AUDs were less likely than Whites with AUDs to use alcohol or drug programs. Ethnicity interacted with alcohol severity to predict alcohol services utilization. At higher levels of alcohol severity, Blacks and Hispanics were less likely than Whites to ever use treatment and to use alcohol services (i.e., human services for Hispanic drinkers, mental health services for Blacks with AUDs, and mutual aid for Hispanics with AUDs). Conclusions Our findings showed increases from 1991-1992 to 2001-2002 in alcohol services utilization for drinkers, but reductions in utilization for individuals with AUDs. Blacks and Hispanics, particularly those at higher levels of alcohol severity, underutilized treatment services compared to Whites. These utilization trends for Blacks and Hispanics may reflect underlying disparities in health care access for minority groups, and language and logistical barriers to utilizing services. PMID:21575015

The Private Market for Long-Term Care Insurance in the U.S.: A Review of the Evidence

PubMed Central

Brown, Jeffrey R.; Finkelstein, Amy

2009-01-01

This paper reviews the growing literature on the market for private long-term care insurance, a market notable for its small size despite the fact that long-term care expenses are potentially large and highly uncertain. After summarizing long-term care utilization and insurance coverage in the United States, the paper reviews research on the supply of and the demand for private long-term care insurance. It concludes that demand-side factors impose important limits on the size of the private market and that we currently have a limited understanding of how public policies could be designed to encourage the growth of this market. PMID:20046809

Impact of Private Health Insurance on Lengths of Hospitalization and Healthcare Expenditure in India: Evidences from a Quasi-Experiment Study.

PubMed

Vellakkal, Sukumar

2013-01-01

The health insurers administer retrospectively package rates for various inpatient procedures as a provider payment mechanism to empanelled hospitals in Indian healthcare market. This study analyzed the impact of private health insurance on healthcare utilization in terms of both lengths of hospitalization and per-day hospitalization expenditure in Indian healthcare market where package rates are retrospectively defined as healthcare provider payment mechanism. The claim records of 94443 insured individuals and the hospitalisation data of 32665 uninsured individuals were used. By applying stepwise and propensity score matching method, the sample of uninsured individual was matched with insured and 'average treatment effect on treated' (ATT) was estimated. Overall, the strategies of hospitals, insured and insurers for maximizing their utility were competing with each other. However, two aligning co-operative strategies between insurer and hospitals were significant with dominant role of hospitals. The hospitals maximize their utility by providing high cost healthcare in par with pre-defined package rates but align with the interest of insurers by reducing the number (length) of hospitalisation days. The empirical results show that private health insurance coverage leads to i) reduction in length of hospitalization, and ii) increase in per day hospital (health) expenditure. It is necessary to regulate and develop a competent healthcare market in the country with proper monitoring mechanism on healthcare utilization and benchmarks for pricing and provision of healthcare services.

An Analysis of Private School Closings

ERIC Educational Resources Information Center

Pandey, Lakshmi; Sjoquist, David L.; Walker, Mary Beth

2009-01-01

We add to the small literature on private school supply by exploring exits of K-12 private schools. We find that the closure of private schools is not an infrequent event and use national survey data from the National Center for Education Statistics to study closures of private schools. We assume that the probability of an exit is a function of…

Utilization of penile prosthesis and male incontinence prosthetics in Saudi Arabia.

PubMed

Alwaal, Amjad; Al-Sayyad, Ahmad J

2017-01-01

Erectile dysfunction is a prevalent disease affecting over 50% of men between the ages of 40 and 70 years. Penile prosthesis represents the end of the line treatment when other less invasive therapies fail or are contraindicated. Male stress urinary incontinence can significantly diminish quality of life and lead to embarrassment and social withdrawal. Surgical therapies, such as male urethral slings and artificial urinary sphincters (AUS), are considered effective and safe treatments for male stress incontinence. No data exist on the utilization of penile prosthesis or male incontinence surgical treatment in Saudi Arabia. Generally, urological prosthetic surgery is performed either in private hospitals or in government hospitals. Our aim was to assess the trend of penile prosthesis and male incontinence device utilization in Saudi Arabia. We utilized sales' data of penile prosthetics, male slings, and AUS from the only two companies selling these devices in Saudi Arabia (AMS ® and Coloplast ® ), from January 2013 to December 2016. There were 2599 penile prosthesis implantation procedures done in the study period, with 67% of them performed in private institutions. There was a progressively increased use of penile prosthetics which nearly doubled from 2013 to 2016. The main type of prosthesis utilized was the semirigid type 70% versus 11% of the 2-piece inflatable and 17% of the 3-piece inflatable device. Only 10 slings and 31 AUS were inserted during the same study period. There is an increased utilization of penile prosthetics in Saudi Arabia. The private sector performs the majority of penile prosthesis procedures, and most of them are of the semirigid type. The governmental sector is more likely to perform inflatable penile prosthesis and male incontinence device procedures. Male incontinence prosthetics' use is very limited in Saudi Arabia.

Sociodemographic and socioeconomic determinants of health services utilization in Greece: the Hellas Health I study.

PubMed

Tountas, Yannis; Oikonomou, Nikolaos; Pallikarona, Georgia; Dimitrakaki, Christine; Tzavara, Chara; Souliotis, Kyriakos; Mariolis, Anargiros; Pappa, Evelina; Kontodimopoulos, Nick; Niakas, Dimitris

2011-02-01

The purpose of the study was to estimate the demographic and socioeconomic determinants of utilization of the Greek primary and hospital health care services. Data were obtained from the cross-sectional nationwide household survey Hellas Health I (2006). The sample (N = 1005) was representative of the Greek adult population in terms of age and residency, and was selected by means of a three-stage, proportional-to-size sampling design. The presence of a family doctor was reported in a higher degree by participants of higher social classes and private insurance. After adjusting for self-perceived general health and chronic illness, contacts with health care professionals during the past four weeks were found less for residents of rural areas, while contacts with health care professionals during the past 12 months were found less for men than women, for individuals without private insurance and for individuals of lower education. More out-of-pocket payments were reported by the 34-44 age group, rural area residents and individuals with private insurance. Higher use of private health care services was reported by participants of higher social classes and residents of rural areas and private insurance. Only hospital admissions were not directly influenced by demographic and socioeconomic factors. The findings imply the existence of inequities in access and use of primary health services with clear implications to related policies.

76 FR 52133 - Defense Federal Acquisition Regulation Supplement; Contractors Performing Private Security...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-19

... 0750-AH28 Defense Federal Acquisition Regulation Supplement; Contractors Performing Private Security..., entitled ``Contractors Performing Private Security Functions in Areas of Combat Operations or Other... of DoD and other Governmental private security contractors. A clause to cover the interagency...

Impact of Self-Regulation Skills on Academic Performance of Young Children in Private Schools of Karachi

ERIC Educational Resources Information Center

Kathawala, Abeer; Bhamani, Shelina

2015-01-01

This research aimed to explore if self-regulation skills had any effect on the academic outcomes of young children in private schools of Karachi, Pakistan. Quantitative research method was used to determine the impact of self-regulation upon the academic outcome of young children by utilizing Early School Self-Regulation Scale-Care Giver Version…

The hardwood resource on nonindustrial private forest land in the Southeast Piedmont

Treesearch

William A. Bechtold; Douglas R. Phillips

1983-01-01

More than half of the commercial forest land in the Southeast Piedment supports hardwood stands held by small nonindustrial private landowners. Only 21 percent of all NIPF stands are fully stocked with growing-stock trees. Only 37 percent of all hardwood biomass harvested from these stands is currently being utilized. As these stands are harvested, about 39 tons of...

Charter Schools in an Arena of Competitive Educational Reforms: An Analysis of the 1999-2000 Schools and Staffing Survey

ERIC Educational Resources Information Center

Lin, Zeng; Gardner, Dianne C.; Vogt, W. Paul

2005-01-01

Accountability countability, choice, equity, and social cohesion are core parts of the public debates over the charter school movement. To examine these important issues, we utilize the "1999-2000 Schools and Staffing Survey" to estimate the possible charter effect on public and private schools. Analyses of charter, public,and private schools…

Exploring the Effects of Managerial Ownership on the Decision to Go Private: A Behavioral Agency Model Approach

ERIC Educational Resources Information Center

Valenti, Alix; Schneider, Marguerite

2012-01-01

This paper utilizes the behavioral agency model to investigate why many formerly public companies have been converted to privately held corporations. Using a matched pairs sample and categorical binary regression, and controlling for effects found in previous studies, we explore how the equity ownership of those entrusted to manage firms, the…

Can developing countries achieve adequate improvements in child health outcomes without engaging the private sector?

PubMed

Bustreo, Flavia; Harding, April; Axelsson, Henrik

2003-01-01

The private sector exerts a significant and critical influence on child health outcomes in developing countries, including the health of poor children. This article reviews the available evidence on private sector utilization and quality of care. It provides a framework for analysing the private sector's influence on child health outcomes. This influence goes beyond service provision by private providers and nongovernmental organizations (NGOs). Pharmacies, drug sellers, private suppliers, and food producers also have an impact on the health of children. Many governments are experimenting with strategies to engage the private sector to improve child health. The article analyses some of the most promising strategies, and suggests that a number of constraints make it hard for policy-makers to emulate these approaches. Few experiences are clearly described, monitored, and evaluated. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of how to engage the private sector most effectively. The starting point should include the evaluation of the presence and potential of the private sector, including actors such as professional associations, producer organizations, community groups, and patients' organizations.

Can developing countries achieve adequate improvements in child health outcomes without engaging the private sector?

PubMed Central

Bustreo, Flavia; Harding, April; Axelsson, Henrik

2003-01-01

The private sector exerts a significant and critical influence on child health outcomes in developing countries, including the health of poor children. This article reviews the available evidence on private sector utilization and quality of care. It provides a framework for analysing the private sector's influence on child health outcomes. This influence goes beyond service provision by private providers and nongovernmental organizations (NGOs). Pharmacies, drug sellers, private suppliers, and food producers also have an impact on the health of children. Many governments are experimenting with strategies to engage the private sector to improve child health. The article analyses some of the most promising strategies, and suggests that a number of constraints make it hard for policy-makers to emulate these approaches. Few experiences are clearly described, monitored, and evaluated. The article suggests that improving the impact of child health programmes in developing countries requires a more systematic analysis of how to engage the private sector most effectively. The starting point should include the evaluation of the presence and potential of the private sector, including actors such as professional associations, producer organizations, community groups, and patients' organizations. PMID:14997241

Effect of private health insurance on health care utilization in a universal public insurance system: a case of South Korea.

PubMed

Jeon, Boyoung; Kwon, Soonman

2013-11-01

This study examined the effect of private health insurance (PHI) on health care utilization in South Korea using a nationally representative sample of 9512 adults participating in Korea Health Panel Survey (KHPS). We compared the health care utilization and subsequent expenditure according to whether or not and how many PHIs are purchased, controlling for the endogeneity of insurance purchase by propensity score matching method and Heckman-type treatment effect model. The results of this study show that the probability of any health care utilization, both outpatient care and inpatient care, is higher for the people who have PHI. For those who utilize health care, PHI has a positive impact on outpatient expenditure, but not on the number of outpatient visits. The effect of PHI on the number of inpatient days and expenditure is not statistically significant among the users of inpatient care. These results imply a need for policy options to mitigate the moral hazard effect of PHI in the outpatient care sector. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Opportunities for electric utilities in telecommunications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meehan, C.M.

1994-11-01

This article examines the opportunities for utility participation in the telecommunications market on private microwave systems and hybrid microwave and fiber systems. The topics of the article include entering the market, national information infrastructure, business opportunities and considerations, levels of participation in telecommunications market, and regulatory objectives.

Analysis of buprenorphine/naloxone dosing impact on treatment duration, resource use and costs in the treatment of opioid-dependent adults: a retrospective study of US public and private health care claims.

PubMed

Khemiri, Amine; Kharitonova, Elizaveta; Zah, Vladimir; Ruby, Jane; Toumi, Mondher

2014-09-01

The buprenorphine/naloxone combination is used to treat the chronic relapsing disorder of opioid dependence. Adequate dosing levels are important to control cravings, prevent withdrawal syndrome, and maintain patients in treatment. The objective of this study was to estimate the impact of dosing on treatment persistence, resource utilization, and total direct health care costs. A retrospective cohort analysis was performed using administrative claims extracted from the MarketScan and Clinformatics databases from January 2007 to June and November 2012. Patients initiating treatment with buprenorphine/naloxone were classified into 2 groups based on the prescribed average dose over the entire treatment period and matched by multiple criteria. The threshold for differentiating the dosing groups was set at 15 and 15.7 mg/day for publicly and privately insured patients, respectively. Resource utilization and related costs were calculated over the 12-month period after the treatment initiation. Patient characteristics at baseline were considerably different between the privately and publicly insured patients. Publicly insured patients were slightly younger (33.1 vs 34.3 years old for privately insured) and had a higher prevalence of mental disorders (70.9% vs 64.9%). In both groups, patients treated with higher doses (> 15 mg and > 15.7 mg per day for publicly and privately insured patients, respectively) had lower risk of discontinuation (public: 11% lower; private: 9% lower) and lower probability of a psychiatric hospitalization than patients treated with lower doses (public: 17% lower; private: 41% lower). Total costs were comparable between the 2 groups (public: $14 600; private: $21 000) despite the expected higher cost of pharmacy in the higher-dose group. Treatment with higher doses of buprenorphine/naloxone was associated with a longer time to treatment discontinuation, less resource use, and lower total medical costs despite higher pharmacy acquisition cost.

Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes.

PubMed

Bonvicini, Laura; Candela, Silvia; Evangelista, Andrea; Bertani, Daniela; Casoli, Morena; Lusvardi, Annarella; Messori, Antonella; Giorgi Rossi, Paolo

2014-02-17

In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common.The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. Observational population-based study. Reggio Emilia Province. 5957 women resident in the province who delivered between October 2010 and November 2011. CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson's Group. Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93-1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30-6.08). CS frequency was higher in private care for all Robson's classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes.

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

Maize Genetic Resources Collections – Utilizing a Treasure Trove

USDA-ARS?s Scientific Manuscript database

The maize genetic resource collection managed by the USDA-ARS's National Plant Germplasm System is heavily utilized by researchers and educators. A collection of landraces, inbred lines from public and private sector sources, synthetics and key populations, it serves both as a living snapshot of th...

78 FR 64291 - Notice of Rail Energy Transportation Advisory Committee Vacancy

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-28

... Committee (RETAC) for a representative of an electric utility. The Board is soliciting suggestions from the... coal producers; five representatives from electric utilities (including at least one rural electric... shipping industry; and two representatives from private car owners, car lessors, or car manufacturers...

Aggregating QECB Allocations & Using QECBs to Support the Private Sector. A Case Study on Massachusetts

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zimring, Mark; Borgeson, Merrian

2012-08-01

Qualified Energy Conservation Bonds (QECBs) are federally-subsidized bonds that enable state, tribal, and local government issuers to borrow money to fund a range of energy conservation projects at very attractive interest rates and long terms. While small allocation sizes have deterred some local governments from pursuing issuances, state agencies in Massachusetts have partnered with local governments to aggregate QECBs to support a range of public and private projects. In most states, QECBs have been utilized primarily to fund energy conservation projects for public entities, but Massachusetts has facilitated over $10 million of private activity QECB issuances to support three privately-ownedmore » renewable energy projects—with more projects in the pipeline.« less

48 CFR 25.302-3 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-10-01

... functions as a primary deliverable or the provision of private security functions is ancillary to the stated... entered into on a non-DoD contract for the performance of private security functions by individual... the Secretary of State. (b) Non-DoD agencies: This section applies to acquisitions by non-DoD agencies...

48 CFR 25.302-3 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-10-01

... functions as a primary deliverable or the provision of private security functions is ancillary to the stated... entered into on a non-DoD contract for the performance of private security functions by individual... the Secretary of State. (b) Non-DoD agencies: This section applies to acquisitions by non-DoD agencies...

[Health services utilization by the adult population in São Leopoldo, Rio Grande do Sul State, Brazil: a cross-sectional study].

PubMed

Dias-da-Costa, Juvenal Soares; Olinto, Maria Teresa Anselmo; Soares, Simoni Assunção; Nunes, Marcelo Felipe; Bagatini, Tatiane; Marques, Maximiliano das Chagas; Guimarães, Lisiane Kiefer; Müller, Letícia Possebon; Machado, Fátima Carina de Souza; Barcellos, Eduardo dos Santos; Pattussi, Marcos Pascoal

2011-05-01

The aim was to describe healthcare utilization by adults in a Brazilian city. The outcomes were medical appointments in the previous month and use of public (Unified National Health System - SUS) versus private healthcare services. A population-based cross-sectional study with 1,098 adults aged 20 years or over was carried out. No medical appointment in the previous month was reported by 623 persons (56.7%, 95%CI: 53.8-59.7). Of the 487 individuals who had consulted a physician, 51.2% used the public healthcare system, 26.9% private care, and 22% other services. Consultation was associated with female gender and older age. Individuals in the intermediate categories for income, schooling, and socioeconomic status consulted less than the corresponding high and low categories. The results suggest that the middle class in this city lacks the purchasing power to seek care in the private sector while also using public services less, thus generally seeking healthcare less frequently.

Three Essays on Terrorism, its Relationship with Natural Disasters, and its Effect on Female Labor Force Participation

DTIC Science & Technology

2011-09-01

civilian, non- government organizations, private citizens and property, religious figures and institutions, tourists , transportation, and utilities...media, maritime – civilian, non- government organizations, private citizens and property, religious figures and institutions, tourists , transportation... government . A society vests much of its security within its government ?s ability to protect; thus, the effectiveness and efficiency of disaster preparedness

Studies in Ambulatory Care Quality Assessment in the Indian Health Service. Volume III: Comparison of Rural Private Practice, Health Maintenance Organizations, and the Indian Health Service.

ERIC Educational Resources Information Center

Nutting, Paul A.; And Others

Utilizing a quality assessment methodology for ambulatory patient care currently under development by the Indian Health Service's (IHS) Office of Research and Development, comparisons were made between results derived from a pilot test in IHS service units, 2 metropolitan Health Maintenance Organizations (HMO), and 3 rural private practices.…

Natural gas projects in the developing world: An empirical evaluation of merits, obstacles, and risks

NASA Astrophysics Data System (ADS)

Mor, Amit

Significant amounts of natural gas have been discovered in developing countries throughout the years during the course of oil exploration. The vast majority of these resources have not been utilized. Some developing countries may benefit from a carefully planned utilization of their indigenous resources, which can either be exported or used domestically to substitute imported or exportable fuels or feedstock. Governments, potential private sector investors, and financiers have been searching for strategies to promote natural gas schemes, some of which have been in the pipeline for more than two decades. The purpose of this thesis is to identify the crucial factors determining the success or failure of launching natural gas projects in the developing world. The methodology used to evaluate these questions included: (1) establishing a representative sample of natural gas projects in developing countries that were either implemented or failed to materialize during the 1980-1995 period, (2) utilizing a Probit limited dependent variable econometric model in which the explained variable is project success or failure, and (3) choosing representing indicators to reflect the assumed factors affecting project success. The study identified two conditions for project success: (1) the economic viability of the project and (2) securing financing for the investment. The factors that explain the ability or inability of the sponsors to secure financing were: (1) the volume of investment that represented the large capital costs of gas transportation, distribution, and storage, (2) the level of foreign exchange constraint in the host country, and (3) the level of development of the country. The conditions for private sector participation in natural gas projects in developing countries were identified in the study by a Probit model in which the explained variable was private sector participation. The results showed that a critical condition for private sector participation is the financial profitability of a project. Other factors that explained private sector participation and the ability of the private-sector sponsor to secure financing for a project were: (1) the political risk associated with the project, (2) the foreign exchange constraint associated with the project, and (3) whether the project was domestic or export-oriented.

Programmatic and economic challenges for commercial space processing

NASA Astrophysics Data System (ADS)

Overfelt, Tony; Watkins, John

1997-01-01

The International Space Station is the largest cooperative space project in history and is likely to be industry's most viable access to the low-g environment for long duration materials processing experiments. Such access will provide unique and competitive research capabilities to industry if private sector entities can commercially utilize the Space Station for their industrial projects. Although ``commercial utilization'' implies a variety of things to different people, the key industrial issues are frequent, reliable, and economical access to space as well as protection of private sector intellectual property rights. This paper discusses how these key issues will influence the programmatic and economic challenges for commercial space processing in the future Space Station era.

Self-selection and moral hazard in Chilean health insurance.

PubMed

Sapelli, Claudio; Vial, Bernardita

2003-05-01

We study the existence of self-selection and moral hazard in the Chilean health insurance industry. Dependent workers must purchase health insurance either from one public or several private insurance providers. For them, we analyze the relationship between health care services utilization and the choice of either private or public insurance. In the case of independent workers, where there is no mandate, we analyze the relationship between utilization and the decision to voluntarily purchase health insurance. The results show self-selection against insurance companies for independent workers, and against public insurance for dependent workers. Moral hazard is negligible in the case of hospitalization, but for medical visits, it is quantitatively important.

Private sector participation in delivering tertiary health care: a dichotomy of access and affordability across two Indian states.

PubMed

Katyal, Anuradha; Singh, Prabal Vikram; Bergkvist, Sofi; Samarth, Amit; Rao, Mala

2015-03-01

Poor quality care in public sector hospitals coupled with the costs of care in the private sector have trapped India's poor in a vicious cycle of poverty, ill health and debt for many decades. To address this, the governments of Andhra Pradesh (AP) and Maharashtra (MH), India, have attempted to improve people's access to hospital care by partnering with the private sector. A number of government-sponsored schemes with differing specifications have been launched to facilitate this strategy. This article aims to compare changes in access to, and affordability and efficiency of private and public hospital inpatient (IP) treatments between MH and AP from 2004 to 2012 and to assess whether the health financing innovations in one state resulted in larger or smaller benefits compared with the other. We used data from household surveys conducted in 2004 and 2012 in the two states and undertook a difference-in-difference (DID) analysis. The results focus on hospitalization, out-of-pocket expenditure and length of stay. The average IP expenditure for private hospital care has increased in both states, but more so in MH. There was also an observable increase in both utilization of and expenditure on nephrology treatment in private hospitals in AP. The duration of stay recorded in days for private hospitals has increased slightly in MH and declined in AP with a significant DID. The utilization of public hospitals has reduced in AP and increased in MH. The state of AP appears to have benefited more than MH in terms of improved access to care by involving the private sector. The Aarogyasri scheme is likely to have contributed to these impacts in AP at least in part. Our study needs to be followed up with repeated evaluations to ascertain the long-term impacts of involving the private sector in providing hospital care. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

[Use of migrant's remittances from California on dependent's healthcare in Mexico].

PubMed

González-Block, Miguel Ángel; de la Sierra-de la Vega, Luz Angélica; Vargas-Bustamante, Arturo

2013-01-01

This paper focuses on public and private healthcare utilization among dependents living in Mexico of Mexican migrants in California, analyzing the link between remittances and enrollment in Seguro Popular, a social health insurance plan. We surveyed 1353 migrants who visited the Mexican consulate of Los Angeles in 2010. 53.9% sent remittances; 72.2% of households receiving remittances used a share of remittances for health care and 74.4% of them were covered by Seguro Popular. The annual median with private health care expenditure was USD 825, compared to USD 293 for public providers. The main predictors remittances utilization for healthcare were having a sick dependent, purchase of prescription drugs, experiencing problems paying for health care and time of U.S. residence. Seguro Popular increases healthcare utilization with public providers, which provides an opportunity to reallocate the use of migrant's remittances for health purposes.

Market segmentation and industry overcapacity considering input resources and environmental costs through the lens of governmental intervention.

PubMed

Jiang, Zhou; Jin, Peizhen; Mishra, Nishikant; Song, Malin

2017-09-01

The problems with China's regional industrial overcapacity are often influenced by local governments. This study constructs a framework that includes the resource and environmental costs to analyze overcapacity using the non-radial direction distance function and the price method to measure industrial capacity utilization and market segmentation in 29 provinces in China from 2002 to 2014. The empirical analysis of the spatial panel econometric model shows that (1) the industrial capacity utilization in China's provinces has a ladder-type distribution with a gradual decrease from east to west and there is a severe overcapacity in the traditional heavy industry areas; (2) local government intervention has serious negative effects on regional industry utilization and factor market segmentation more significantly inhibits the utilization rate of regional industry than commodity market segmentation; (3) economic openness improves the utilization rate of industrial capacity while the internet penetration rate and regional environmental management investment have no significant impact; and(4) a higher degree of openness and active private economic development have a positive spatial spillover effect, while there is a significant negative spatial spillover effect from local government intervention and industrial structure sophistication. This paper includes the impact of resources and the environment in overcapacity evaluations, which should guide sustainable development in emerging economies.

In Their Own Words: Best Practices for Advising Millennial Students about Majors

ERIC Educational Resources Information Center

Montag, Tamara; Campo, Jill; Weissman, Julie; Walmsley, Angela; Snell, Alex

2012-01-01

Utilizing generational theory, we explored the relationship between Millennial characteristics and students' major selection and academic advising experiences. We conducted focus groups of students with senior standing at a private, midwestern university, and we utilized a closed coding technique to analyze the qualitative data. Consistent with…

76 FR 72752 - Notice of Rail Energy Transportation Advisory Committee Vacancy

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-25

... Transportation Advisory Committee for a representative of a state- or municipally-owned electric utility. The... producers, 5 representatives from electric utilities (including at least 1 rural electric cooperative and 1... distributors, or biofuel feedstock growers or providers, and 2 representatives from private car owners, car...

Patient satisfaction in Turkey: differences between public and private hospitals.

PubMed

Tengilimoglu, D; Kisa, A; Dziegielewski, S F

1999-02-01

This article reports the results of a patient-satisfaction survey administered by interview to 2045 adults discharged from several major public and private hospitals in Turkey. The direct measurement of patient-satisfaction is a new phenomenon for this country. An instrument was designed similar to those available in the United States and administered during exit interviews. Two primary areas of analyses were determined in comparing services provided by these public and private hospitals: demographic factors with regard to accessibility and consumer perceptions of the quality of service provided. Relationships and percentages within and among the five public and two private hospitals are reported. Several statistically significant differences were found between the hospitals, with the private hospitals achieving the greatest satisfaction on most of the quality of services issues examined. Future recommendations outline the need to take into account the public's perception of these hospitals and enhancing customer satisfaction as a means of increasing service utilization.

Privacy preserving RBF kernel support vector machine.

PubMed

Li, Haoran; Xiong, Li; Ohno-Machado, Lucila; Jiang, Xiaoqian

2014-01-01

Data sharing is challenging but important for healthcare research. Methods for privacy-preserving data dissemination based on the rigorous differential privacy standard have been developed but they did not consider the characteristics of biomedical data and make full use of the available information. This often results in too much noise in the final outputs. We hypothesized that this situation can be alleviated by leveraging a small portion of open-consented data to improve utility without sacrificing privacy. We developed a hybrid privacy-preserving differentially private support vector machine (SVM) model that uses public data and private data together. Our model leverages the RBF kernel and can handle nonlinearly separable cases. Experiments showed that this approach outperforms two baselines: (1) SVMs that only use public data, and (2) differentially private SVMs that are built from private data. Our method demonstrated very close performance metrics compared to nonprivate SVMs trained on the private data.

Privacy Preserving RBF Kernel Support Vector Machine

PubMed Central

Xiong, Li; Ohno-Machado, Lucila

2014-01-01

Data sharing is challenging but important for healthcare research. Methods for privacy-preserving data dissemination based on the rigorous differential privacy standard have been developed but they did not consider the characteristics of biomedical data and make full use of the available information. This often results in too much noise in the final outputs. We hypothesized that this situation can be alleviated by leveraging a small portion of open-consented data to improve utility without sacrificing privacy. We developed a hybrid privacy-preserving differentially private support vector machine (SVM) model that uses public data and private data together. Our model leverages the RBF kernel and can handle nonlinearly separable cases. Experiments showed that this approach outperforms two baselines: (1) SVMs that only use public data, and (2) differentially private SVMs that are built from private data. Our method demonstrated very close performance metrics compared to nonprivate SVMs trained on the private data. PMID:25013805

Harnessing Private-Sector Innovation to Improve Health Insurance Exchanges

PubMed Central

Gresenz, Carole Roan; Hoch, Emily; Eibner, Christine; Rudin, Robert S.; Mattke, Soeren

2016-01-01

Abstract Overhauling the individual health insurance market—including through the creation of health insurance exchanges—was a key component of the Patient Protection and Affordable Care Act's multidimensional approach to addressing the long-standing problem of the uninsured in the United States. Despite succeeding in enrolling millions of Americans, the exchanges still face several challenges, including poor consumer experience, high operational and development costs, and incomplete market penetration. In light of these challenges, analysts considered a different model for the exchanges—privately facilitated exchanges—which could address these challenges and deepen the Affordable Care Act's impact. In this model, the government retains control over sovereign exchange functions but allows the private sector to assume responsibility for more-peripheral exchange functions, such as developing and sustaining exchange websites. Although private-sector entities have already undertaken exchange-related functions on a limited basis, privately facilitated exchanges could conceivably relieve the government of its responsibility for front-end website operations and consumer decision-support functions entirely. A shift to privately facilitated exchanges could improve the consumer experience, increase enrollment, and lower costs for state and federal governments. A move to such a model requires, nonetheless, managing its risks, such as reduced consumer protection, increased consumer confusion, and the possible lack of a viable revenue base for privately facilitated exchanges, especially in less populous states. On net, the benefits are large enough and the risks sufficiently manageable to seriously consider such a shift. This paper provides background information and more detail on the analysts' assessment. PMID:28083414

Harnessing Private-Sector Innovation to Improve Health Insurance Exchanges.

PubMed

Gresenz, Carole Roan; Hoch, Emily; Eibner, Christine; Rudin, Robert S; Mattke, Soeren

2016-05-09

Overhauling the individual health insurance market-including through the creation of health insurance exchanges-was a key component of the Patient Protection and Affordable Care Act's multidimensional approach to addressing the long-standing problem of the uninsured in the United States. Despite succeeding in enrolling millions of Americans, the exchanges still face several challenges, including poor consumer experience, high operational and development costs, and incomplete market penetration. In light of these challenges, analysts considered a different model for the exchanges-privately facilitated exchanges-which could address these challenges and deepen the Affordable Care Act's impact. In this model, the government retains control over sovereign exchange functions but allows the private sector to assume responsibility for more-peripheral exchange functions, such as developing and sustaining exchange websites. Although private-sector entities have already undertaken exchange-related functions on a limited basis, privately facilitated exchanges could conceivably relieve the government of its responsibility for front-end website operations and consumer decision-support functions entirely. A shift to privately facilitated exchanges could improve the consumer experience, increase enrollment, and lower costs for state and federal governments. A move to such a model requires, nonetheless, managing its risks, such as reduced consumer protection, increased consumer confusion, and the possible lack of a viable revenue base for privately facilitated exchanges, especially in less populous states. On net, the benefits are large enough and the risks sufficiently manageable to seriously consider such a shift. This paper provides background information and more detail on the analysts' assessment.

Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance.

PubMed

Sommers, Benjamin D; Blendon, Robert J; Orav, E John; Epstein, Arnold M

2016-10-01

Under the Affordable Care Act (ACA), more than 30 states have expanded Medicaid, with some states choosing to expand private insurance instead (the "private option"). In addition, while coverage gains from the ACA's Medicaid expansion are well documented, impacts on utilization and health are unclear. To assess changes in access to care, utilization, and self-reported health among low-income adults in 3 states taking alternative approaches to the ACA. Differences-in-differences analysis of survey data from November 2013 through December 2015 of US citizens ages 19 to 64 years with incomes below 138% of the federal poverty level in Kentucky, Arkansas, and Texas (n = 8676). Data analysis was conducted between January and May 2016. Medicaid expansion in Kentucky and use of Medicaid funds to purchase private insurance for low-income adults in Arkansas (private option), compared with no expansion in Texas. Self-reported access to primary care, specialty care, and medications; affordability of care; outpatient, inpatient, and emergency utilization; receiving glucose and cholesterol testing, annual check-up, and care for chronic conditions; quality of care, depression score, and overall health. Among the 3 states included in the study, Arkansas (n=2890), Kentucky (n=2898, and Texas (n=2888), there were no differences in sex, income, or marital status. Respondents from Texas were younger, more urban, and disproportionately Latino compared with those in Arkansas and Kentucky. Significant changes in coverage and access were more apparent in 2015 than in 2014. By 2015, expansion was associated with a 22.7 percentage-point reduction in the uninsured rate compared with nonexpansion (P < .001). Expansion was associated with significantly increased access to primary care (12.1 percentage points; P < .001), fewer skipped medications due to cost (-11.6 percentage points; P < .001), reduced out-of-pocket spending (-29.5%; P = .02), reduced likelihood of emergency department visits (-6.0 percentage points, P = .04), and increased outpatient visits (0.69 visits per year; P = .04). Screening for diabetes (6.3 percentage points; P = .05), glucose testing among patients with diabetes (10.7 percentage points; P = .03), and regular care for chronic conditions (12.0 percentage points; P = .008) all increased significantly after expansion. Quality of care ratings improved significantly (-7.1 percentage points with "fair/poor quality of care"; P = .03), as did the share of adults reporting excellent health (4.8 percentage points; P = .04). Comparisons of Arkansas vs Kentucky showed increased private coverage in the former (21.7 percentage points; P < .001), increased Medicaid in the latter (21.3 percentage points; P  < .001), and higher diabetic glucose testing rates in Kentucky (11.6 percentage points; P = .04), but no other statistically significant differences. In the second year of expansion, Kentucky's Medicaid program and Arkansas's private option were associated with significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health. Aside from the type of coverage obtained, outcomes were similar for nearly all other outcomes between the 2 states using alternative approaches to expansion.

Regional density of private dentists: empirical evidence from Austria.

PubMed

Gächter, Martin; Schwazer, Peter; Theurl, Engelbert; Winner, Hannes

2014-02-01

We investigated the determinants of disparities in the regional density of private dentists in Austria. Specifically, we focused on the relationship between the density of private dentists and their public counterparts, thereby controlling for other possible covariates of dentist density. Dentist density was measured at the district level. We used panel data of dentist density from 121 Austrian districts over the years 2001-2008. We applied a Hausman-Taylor framework to cope with possible endogeneity and to control for cross-district effects in the dentist density. A significant negative relationship was found between the density of private and public dentists, indicating a substitution effect between the two dentist groups. A significant positive spatial relationship also existed for private and public dentists in the neighboring regions. Dental capacities in public and private hospitals and dental laboratories run by the public health insurance system did not have a significant effect on private dentist density. Although a strong negative relationship existed between private and public dentists within the districts, one should not draw the conclusion that private dentists in Austria are close substitutes for public dentists. Such a conclusion would require further empirical analysis on the utilization patterns of dental services and their relationships with financing mechanisms. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Utilization of skilled birth attendants in public and private sectors in Vietnam.

PubMed

Do, Mai

2009-05-01

The private sector in health care in Vietnam has been increasingly competing with the government in primary health care services. However, little is known about the use of skilled birth attendance or about choice of public and private sectors among those who opt for skilled attendants. Using data from the Vietnam 2002 Demographic and Health Survey, this study examines factors related to women's decision-making of whether to have a skilled birth attendant at a recent childbirth, and if they did, whether it was a public or private sector provider. The study indicates that the use of the private sector for delivery services was significant. Women's household wealth, education, antenatal care and community's wealth were positively related to skilled birth attendance, while ethnicity and order of childbirth were negatively related. Order of childbirth was positively associated with skilled birth attendance in the private sector. Among service environment factors, increased access to public sector health centres was associated with an increased likelihood of skilled birth attendance in general, but a lowered chance of that in the private sector. Further studies are needed to assess the current situation in the private sector, the demand for delivery services in the private sector, and its readiness to provide quality services.

The dominance of the private sector in the provision of emergency obstetric care: studies from Gujarat, India.

PubMed

Salazar, Mariano; Vora, Kranti; De Costa, Ayesha

2016-07-07

India has experienced a steep rise in institutional childbirth. The relative contributions of public and private sector facilities to emergency obstetric care (EmOC) has not been studied in this setting. This paper aims to study in three districts of Gujarat state, India:(a) the availability of EmOC facilities in the public and private sectors; (b) the availability and distribution of human resources for birth attendance in the two sectors; and (c) to benchmark the above against 2005 World Health Report benchmarks (WHR2005). A cross-sectional survey of obstetric care facilities reporting 30 or more births in the last three months was conducted (n = 159). Performance of EmOC signal functions and availability of human resources were assessed. EmOC provision was dominated by private facilities (112/159) which were located mainly in district headquarters or small urban towns. The number of basic and comprehensive EmOC facilities was below WHR2005 benchmarks. A high number of private facilities performed C-sections but not all basic signal functions (72/159). Public facilities were the main EmOC providers in rural areas and 40/47 functioned at less than basic EmOC level. The rate of obstetricians per 1000 births was higher in the private sector. The private sector is the dominant EmOC provider in the state. Given the highly skewed distribution of facilities and resources in the private sector, state led partnerships with the private sector so that all women in the state receive care is important alongside strengthening the public sector.

Health reform and cesarean sections in the private sector: The experience of Peru.

PubMed

Arrieta, Alejandro

2011-02-01

To test the hypothesis that the health reform enacted in Peru in 1997 increased the rate of cesarean sections in the private sector due to non-clinical factors. Different rounds of the Demographic and Health Survey are used to estimate determinants of c-section rates in private and public facilities before and after the healthcare reform. Estimations are based on a pooled linear regression controlling by obstetric and socioeconomic characteristics. C-section rates in the private sector grew from 28 to 53% after the health reform. Compared to the Ministry of Health (MOH), giving birth in a private hospital in the post-reform period adds 19% to the probability of c-section. The health reform implemented in the private sector increased physician incentives to over-utilize c-sections. The reform consolidated and raised the market power of private health insurers, but at the same time did not provide mechanisms to enlarge, regulate and disclose information of private providers. All these factors created the conditions for fee-for-service paid providers to perform more c-sections. Comparable trends in c-section rates have been observed in Latin American countries who implemented similar reforms in their private sector, suggesting a need to rethink the role of private health providers in developing countries. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Impact of Affordable Care Act coverage expansion on women's reproductive preventive services in the United States.

PubMed

Arora, Prachi; Desai, Karishma

2016-08-01

The Affordable Care Act (ACA) expansion mandated the private health plans to cover women's preventive services starting August 2012. With limited and contradictory evidence, this study intends to assess the impact of ACA on the utilization rates and the cost burden of women's reproductive preventive service. A pre-post analysis was conducted using a nationally representative sample of females (aged 15-44years, n=4397) participating in the 2011-2013 National Survey of Family Growth. The utilization rates and cost burdens were compared for six services using bivariate and multivariable logistic regression models. After the ACA expansion, there wasn't a significant increase in the utilization rates of birth control/prescription (33.7% vs. 30.7%), birth control counseling (17.7% vs. 16.9%), sterilization counseling (3.3% vs. 3.5%), STI counsel/test/treat (15% vs. 14.6%) and HIV screening (24.1% vs. 23.1%). Respondents paying through insurance increased after ACA, but out-of-pocket spending (cost-sharing) didn't decrease for respondents. Type of insurance was an important predictor of utilization rates with publicly insured having significantly higher Odds Ratio (OR) or likelihood of receiving birth control counseling (OR:1.71), sterilization counseling (OR:2.67), STI counsel/test/treat (OR:1.54) and HIV screening (OR:1.69) compared to privately insured. The early-on impact of ACA expansion on utilization rates of women's reproductive preventive services didn't appear to be significant. Private health plans, however, might have expanded their coverage but burden of cost sharing still existed. Future research should evaluate the long term impact of ACA expansion on women's health and the economic gains. Copyright © 2016 Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Solis, John Hector

In this paper, we present a modular framework for constructing a secure and efficient program obfuscation scheme. Our approach, inspired by the obfuscation with respect to oracle machines model of [4], retains an interactive online protocol with an oracle, but relaxes the original computational and storage restrictions. We argue this is reasonable given the computational resources of modern personal devices. Furthermore, we relax the information-theoretic security requirement for computational security to utilize established cryptographic primitives. With this additional flexibility we are free to explore different cryptographic buildingblocks. Our approach combines authenticated encryption with private information retrieval to construct a securemore » program obfuscation framework. We give a formal specification of our framework, based on desired functionality and security properties, and provide an example instantiation. In particular, we implement AES in Galois/Counter Mode for authenticated encryption and the Gentry-Ramzan [13]constant communication-rate private information retrieval scheme. We present our implementation results and show that non-trivial sized programs can be realized, but scalability is quickly limited by computational overhead. Finally, we include a discussion on security considerations when instantiating specific modules.« less

The Effect of Medicaid Physician Fee Increases on Health Care Access, Utilization, and Expenditures.

PubMed

Callison, Kevin; Nguyen, Binh T

2018-04-01

To evaluate the effect of Medicaid fee changes on health care access, utilization, and spending for Medicaid beneficiaries. We use the 2008 and 2012 waves of the Medical Expenditure Panel Survey linked to state-level Medicaid-to-Medicare primary care reimbursement ratios obtained through surveys conducted by the Urban Institute. We also incorporate data from the Current Population Survey and the Area Resource Files. Using a control group made up of the low-income privately insured, we conduct a difference-in-differences analysis to assess the relationship between Medicaid fee changes and access to care, utilization of health care services, and out-of-pocket medical expenditures for Medicaid enrollees. We find that an increase in the Medicaid-to-Medicare payment ratio for primary care services results in an increase in outpatient physician visits, emergency department utilization, and prescription fills, but only minor improvements in access to care. In addition, we report an increase in total annual out-of-pocket expenditures and spending on prescription medications. Compared to the low-income privately insured, increased primary care reimbursement for Medicaid beneficiaries leads to higher utilization and out-of-pocket spending for Medicaid enrollees. © Health Research and Educational Trust.

Development of Optimization method about Capital Structure and Senior-Sub Structure by considering Project-Risk

NASA Astrophysics Data System (ADS)

Kawamoto, Shigeru; Ikeda, Yuichi; Fukui, Chihiro; Tateshita, Fumihiko

Private finance initiative is a business scheme that materializes social infrastructure and public services by utilizing private-sector resources. In this paper we propose a new method to optimize capital structure, which is the ratio of capital to debt, and senior-sub structure, which is the ratio of senior loan to subordinated loan, for private finance initiative. We make the quantitative analysis of a private finance initiative's project using the proposed method. We analyze trade-off structure between risk and return in the project, and optimize capital structure and senior-sub structure. The method we propose helps to improve financial stability of the project, and to make a fund raising plan that is expected to be reasonable for project sponsor and moneylender.

Determination of the optimal proportions of public and private funds in project budget management

NASA Astrophysics Data System (ADS)

Pykhtin, Kirill; Simankina, Tatyana; Karmokova, Kristina; Zonova, Alevtina

2017-10-01

Although the historical period of public-private partnership in the Russian federation is rather short, yet this type of cooperation of private entrepreneurs and authorities became the major driver of growth in such areas as construction, utilities, infrastructure and energetics. However, even though the experience of foreign countries is much larger than of Russia, great number of human resources are still consumed within disputes and disquisitions in order to assess the ratio of private and public funds. The present paper is based on the idea that this ratio can be determined for each of the industries with the use of statistical data. The authors offered the change in project cost range within the project classification regarding to the “project scale” characteristic.

Business Cases for Microgrids: Modeling Interactions of Technology Choice, Reliability, Cost, and Benefit

NASA Astrophysics Data System (ADS)

Hanna, Ryan

Distributed energy resources (DERs), and increasingly microgrids, are becoming an integral part of modern distribution systems. Interest in microgrids--which are insular and autonomous power networks embedded within the bulk grid--stems largely from the vast array of flexibilities and benefits they can offer stakeholders. Managed well, they can improve grid reliability and resiliency, increase end-use energy efficiency by coupling electric and thermal loads, reduce transmission losses by generating power locally, and may reduce system-wide emissions, among many others. Whether these public benefits are realized, however, depends on whether private firms see a "business case", or private value, in investing. To this end, firms need models that evaluate costs, benefits, risks, and assumptions that underlie decisions to invest. The objectives of this dissertation are to assess the business case for microgrids that provide what industry analysts forecast as two primary drivers of market growth--that of providing energy services (similar to an electric utility) as well as reliability service to customers within. Prototypical first adopters are modeled--using an existing model to analyze energy services and a new model that couples that analysis with one of reliability--to explore interactions between technology choice, reliability, costs, and benefits. The new model has a bi-level hierarchy; it uses heuristic optimization to select and size DERs and analytical optimization to schedule them. It further embeds Monte Carlo simulation to evaluate reliability as well as regression models for customer damage functions to monetize reliability. It provides least-cost microgrid configurations for utility customers who seek to reduce interruption and operating costs. Lastly, the model is used to explore the impact of such adoption on system-wide greenhouse gas emissions in California. Results indicate that there are, at present, co-benefits for emissions reductions when customers adopt and operate microgrids for private benefit, though future analysis is needed as the bulk grid continues to transition toward a less carbon intensive system.

Constraints Affecting ICT Utilization by Agricultural Extension Officers in the Niger Delta, Nigeria

ERIC Educational Resources Information Center

Akpabio, I. A.; Okon, D. P.; Inyang, E. B.

2007-01-01

The study focused on constraints affecting the utilization of Information and Communication Technologies (ICT) for agricultural extension activities by Agricultural Extension Officers in Nigeria's Niger Delta Region. Data were derived from 160 extension officers affiliated to both public and private extension organizations in four states of the…

Retrieving residue after overstory removal in true fir, northeastern California

Treesearch

Gary O. Fiddler; C. Phillip Weatherspoon

1986-01-01

Overstory removal cutting, the most common means of converting old-growth stands to young growth stands in California, can produce excessive residues that pose management problems. Utilization is an attractive option for managing residues. However, the cost of residue retrieval and utilization is often prohibitive. Residue retrieval by a private contractor was studied...

A Guide to Community Shared Solar: Utility, Private, and Non-Profit Project Development (Book)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Coughlin, J.; Grove, J.; Irvine, L.

2012-05-01

This guide is organized around three sponsorship models: utility-sponsored projects, projects sponsored by special purpose entities - businesses formed for the purpose of producing community solar power, and non-profit sponsored projects. The guide addresses issues common to all project models, as well as issues unique to each model.

[Determinants of dental services utilization by adults: a population-based study in Florianópolis, Santa Catarina State, Brazil].

PubMed

Miranda, Camila Dal-Bó Coradini; Peres, Marco Aurélio

2013-11-01

This study aimed to estimate the prevalence of dental services utilization by adults and to identify associated socioeconomic, demographic, behavioral, and self-awareness factors. A cross-sectional population-based study was conducted with adults living in the urban area of Florianópolis, Santa Catarina State, Brazil, in 2009. Associations were tested between use of dental services and predisposing, enabling, and needs-based variables. Multivariate analysis was conducted using Poisson regression with estimates of prevalence ratios and was stratified by place of last dental appointment. Prevalence of dental services utilization was 66% (95%CI: 62.9-70.7). Dental visits were 20% more frequent among women and 72% more frequent among individuals with more schooling (the latter in both public and private dental services). Individuals with private dental plans used dental services 13% more than those without. Schooling was the most important variable in predicting utilization. The study's results show the importance of monitoring associated factors in order to promote more equitable use of dental services.

Socioeconomic disparities in the utilization of mechanical thrombectomy for acute ischemic stroke in US hospitals.

PubMed

Brinjikji, W; Rabinstein, A A; McDonald, J S; Cloft, H J

2014-03-01

Previous studies have demonstrated that socioeconomic disparities in the treatment of cerebrovascular diseases exist. We studied a large administrative data base to study disparities in the utilization of mechanical thrombectomy for acute ischemic stroke. With the utilization of the Perspective data base, we studied disparities in mechanical thrombectomy utilization between patient race and insurance status in 1) all patients presenting with acute ischemic stroke and 2) patients presenting with acute ischemic stroke at centers that performed mechanical thrombectomy. We examined utilization rates of mechanical thrombectomy by race/ethnicity (white, black, and Hispanic) and insurance status (Medicare, Medicaid, self-pay, and private). Multivariate logistic regression analysis adjusting for potential confounding variables was performed to study the association between race/insurance status and mechanical thrombectomy utilization. The overall mechanical thrombectomy utilization rate was 0.15% (371/249,336); utilization rate at centers that performed mechanical thrombectomy was 1.0% (371/35,376). In the sample of all patients with acute ischemic stroke, multivariate logistic regression analysis demonstrated that uninsured patients had significantly lower odds of mechanical thrombectomy utilization compared with privately insured patients (OR = 0.52, 95% CI = 0.25-0.95, P = .03), as did Medicare patients (OR = 0.53, 95% CI = 0.41-0.70, P < .0001). Blacks had significantly lower odds of mechanical thrombectomy utilization compared with whites (OR = 0.35, 95% CI = 0.23-0.51, P < .0001). When considering only patients treated at centers performing mechanical thrombectomy, multivariate logistic regression analysis demonstrated that insurance was not associated with significant disparities in mechanical thrombectomy utilization; however, black patients had significantly lower odds of mechanical thrombectomy utilization compared with whites (OR = 0.41, 95% CI = 0.27-0.60, P < .0001). Significant socioeconomic disparities exist in the utilization of mechanical thrombectomy in the United States.

Improvements of Quantum Private Comparison Protocol Based on Cluster States

NASA Astrophysics Data System (ADS)

Zhou, Ming-Kuai

2018-01-01

Quantum private comparison aims to determine whether the secrets from two different users are equal or not by utilizing the laws of quantum mechanics. Recently, Sun and Long put forward a quantum private comparison (QPC) protocol by using four-particle cluster states (Int. J. Theor. Phys. 52, 212-218, 2013). In this paper, we investigate this protocol in depth, and suggest the corresponding improvements. Compared with the original protocol, the improved protocol has the following advantages: 1) it can release the requirements of authenticated classical channels and unitary operations; 2) it can prevent the malicious attack from the genuine semi-honest TP; 3) it can enhance the qubit efficiency.

Health care access and utilization among children of single working and nonworking mothers in the United States.

PubMed

Clarke, Tainya C; Arheart, Kristopher L; Muennig, Peter; Fleming, Lora E; Caban-Martinez, Alberto J; Dietz, Noella; Lee, David J

2011-01-01

To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators.

Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes

PubMed Central

2014-01-01

Background In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common. The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. Methods Design: Observational population-based study. Setting: Reggio Emilia Province. Population: 5957 women resident in the province who delivered between October 2010 and November 2011. Main outcome measures: CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson’s Group. Results Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93–1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30–6.08). CS frequency was higher in private care for all Robson’s classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. Conclusions The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes. PMID:24533853

Utilization of a state run public private emergency transportation service exclusively for childbirth: the Janani (maternal) Express program in Madhya Pradesh, India.

PubMed

Sidney, Kristi; Ryan, Kayleigh; Diwan, Vishal; De Costa, Ayesha

2014-01-01

In 2009 the state government of Madhya Pradesh, India launched an emergency obstetric transportation service, Janani Express Yojana (JEY), to support the cash transfer program that promotes institutional delivery. JEY, a large scale public private partnership, lowers geographical access barriers to facility based care. The state contracts and pays private agencies to provide emergency transportation at no cost to the user. The objective was to study (a) the utilization of JEY among women delivering in health facilities, (b) factors associated with usage, (c) the timeliness of the service. A cross sectional facility based study was conducted in facilities that carried out > ten deliveries a month. Researchers who spent five days in each facility administered a questionnaire to all women who gave birth there to elicit socio-demographic characteristics and transport related details. 35% of women utilised JEY to reach a facility, however utilization varied between study districts. Uptake was highest among women from rural areas (44%), scheduled tribes (55%), and poorly educated women (40%). Living in rural areas and belonging to scheduled tribes were significant predictors for JEY usage. Almost 1/3 of JEY users (n = 104) experienced a transport related delay. The JEY service model complements the cash transfer program by providing transport to a facility to give birth. A study of the distribution of utilization in population subgroups suggests the intervention was successful in reaching the most vulnerable population, promoting equity in access. While 1/3 of women utilized the service and it saved them money; 30% experienced significant transport related delays in reaching a facility, which is comparable to women using public transportation. Further research is needed to understand why utilization is low, to explore if there is a need for service expansion at the community level and to improve the overall time efficiency of JEY.

Diversity and Utilization of Bamboo Plants in The Area of Hotel in Kedewatan Village, Ubud, Bali

NASA Astrophysics Data System (ADS)

Utami, N. W. F.; Pradnyawathi, N. L. M.

2017-10-01

Bamboo or tiying (Balinese language) is a widely used non-timber plant in Indonesia especially in Bali. The presence of bamboo appertains to its ethno-botanical function of bamboo especially for rituals. However, there are other utilization of bamboo which is naturally grown or intentionally planted. Kedewatan as a famous place in northern Ubud, Bali have many lavish hotels with its natural environment and appealing place. The aims of this study is to invent bamboo species diversity and bamboo utilization on private areas of hotel in Kedewatan. Methods used in this study was field survey with observation and interview technic. Observation was implemented by purposive sampling methods by selecting hotel which adjacent to Ayung and Wos rivers. Interview was conducted with some key persons in charge on managing hotel garden. In addition, bamboo species identification was established through literature study. The results show that there are eleven bamboo species found on the survey area with most commonly employed species in the area were tiying tali (Gigantochloa apus (J.A. & J.H. Schultes) Kurz.) and tiying gading (Phyllostachys sulphurea (Carr.) A. e.t. C. Riv.) which were belong to exotic species. The areas which bamboo cultivated were welcome area as a hedgerow and near hotel lobby, between, outside and inside villa buildings, and naturally grown in the riverbanks with a good landscaping arrangement. Bamboo plantations were utilized to adorn and support the quality of the hotel building as well as to conserve soil and water along Ayung and Wos river canyons. The other utilization of bamboo was to facilitate ritual activity in Kedewatan village. They are allowed to ask for limited amount of bamboo culms with condition not to damage the physical appearance and function that desired by the hotel manager or hotel owner.

Production Economics of Private Forestry: A Comparison of Industrial and Nonindustrial Forest Owners

Treesearch

David H. Newman; David N. Wear

1993-01-01

This paper compares the producrion behavior of industrial and nonindustrial private forestland owners in the southeastern U.S. using a restricted profit function. Profits are modeled as a function of two outputs, sawtimber and pulpwood. one variable input, regeneration effort. and two quasi-fixed inputs, land and growing stock. Although an identical profit function is...

1 CFR 301.3 - Organization.

Code of Federal Regulations, 2012 CFR

2012-01-01

... as to provide broad representation of the views of private citizens and utilize diverse experience... committees, each assigned a broad area of interest as follows: Adjudication, Administration, Public Processes...

1 CFR 301.3 - Organization.

Code of Federal Regulations, 2011 CFR

2011-01-01

... as to provide broad representation of the views of private citizens and utilize diverse experience... committees, each assigned a broad area of interest as follows: Adjudication, Administration, Public Processes...

1 CFR 301.3 - Organization.

Code of Federal Regulations, 2013 CFR

2013-01-01

... as to provide broad representation of the views of private citizens and utilize diverse experience... committees, each assigned a broad area of interest as follows: Adjudication, Administration, Public Processes...

1 CFR 301.3 - Organization.

Code of Federal Regulations, 2014 CFR

2014-01-01

... as to provide broad representation of the views of private citizens and utilize diverse experience... committees, each assigned a broad area of interest as follows: Adjudication, Administration, Public Processes...

Research utilization in the building industry: decision model and preliminary assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Watts, R.L.; Johnson, D.R.; Smith, S.A.

1985-10-01

The Research Utilization Program was conceived as a far-reaching means for managing the interactions of the private sector and the federal research sector as they deal with energy conservation in buildings. The program emphasizes a private-public partnership in planning a research agenda and in applying the results of ongoing and completed research. The results of this task support the hypothesis that the transfer of R and D results to the buildings industry can be accomplished more efficiently and quickly by a systematic approach to technology transfer. This systematic approach involves targeting decision makers, assessing research and information needs, properly formatingmore » information, and then transmitting the information through trusted channels. The purpose of this report is to introduce elements of a market-oriented knowledge base, which would be useful to the Building Systems Division, the Office of Buildings and Community Systems and their associated laboratories in managing a private-public research partnership on a rational systematic basis. This report presents conceptual models and data bases that can be used in formulating a technology transfer strategy and in planning technology transfer programs.« less

Quality comparisons between privately and publicly managed health care centres in a suburban area of Stockholm, Sweden.

PubMed

Hansagi, H; Calltorp, J; Andréasson, S

1993-03-01

As in many other countries, the health care system in Sweden is currently undergoing rapid changes. Within a framework of public financing, the delivery of health care is to an increasing extent being transferred to various entrepreneurs; private, public or cooperatives. A privately run, but publicly financed, health care centre was evaluated with regard to quality and costs. Quality was defined in terms of the central guidelines for Swedish primary health care: first level responsibility, accessibility, a holistic view of the patient, and continuity of care and safety. The services offered by the private health care centre were evaluated by different methods--questionnaires, health care utilization data and economic analyses--and found to be of similar quality but produced at a lower cost than by three publicly managed health care centres.

The political economy of United States multiutilities: The United States electric power industry and communication services

NASA Astrophysics Data System (ADS)

Quail, Christine M.

This study consists of a political economic analysis of the multiutility industry, the industry located at the confluence of electric utilities, telephone, cable, and Internet markets. The study uses a theoretical framework based in political economy and urban theory. Methodologies used include industrial analysis and instrumental analysis. A discussion of technological convergence establishes the technical means by which multiutilities developed. Refusing technological determinism, however, the study presents a critical analysis of the history, philosophy, and regulation of utilities. Distinctions are made between public and private ownership structures in the electric utility industry. Next, the study embarks on an industrial analysis of the multiutility industry. The industrial analysis includes a discussion of the industry's history, markets, ownership types, and legal struggles. Following the broad industrial overview, two case studies are presented: Hawarden Integrated Technology, Energy and Communications (HITEC), and Con Edison Communications, LLC. HITEC is a public multiutility in the City of Hawarden, Iowa. Con Edison Communications is a private multiutility, based in New York City. The case studies provide a vehicle by which theoretical and philosophical underpinnings, as well as general trends, in the multiutility industry are localized and concretized. Finally, the study draws conclusions about the nature, history, and future of public versus private control of multiutilities' converged communications infrastructures. Questions of democratic control of media infrastructures are raised.

Drug utilization review of potassium chloride injection formulations available in a private hospital in kuching, sarawak, malaysia.

PubMed

Melissa, Mohammad Hirman; Azmi, Sarriff

2013-07-01

The concentrated potassium chloride injection is a high-alert medication and replacing it with a pre-mixed formulation can reduce the risks associated with its use. The aim of this study was to determine the clinical characteristics of patients receiving different potassium chloride formulations available at a private institution. The study also assessed the effectiveness and safety of pre-mixed formulations in the correction of hypokalaemia. This was a retrospective observational study consisting of 296 cases using concentrated and pre-mixed potassium chloride injections in 2011 in a private hospital in Kuching, Sarawak, Malaysia. There were 135 (45.6%) cases that received concentrated potassium chloride, and 161 (54.4%) cases that received pre-mixed formulations. The patients' clinical characteristics that were significantly related to the utilization of the different formulations were diagnosis (P < 0.001), potassium serum blood concentration (P < 0.05), and fluid overload risk (P < 0.05). The difference observed for the cases that achieved or maintained normokalaemia was statistically insignificant (P = 0.172). Infusion-related adverse effects were seen more in pre-mixes compared to concentrated formulations (6.8% versus 2.2%, P < 0.05). This study provides insight into the utilization of potassium chloride injections at this specific institution. The results support current recommendations to use pre-mixed formulations whenever possible.

Demand for private health insurance: how important is the quality gap?

PubMed

Costa, Joan; García, Jaume

2003-07-01

Perceived quality of private and public health care, income and insurance premium are among the determinants of demand for private health insurance (PHI). In the context of a model in which individuals are expected utility maximizers, the non purchasing choice can result in consuming either public health care or private health care with full cost paid out-of-pocket. This paper empirically analyses the effect of the determinants of the demand for PHI on the probability of purchasing PHI by estimating a pseudo-structural model to deal with missing data and endogeneity issues. Our findings support the hypothesis that the demand for PHI is indeed driven by the quality gap between private and public health care. As expected, PHI is a normal good and a rise in the insurance premium reduces the probability of purchasing PHI albeit displaying price elasticities smaller than one in absolute value for different groups of individuals. Copyright 2002 John Wiley & Sons, Ltd.

A Public-Private Partnership Improves Clinical Performance In A Hospital Network In Lesotho.

PubMed

McIntosh, Nathalie; Grabowski, Aria; Jack, Brian; Nkabane-Nkholongo, Elizabeth Limakatso; Vian, Taryn

2015-06-01

Health care public-private partnerships (PPPs) between a government and the private sector are based on a business model that aims to leverage private-sector expertise to improve clinical performance in hospitals and other health facilities. Although the financial implications of such partnerships have been analyzed, few studies have examined the partnerships' impact on clinical performance outcomes. Using quantitative measures that reflected capacity, utilization, clinical quality, and patient outcomes, we compared a government-managed hospital network in Lesotho, Africa, and the new PPP-managed hospital network that replaced it. In addition, we used key informant interviews to help explain differences in performance. We found that the PPP-managed network delivered more and higher-quality services and achieved significant gains in clinical outcomes, compared to the government-managed network. We conclude that health care public-private partnerships may improve hospital performance in developing countries and that changes in management and leadership practices might account for differences in clinical outcomes. Project HOPE—The People-to-People Health Foundation, Inc.

Principals' Personal Variables and Information and Communication Technology Utilization in Federal Capital Territory Senior Secondary Schools, Abuja, Nigeria

ERIC Educational Resources Information Center

Ogunshola, Roseline Folashade; Adeniyi, Abiodun

2017-01-01

The study investigated principals' personal variables and information and communication technology utilization in Federal Capital Territory (FCT) senior secondary schools, Abuja, Nigeria. The study adopted the correlational research design. The study used a sample of 94 senior secondary schools (including public and private) in FCT. Stratified…

Technoeconomic aspects of alternative municipal solid wastes treatment methods.

PubMed

Economopoulos, Alexander P

2010-04-01

This paper considers selected treatment technologies for comingled domestic and similar wastes and provides technoeconomic data and information, useful for the development of strategic management plans. For this purpose, treatment technologies of interest are reviewed and representative flow diagrams, along with material and energy balances, are presented for the typical composition of wastes in Greece; possible difficulties in the use of treatment products, along with their management implications, are discussed, and; cost functions are developed, allowing assessment of the initial capital investment and annual operating costs. Based on the latter, cost functions are developed for predicting the normalized treatment costs of alternative methods (in euro/t of MSW treated), as function of the quantity of MSW processed by plants built and operated (a) by municipality associations, and (b) by private enterprises. Finally, the alternative technologies considered are evaluated on the basis of their cost aspects, product utilization and compatibility with the EU waste framework Directive 2008/98. Copyright 2009 Elsevier Ltd. All rights reserved.

Photovoltaic utility/customer interface study

NASA Astrophysics Data System (ADS)

Eichler, C. H.; Hayes, T. P.; Matthews, M. M.; Wilraker, V. F.

1980-12-01

The technical, economic, and legal and regulatory issues of interconnecting small, privately-owned, on-site photovoltaic generating systems to an electric utility are addressed. Baseline residential, commercial and industrial class photovoltaic systems were developed. Technical issues of concern affecting this interconnection were identified and included fault protection, undervoltage protection, lamp flicker, revenue metering, loss of synchromism, electrical safety, prevention of backfeeding a de-energized utility feeder, effects of on-site generation on utility relaying schemes, effects of power conditioner harmonic distortion on the electric utility, system isolation, electromagnetic interference and site power factor as seen by the utility. Typical interconnection wiring diagrams were developed for interconnecting each class of baseline photovoltaic generating system.

Stability of children's insurance coverage and implications for access to care: evidence from the Survey of Income and Program Participation.

PubMed

Buchmueller, Thomas; Orzol, Sean M; Shore-Sheppard, Lara

2014-06-01

Even as the number of children with health insurance has increased, coverage transitions--movement into and out of coverage and between public and private insurance--have become more common. Using data from 1996 to 2005, we examine whether insurance instability has implications for access to primary care. Because unobserved factors related to parental behavior and child health may affect both the stability of coverage and utilization, we estimate the relationship between insurance and the probability that a child has at least one physician visit per year using a model that includes child fixed effects to account for unobserved heterogeneity. Although we find that unobserved heterogeneity is an important factor influencing cross-sectional correlations, conditioning on child fixed effects we find a statistically and economically significant relationship between insurance coverage stability and access to care. Children who have part-year public or private insurance are more likely to have at least one doctor's visit than children who are uninsured for a full year, but less likely than children with full-year coverage. We find comparable effects for public and private insurance. Although cross-sectional analyses suggest that transitions directly between public and private insurance are associated with lower rates of utilization, the evidence of such an effect is much weaker when we condition on child fixed effects.

Social Media in Pediatric Orthopaedics.

PubMed

Lander, Sarah T; Sanders, James O; Cook, Peter C; O'Malley, Natasha T

Internet searches and social media utilization in health care has exploded over the past 5 years, and patients utilize it to gain information on their health conditions and physicians. Social media has the potential to serve as a means for education, communication, and marketing in all health care specialties. Physicians are sometimes reluctant to engage because of concerns of privacy, litigation, and lack of experience with this modality. Many surgical subspecialties have capitalized on social media but no study to date has examined the specific footprint of pediatric orthopaedic surgeons in this realm. We aim to quantify the utilization of individual social media platforms by pediatric orthopaedic surgeons, and identify any differences between private and hospital-based physicians, but also regional differences. Using the Pediatric Orthopaedic Society of North America Member Directory, each active member's social media presence was reviewed through an Internet search. Members were stratified on the basis of practice model and geographic location. Individual Internet searches, social media sites, and number of publications were reviewed for social media presence. Of 987 Pediatric Orthopaedic Society of North America members, 95% had a professional webpage, 14.8% a professional Facebook page, 2.2% a professional Twitter page, 36.8% a LinkedIn profile, 25.8% a ResearchGate profile, 33% at least 1 YouTube. Hospital-based physicians had a lower mean level of utilization of social media compared with their private practice peers, and a higher incidence of Pubmed publications. Private practice physicians had double the social media utilization. Regional differences reveal that practicing Pediatric Orthopaedists in the Northeast had increased utilization of ResearchGate and LinkedIn and the West had the lowest mean social media utilization levels. The rapid expansion of social media usage by patients and their family members is an undeniable force affecting the health care industry. The Internet and social media platforms provide all physicians with a means to educate patients, collaborate with colleagues, and promote their practice and areas of interest. Our survey indicates that pediatric orthopaedic surgeons may be underutilizing their potential social media presence. Level IV.

[On the role of the state-private partnership in public health].

PubMed

Nechaev, V S; Nisan, B A

2012-01-01

The article deals with the issues of study of state-private partnership in the framework of development of strategic measures of regulation of this area in public health. It is demonstrated that the regulation of state-private partnership has to combine the dynamism inherent in entrepreneurship and the public stability needed for normal public health functioning. The control functions of state authorities in the area of public health policy developed into concept of "supervision" which obligates the state to manage the health system guided by norms of ethics and financial expediency. The regulation as a main tool of "supervision" in the state-private partnership has to meet the same two requirements. The activation of entrepreneur activity in public health by no means is caused by increase of privatization in this sector. Under these conditions, the implementation of market mechanisms in public health system make is more effective and efficient.

Michigan School Privatization Survey 2016. A Mackinac Center Report

ERIC Educational Resources Information Center

Hohman, James M.; Cammenga, Janelle

2016-01-01

Public school districts are government entities, but they rely on the private sector to support their function of delivering educational services to students. Private contractors, for example, construct district buildings, write textbooks and manufacture the supplies necessary to keep the district operational, among other things. And over the past…

Re-powering and site recycling in a competitive environment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Taylor, A.; Kahn, E.P.

1991-03-01

Re-powering and site recycling are strategies designed to expand electric generating capacity by using depreciated assets. The resource base for the these strategies is large. By 1995, over 170,000 MW of fossil-fired capacity will be in excess of thirty years old, and approaching the end of its conventional economic lifetime. This paper explores how these assets might be developed using competitive market forces. While some re-powering is being pursued under traditional ratebase regulation, there are four other generic alternatives. These are: (1) utility investment at fixed prices with regulatory pre-approval, (2) utility investment under competitive bidding, (3) utility leasing formore » private producer development, and (4) utility sale of sites for private producer development. Issues associated with each alternative are explored and illustrated with examples. State regulatory policy will be the critical determinant of whether a market develops for depreciated power plants. Financial incentives will stimulate utilities to re-deploy depreciated assets. This means some form of profit-sharing between customers and shareholders of the grains from asset sales. Different approaches to profit sharing are reviewed. These developments are still in an experimental state, however, and no single approach appears to have emerged as a dominant trend. 36 refs., 1 tab.« less

Alternative Fuels Data Center

Science.gov Websites

of the following measures: Payment of incentives to customers that install EVSE; Time-of-use rates customers; and Technical assistance programs for government fleets and private organizations. Utilities may

78 FR 27991 - Notice of Request for Nominees for the Advisory Committee on Water Information

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-13

... water-related associations, academia, private industry, water utility associations, civil engineering... associations, environmental and educational groups. Member organizations designate their representatives and...

Levers supporting tariff growth for water services: evidence from a contingent valuation analysis.

PubMed

Guerrini, Andrea; Vigolo, Vania; Romano, Giulia; Testa, Federico

2018-02-01

The backwardness of the water utilities sector necessitates urgent investment in infrastructure to improve water quality and efficiency in water supply networks. A policy of tariff growth represents the main source to sustain such investments. Therefore, customer engagement in the form of willingness to pay (WTP) is highly desirable by water utilities to obtain social legitimization and support. This study examines the determinants of consumers' WTP for improvement programs for three drinking water issues: quality of water sources, renewal of water mains, and building of new wastewater treatment plants. The study is based on a survey conducted among a sample of 587 customers of a water utility located in the province of Verona in the north of Italy. The contingence valuation method is used to measure WTP. Specifically, an ordinal logistic regression model yields the following significant determinants of WTP: quality of water and services provided, preference for privatization of the water utility, sustainable consumption of water, and some socio-demographic variables. The findings provide interesting insights into the drivers of WTP as well as managerial recommendations for water utilities. In particular, the findings show that water utilities need to improve service and water quality to increase customers' acceptance of tariff growth. In addition, utilities should invest in customer education and communication activities focusing on specific age groups (e.g., older customers) to enhance their WTP. Finally, communication strategies should reinforce the possible role of liberalization and privatization in supporting infrastructure investments. Copyright © 2017 Elsevier Ltd. All rights reserved.

Restructuring and performance in India's electricity sector

NASA Astrophysics Data System (ADS)

Panda, Arun Kumar

Restructuring and privatization, used as major tools in electricity sector reform, are often viewed as part of the same process and the terms used interchangeably. Although related, they represent quite different dimensions of change and reform. Privatization is the result of change in the management/ownership. Restructuring, on the other hand, refers to changes in structure such as the unbundling of vertically integrated utilities, and the introduction of competition. Most studies attempt to assess the impact of privatization of the electric utilities on their tariff structure, performance and efficiency. They have not tried to estimate the effect of restructuring on the performance of the unbundled utilities. Using panel data on the state electricity boards and the thermal power plants, and employing variance-component fixed effects and random effects models, this study examines the effects of restructuring and ownership on the performance of India's electricity sector. We also study the effects of absolute majority of political parties on performance. The study also uses a cross-country-comparison-framework to compare the electricity sector reforms of India with those of Chile, Hungary and Norway. Results show that restructuring has significantly positive effects on such performance indicators as plant availability, plant load factor, forced outage, average tariff collection, and sales revenue as a ratio of cost. With regard to labor efficiency indicators, we find mixed results. Restructuring also appears to entail reduction in the extent of cross-subsidization. However, the cost of supply seems to be unaffected by restructuring. Absolute majority of the party in government shows adverse effects on costs, sales revenue as a ratio of cost, and labor efficiency. The effects of ownership are somewhat mixed, with state ownership (as opposed to federal or private) indicating adverse effects on plant performance. Interestingly, after controlling for location-specific effects, we do not find significant difference between privately owned plants and other plants in areas like plant availability, and plant load factor. In a developing country like India with a long tradition of public ownership and vertical integration in electricity sector, this has important policy implications.

Preserving Differential Privacy in Degree-Correlation based Graph Generation

PubMed Central

Wang, Yue; Wu, Xintao

2014-01-01

Enabling accurate analysis of social network data while preserving differential privacy has been challenging since graph features such as cluster coefficient often have high sensitivity, which is different from traditional aggregate functions (e.g., count and sum) on tabular data. In this paper, we study the problem of enforcing edge differential privacy in graph generation. The idea is to enforce differential privacy on graph model parameters learned from the original network and then generate the graphs for releasing using the graph model with the private parameters. In particular, we develop a differential privacy preserving graph generator based on the dK-graph generation model. We first derive from the original graph various parameters (i.e., degree correlations) used in the dK-graph model, then enforce edge differential privacy on the learned parameters, and finally use the dK-graph model with the perturbed parameters to generate graphs. For the 2K-graph model, we enforce the edge differential privacy by calibrating noise based on the smooth sensitivity, rather than the global sensitivity. By doing this, we achieve the strict differential privacy guarantee with smaller magnitude noise. We conduct experiments on four real networks and compare the performance of our private dK-graph models with the stochastic Kronecker graph generation model in terms of utility and privacy tradeoff. Empirical evaluations show the developed private dK-graph generation models significantly outperform the approach based on the stochastic Kronecker generation model. PMID:24723987

76 FR 72418 - Statement of Organization, Functions, and Delegations of Authority; Administration on...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... components of ACF as well as other public, private, and voluntary sector partners, ADD develops and..., intergovernmental and public-private sector agreements, committees, task forces, commissions or joint-funding... the function to ADD as a result of the Charter Amendment for PCPID governed by Public Law 92-463...

Cumulative Inequality and Racial Disparities in Health: Private Insurance Coverage and Black/White Differences in Functional Limitations

PubMed Central

Taylor, Miles G.

2014-01-01

Objectives. To test different forms of private insurance coverage as mediators for racial disparities in onset, persistent level, and acceleration of functional limitations among Medicare age-eligible Americans. Method. Data come from 7 waves of the Health and Retirement Study (1996–2008). Onset and progression latent growth models were used to estimate racial differences in onset, level, and growth of functional limitations among a sample of 5,755 people aged 65 and older in 1996. Employer-provided insurance, spousal insurance, and market insurance were next added to the model to test how differences in private insurance mediated the racial gap in physical limitations. Results. In baseline models, African Americans had larger persistent level of limitations over time. Although employer-provided, spousal provided, and market insurances were directly associated with lower persistent levels of limitation, only differences in market insurance accounted for the racial disparities in persistent level of limitations. Discussion. Results suggest private insurance is important for reducing functional limitations, but market insurance is an important mediator of the persistently larger level of limitations observed among African Americans. PMID:24569001

Utilization of HIV-related services from the private health sector: A multi-country analysis.

PubMed

Wang, Wenjuan; Sulzbach, Sara; De, Susna

2011-01-01

Increasing the participation of the private health sector in the AIDS response could help to achieve universal access to comprehensive HIV prevention, treatment, care and support. Yet little is known about the extent to which the private health sector is delivering HIV-related services. This study uses data from the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) from 12 countries in Africa, Asia and Latin America and the Caribbean to explore use of HIV testing and STI care from the private for-profit sector, and its association with household wealth status. The analysis indicates that the private for-profit health sector is active in HIV-related service delivery, although the level of participation varies by region and country. From 3 to 45 percent of women and 6 to 42 percent of men reported the private for-profit sector as their source of the most recent HIV testing. While in some countries, use of the private for-profit health sector for HIV testing and STI care increases with wealth, in others the relationship is not clear, as there are no significant differences in using private for-profit HIV-related services between the rich and the poor. We conclude that as the global AIDS response evolves from emergency relief to sustained country programs, broader consideration of the role of the private for-profit health sector may be warranted. Copyright © 2010 Elsevier Ltd. All rights reserved.

Key Generation for Fast Inversion of the Paillier Encryption Function

NASA Astrophysics Data System (ADS)

Hirano, Takato; Tanaka, Keisuke

We study fast inversion of the Paillier encryption function. Especially, we focus only on key generation, and do not modify the Paillier encryption function. We propose three key generation algorithms based on the speeding-up techniques for the RSA encryption function. By using our algorithms, the size of the private CRT exponent is half of that of Paillier-CRT. The first algorithm employs the extended Euclidean algorithm. The second algorithm employs factoring algorithms, and can construct the private CRT exponent with low Hamming weight. The third algorithm is a variant of the second one, and has some advantage such as compression of the private CRT exponent and no requirement for factoring algorithms. We also propose the settings of the parameters for these algorithms and analyze the security of the Paillier encryption function by these algorithms against known attacks. Finally, we give experimental results of our algorithms.

Reviews of Data on Science Resources, No. 29. Current and Future Utilization of Scientific and Technical Personnel in Energy-Related Activities.

ERIC Educational Resources Information Center

National Science Foundation, Washington, DC. Div. of Science Resources Studies.

This National Science Foundation (NSF) bulletin summarizes the NSF program of energy manpower studies that assessed the impact of past energy developments and future options for scientific and technical manpower. This document summarizes the utilization of scientific personnel in energy-related activities in private industry in 1975 and shortages…

National Action Plan for Energy Efficiency

EPA Pesticide Factsheets

Provides resources for policy-makers, consumers, utilities, and others produced through NAPEE - a private-public initiative to create a sustainable, aggressive national commitment to energy efficiency through a collaborative effort of stakeholders.

7 CFR 23.1 - General.

Code of Federal Regulations, 2013 CFR

2013-01-01

... utilize and build upon the research, extension, and community service capability of public and private... title V shall be organized and conducted by one or more colleges or universities in each State to...

Public health care and private insurance demand: the waiting time as a link.

PubMed

Jofre-Bonet, M

2000-01-01

This paper analyzes the effect of waiting times in the Spanish public health system on the demand for private health insurance. Expected utility maximization determines whether or not individuals buy a private health insurance. The decision depends not only on consumer's covariates such as income, socio-demographic characteristics and health status, but also on the quality of the treatment by the public provider. We interpret waiting time as a qualitative attribute of the health care provision. The empirical analysis uses the Spanish Health Survey of 1993. We cope with the absence of income data by using the Spanish Family Budget Survey of 1990-91 as a complementary data set, following the Arellano-Meghir method [4]. Results indicate that a reduction in the waiting time lowers the probability of buying private health insurance. This suggests the existence of a crowd-out in the health care provision market.

Report of the In Situ Resources Utilization Workshop

NASA Technical Reports Server (NTRS)

Fairchild, Kyle (Editor); Mendell, Wendell W. (Editor)

1988-01-01

The results of a workshop of 50 representatives from the public and private sector which investigated the potential joint development of the key technologies and mechanisms that will enable the permanent habitation of space are presented. The workshop is an initial step to develop a joint public/private assessment of new technology requirements of future space options, to share knowledge on required technologies that may exist in the private sector, and to investigate potential joint technology development opportunities. The majority of the material was produced in 5 working groups: (1) Construction, Assembly, Automation and Robotics; (2) Prospecting, Mining, and Surface Transportation; (3) Biosystems and Life Support; (4) Materials Processing; and (5) Innovative Ventures. In addition to the results of the working groups, preliminary technology development recommendations to assist in near-term development priority decisions are presented. Finally, steps are outlined for potential new future activities and relationships among the public, private, and academic sectors.

Oral health care utilization by US rural residents, National Health Interview Survey 1999.

PubMed

Vargas, Clemencia M; Dye, Bruce A; Hayes, Kathy

2003-01-01

To compare the dental care utilization practices of rural and urban residents in the United States. Data on dental care utilization from the 1999 National Health Interview Survey for persons 2 years of age and older (n=42, 139) were analyzed by rural/urban status. Percentages and 95 percent confidence intervals were calculated to produce national estimates for having had a visit in the past year, the number of visits, reasons given for last dental visit and for not visiting a dentist, unmet dental needs, and private dental insurance. Rural residents were more likely to report that their last dental visit was because something was "bothering or hurting" (23.3% vs 17.6%) and that they had unmet dental needs (10.1% vs 7.5%). Urban residents were more likely to report having a dental visit in the past year (57.7% vs 66.5%) and having private dental insurance (32.7% vs 37.2%), compared to rural residents. There were no significant differences in most reasons given for not visiting the dentist between rural and urban respondents. Dental care utilization characteristics differ between rural and urban residents in the United States, with rural residents tending to underutilize dental care.

Experimental extraction of secure correlations from a noisy private state.

PubMed

Dobek, K; Karpiński, M; Demkowicz-Dobrzański, R; Banaszek, K; Horodecki, P

2011-01-21

We report experimental generation of a noisy entangled four-photon state that exhibits a separation between the secure key contents and distillable entanglement, a hallmark feature of the recently established quantum theory of private states. The privacy analysis, based on the full tomographic reconstruction of the prepared state, is utilized in a proof-of-principle key generation. The inferiority of distillation-based strategies to extract the key is exposed by an implementation of an entanglement distillation protocol for the produced state.

U.S. commercial space activities - Returning the U.S. to preeminence in space

NASA Technical Reports Server (NTRS)

Stone, Barbara A.

1987-01-01

The current status of NASA's activities related to the commercial development of space is reviewed with particular reference to the emerging new commercial space activities and the post-Challenger policy developments affecting space commerce. The discussion covers the development of U.S. private sector launching capabilities, cooperative agreements with the private sector, the NASA technology utilization program, the technology applications activities of the Office of Commercial Programs, and the activities of the Centers for the Commercial Development of Space program.

The impact of socioeconomic inequalities and lack of health insurance on physical functioning among middle-aged and older adults in the United States.

PubMed

Kim, Jinhyun; Richardson, Virginia

2012-01-01

Socioeconomic inequalities and lack of private health insurance have been viewed as significant contributors to health disparities in the United States. However, few studies have examined their impact on physical functioning over time, especially in later life. The current study investigated the impact of socioeconomic inequalities and lack of private health insurance on individuals' growth trajectories in physical functioning, as measured by activities of daily living. Data from the Health and Retirement Study (1994-2006) were used for this study, 6519 black and white adults who provided in-depth information about health, socioeconomic, financial and health insurance information were analysed. Latent growth curve modelling was used to estimate the initial level of physical functioning and its rate of change over time. Results showed that higher level of income and assets and having private health insurance significantly predicted better physical functioning. In particular, decline in physical functioning was slower among those who had private health insurance. Interestingly, changes in economic status, such as decreases in income and assets, had a greater impact on women's physical functioning than on men's. Black adults did not suffer more rapid declines in physical functioning than white adults after controlling for socioeconomic status. The current longitudinal study suggested that anti-poverty and health insurance policies should be enhanced to reduce the negative impact of socioeconomic inequalities on physical functioning throughout an individual's life course. © 2011 Blackwell Publishing Ltd.

Privatization and environmental pollution in an international mixed Cournot model

NASA Astrophysics Data System (ADS)

Ferreira, Fernanda A.

2016-06-01

In this paper, we consider a competition between a domestic public firm and a foreign private firm, supposing that the production processes generates environmental pollution. Introducing the residents' environmental preference into the public firm's objective function, we analyse its economic impacts. We also analyse the economic impacts of the privatization.

Who pays when VA users are hospitalized in the private sector? Evidence from three data sources.

PubMed

West, Alan N; Weeks, William B

2007-10-01

Older veterans enrolled in VA healthcare receive much of their medical care in the private sector, through Medicare. Less is known about younger VA enrollees' use of the private sector, or its funding. We compare payers for younger and older enrollees' private sector use in 3 hospitalization datasets. From 1998 to 2000, using private sector discharge data for VA enrollees in New York State, we categorized hospitalizations according to payer (self/family, private insurance, Medicare, Medicaid, other sources). We compared this payer distribution to population-weighted national Medical Expenditure Panel Survey (MEPS) data from 1996-2003 for veterans in VA healthcare. We also compared Medicare utilization in either dataset to hospitalizations for New York veterans from 1998-2000 in the VA-Medicare dataset. Analyses separated patients younger than age 65 from those age 65 or older. VA enrollees under age 65 obtain roughly half their hospitalizations in the private sector; older enrollees use the private sector at least twice as often as the VA. Datasets generally agree on payer distributions. Although older enrollees rely heavily on Medicare, they also use commercial insurance and self/family payments substantially. Half of younger enrollees' non-VA hospitalizations are paid by private insurance, but Medicare, Medicaid, and self/family each pay for one-quarter to one-third of admissions. VA enrollees use the private sector for most of their inpatient care, which is funded by multiple sources. Developing a national UB-92/VA dataset would be critical to understanding veterans' use of the private sector for specific diagnoses and procedures, particularly for the fast growing population of younger veterans.

Private sector participation and health system performance in sub-saharan Africa.

PubMed

Yoong, Joanne; Burger, Nicholas; Spreng, Connor; Sood, Neeraj

2010-10-07

The role of the private health sector in developing countries remains a much-debated and contentious issue. Critics argue that the high prices charged in the private sector limits the use of health care among the poorest, consequently reducing access and equity in the use of health care. Supporters argue that increased private sector participation might improve access and equity by bringing in much needed resources for health care and by allowing governments to increase focus on underserved populations. However, little empirical exists for or against either side of this debate. We examine the association between private sector participation and self-reported measures of utilization and equity in deliveries and treatment of childhood respiratory disease using regression analysis, across a sample of nationally-representative Demographic and Health Surveys from 34 SSA economies. We also examine the correlation between private sector participation and key background factors (socioeconomic development, business environment and governance) and use multivariate regression to control for potential confounders. Private sector participation is positively associated with greater overall access and reduced disparities between rich and poor as well as urban and rural populations. The positive association between private sector participation and improved health system performance is robust to controlling for confounders including per capita income and maternal education. Private sector participation is positively correlated with measures of socio-economic development and favorable business environment. Greater participation is associated with favorable intermediate outcomes in terms of access and equity. While these results do not establish a causal link between private sector participation and health system performance, they suggest that there is no deleterious link between private sector participation and health system performance in SSA.

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.

Materials and Waste Management Research

EPA Pesticide Factsheets

EPA is developing data and tools to reduce waste, manage risks, reuse and conserve natural materials, and optimize energy recovery. Collaboration with states facilitates assessment and utilization of technologies developed by the private sector.

Child center closures: Does nonprofit status provide a comparative advantage?

PubMed

Lam, Marcus; Klein, Sacha; Freisthler, Bridget; Weiss, Robert E

2013-03-01

Reliable access to dependable, high quality childcare services is a vital concern for large numbers of American families. The childcare industry consists of private nonprofit, private for-profit, and governmental providers that differ along many dimensions, including quality, clientele served, and organizational stability. Nonprofit providers are theorized to provide higher quality services given comparative tax advantages, higher levels of consumer trust, and management by mission driven entrepreneurs. This study examines the influence of ownership structure, defined as nonprofit, for-profit sole proprietors, for-profit companies, and governmental centers, on organizational instability, defined as childcare center closures. Using a cross sectional data set of 15724 childcare licenses in California for 2007, we model the predicted closures of childcare centers as a function of ownership structure as well as center age and capacity. Findings indicate that for small centers (capacity of 30 or less) nonprofits are more likely to close, but for larger centers (capacity 30+) nonprofits are less likely to close. This suggests that the comparative advantages available for nonprofit organizations may be better utilized by larger centers than by small centers. We consider the implications of our findings for parents, practitioners, and social policy.

Child center closures: Does nonprofit status provide a comparative advantage?

PubMed Central

Lam, Marcus; Klein, Sacha; Freisthler, Bridget; Weiss, Robert E.

2013-01-01

Reliable access to dependable, high quality childcare services is a vital concern for large numbers of American families. The childcare industry consists of private nonprofit, private for-profit, and governmental providers that differ along many dimensions, including quality, clientele served, and organizational stability. Nonprofit providers are theorized to provide higher quality services given comparative tax advantages, higher levels of consumer trust, and management by mission driven entrepreneurs. This study examines the influence of ownership structure, defined as nonprofit, for-profit sole proprietors, for-profit companies, and governmental centers, on organizational instability, defined as childcare center closures. Using a cross sectional data set of 15724 childcare licenses in California for 2007, we model the predicted closures of childcare centers as a function of ownership structure as well as center age and capacity. Findings indicate that for small centers (capacity of 30 or less) nonprofits are more likely to close, but for larger centers (capacity 30+) nonprofits are less likely to close. This suggests that the comparative advantages available for nonprofit organizations may be better utilized by larger centers than by small centers. We consider the implications of our findings for parents, practitioners, and social policy. PMID:23543882

An Energy Resource List.

ERIC Educational Resources Information Center

VocEd, 1979

1979-01-01

Selected energy resource information, from both federal and private sources, is listed under funding, general information and assistance, recycling, solar, transportation, utilities, and wind power. Books, pamphlets, films, journals, newsletters, and other materials are included. (MF)

78 FR 58383 - Renewal of Rail Energy Transportation Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-23

... electric utilities (including at least one rural electric cooperative and one state- or municipally-owned..., and distributors; 2 representatives from private car owners, car lessors, or car manufacturers; and, 1...

The effect of health and dental insurance on US children's dental care utilization for urgent and non-urgent dental problems - 2008.

PubMed

Naavaal, Shillpa; Barker, Laurie K; Griffin, Susan O

2017-12-01

We examined the association between utilization of care for a dental problem (utilization-DP) and parent-reported dental problem (DP) urgency among children with DP by type of health care insurance coverage. We used weighted 2008 National Health Interview Survey data from 2,834 children, aged 2-17 years with at least one DP within the 6 months preceding survey. Explanatory variables were selected based on Andersen's model of healthcare utilization. Need was considered urgent if DP included toothache, bleeding gums, broken or missing teeth, broken or missing filling, or decayed teeth and otherwise as non-urgent. The primary enabling variable, insurance, had four categories: none, private health no dental coverage (PHND), private health and dental (PHD), or Medicaid/State Children's Health Insurance Program (SCHIP). Predisposing variables included sociodemographic characteristics. We used bivariate and multivariate analyses to identify explanatory variables' association with utilization-DP. Using logistic regression, we obtained adjusted estimates of utilization-DP by urgency for each insurance category. In bivariate analyses, utilization-DP was associated with both insurance and urgency. In multivariate analyses, the difference in percent utilizing care for an urgent versus non-urgent DP among children covered by Medicaid/SCHIP was 32 percentage points; PHD, 25 percentage points; PHND, 12 percentage points; and no insurance, 14 percentage points. The difference in utilization by DP urgency was higher for children with Medicaid/SCHIP compared with either PHND or uninsured children. Expansion of Medicaid/SCHIP may permit children to receive care for urgent DPs who otherwise may not, due to lack of dental insurance. © 2016 American Association of Public Health Dentistry.

Access to physician services: does supplemental insurance matter? evidence from France.

PubMed

Buchmueller, Thomas C; Couffinhal, Agnès; Grignon, Michel; Perronnin, Marc

2004-07-01

In France, public health insurance is universal but incomplete, with private payments accounting for roughly 25% of all spending. As a result, most people have supplemental private health insurance. We investigate the effects of such insurance on the utilization of physician services using data from the 1998 Enquête sur la santé et la protection sociale, a nationally representative survey of the non-institutionalized French population. Our results indicate that insurance has a strong and significant effect on the utilization of physician services. Individuals with supplemental coverage have substantially more physician visits than those without. While French patients have greater freedom than patients in other countries to choose to see a specialist rather than a general practitioner, we find no evidence that supplemental insurance affects this decision. Copyright 2004 John Wiley & Sons, Ltd.

Cardiovascular disease prevention in low resource settings: lessons from the Heartfile experience in Pakistan.

PubMed

Nishtar, Sania

2003-01-01

This paper outlines activities of the Heartfile Program in Pakistan (http://heartfile.org). The program focuses on cardiovascular disease prevention and health promotion, and includes several initiatives that encompass building policy, reorienting health services, and developing community interventions that utilize the print and electronic media and outreach at the grass-root level to incorporate social marketing approaches. Initiated by the nonprofit private sector, the program now links with major public sector primary healthcare programs, and is currently spearheading formulation of the National Action Plan on Noncommunicable Disease Prevention and Control in Pakistan. In addition, the program is being refined, validated, and packaged as a replicable model for other developing countries and in low resource settings, utilizing appropriate principles of franchising with inbuilt components sensitive to cultural and social adaptations. A review of the planning process, implementation strategy, and fund-raising experience is presented. Strategies unique to low resource settings, such as the development of cost- and time-efficient strategic alliances and partnerships, have also been highlighted. In addition, specific caveats are identified as being helpful to private sector development of chronic disease prevention programs in resource-constrained settings, and a road map to a sustainable public-private sector partnership is provided.

California Energy Systems for the 21st Century 2016 Annual Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Randwyk, J.; Boutelle, A.; McClelland, C.

The California Energy Systems for the 21st Century (CES-21) Program is a public-private collaborative research and development program between the California Joint Utilities1 and Lawrence Livermore National Laboratory (LLNL). The purpose of this annual report is to provide the California Public Utilities Commission (CPUC or Commission) with a summary of the 2016 progress of the CES-21 Program.

Facilities Inventory and Utilization Study, Fall of 1991, for the State of North Carolina. Twenty-Fifth Edition.

ERIC Educational Resources Information Center

North Carolina Univ., Chapel Hill. Commission on Higher Education Facilities.

This publication presents the results of the 25th annual inventory and utilization study of the status of space in North Carolina institutions of higher education at the end of the fall term of 1991. The study provides data for 113 institutions including the public institutions which comprise the University of North Carolina, 39 private non-profit…

Final Cannon AFB Housing Privatization Environmental Assessment

DTIC Science & Technology

2009-07-01

parking areas, sidewalks, street lighting , utilities, and storm water drainage systems within the MFH areas would be the responsibility of the PO. The...accordance with the quality standards established. Infrastructure such as roads, parking areas, sidewalks, street lighting , utilities, and storm water...to new residents presents instructions for proper disposal of used oil, batteries, tires, and fluorescent light bulbs. 3.7 AIR QUALITY 3.7.1

Analysis of changes in the association of income and the utilization of curative health services in Mexico between 2000 and 2006

PubMed Central

2011-01-01

Background A common characteristic of health systems in most developing countries is unequal access to health services. As a result, members of the poorest population groups often do not receive formal attention for health services, because they cannot afford it. In 2001 in Mexico, to address income-related differences in the use of health services, the government launched a major healthcare reform, which includes a health insurance program called Seguro Popular, aimed at improving healthcare access among poor, uninsured residents. This paper analyzes the before and after changes in the demand for curative ambulatory health services focusing on the association of income-related characteristics and the utilization of formal healthcare providers vs. no healthcare service utilization. Methods By using two nationally representative health surveys (ENSA-2000 and ENSANUT-2006), we modeled an individual's decision when experiencing an illness to use services provided by the (1) Ministry of Health (MoH), (2) social security, (3) private entities, or (4) to not use formal services (no healthcare service utilization). Results Poorer individuals were more likely in 2006 than in 2000 to respond to an illness by using formal healthcare providers. Trends in provider selection differed, however. The probability of using public services from the MoH increased among the poorest population, while the findings indicated an increase in utilization of private health services among members of low- and middle-income groups. No significant change was seen among formal workers -covered by social security services-, regardless of socioeconomic status. Conclusions Overall, for 2006 the Mexican population appears less differentiated in using healthcare across economic groups than in 2000. This may be related, in part, to the implementation of Seguro Popular, which seems to be stimulating healthcare demand among the poorest and previously uninsured segment of the population. Still, public health authorities need to address the remaining income-related healthcare utilization differences, the differences in quality between public and private health services, and the general perception that MoH facilities offer inferior services. PMID:21978183

Analysis of changes in the association of income and the utilization of curative health services in Mexico between 2000 and 2006.

PubMed

Danese-Dlsantos, Laura G; Sosa-Rubí, Sandra G; Valencia-Mendoza, Atanacio

2011-10-07

A common characteristic of health systems in most developing countries is unequal access to health services. As a result, members of the poorest population groups often do not receive formal attention for health services, because they cannot afford it. In 2001 in Mexico, to address income-related differences in the use of health services, the government launched a major healthcare reform, which includes a health insurance program called Seguro Popular, aimed at improving healthcare access among poor, uninsured residents. This paper analyzes the before and after changes in the demand for curative ambulatory health services focusing on the association of income-related characteristics and the utilization of formal healthcare providers vs. no healthcare service utilization. By using two nationally representative health surveys (ENSA-2000 and ENSANUT-2006), we modeled an individual's decision when experiencing an illness to use services provided by the (1) Ministry of Health (MoH), (2) social security, (3) private entities, or (4) to not use formal services (no healthcare service utilization). Poorer individuals were more likely in 2006 than in 2000 to respond to an illness by using formal healthcare providers. Trends in provider selection differed, however. The probability of using public services from the MoH increased among the poorest population, while the findings indicated an increase in utilization of private health services among members of low- and middle-income groups. No significant change was seen among formal workers -covered by social security services-, regardless of socioeconomic status. Overall, for 2006 the Mexican population appears less differentiated in using healthcare across economic groups than in 2000. This may be related, in part, to the implementation of Seguro Popular, which seems to be stimulating healthcare demand among the poorest and previously uninsured segment of the population. Still, public health authorities need to address the remaining income-related healthcare utilization differences, the differences in quality between public and private health services, and the general perception that MoH facilities offer inferior services.

Physiotherapy as a disciplinary institution in modern society - a Foucauldian perspective on physiotherapy in Danish private practice.

PubMed

Praestegaard, Jeanette; Gard, Gunvor; Glasdam, Stinne

2015-01-01

In many Western countries, physiotherapy in a private context is practiced and managed within a neoliberal ideology. Little is known about how private physiotherapeutic practice functions, which is why this study aims to explore how physiotherapy is practiced from the perspective of physiotherapists in Danish private practice, within a Foucauldian perspective. This study consisted of 21 interviews with physiotherapists employed in private practice and observation notes of the clinic. Interviews and observation notes were analyzed through the lens of Foucault's concepts of discipline, self-discipline, power and resistance. Three categories were constructed: (1) the tacit transition from person to patient; (2) the art of producing docile bodies; and (3) the inhibition of freedom of action by practicing in private homes. From a Foucauldian perspective, private physiotherapeutic practices have a disciplinary function in modern society as the physiotherapists produce docile bodies through disciplinary technologies, whereby their business becomes profitable. Most patients support the physiotherapists' "regime of truth" but if they resist, they are either excluded or accepted as "abnormal" but as a necessary source of income. The physiotherapists appear to be unconscious of the bio-powers working "behind their backs" as they are subject to the Western medical logic, and the neoliberal framework that rules their businesses.

Fuel cell programs in the United States for stationary power applications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Singer, M.

1996-04-01

The Department of Energy (DOE), Office of Fossil Energy, is participating with the private sector in sponsoring the development of molten carbonate fuel cell (MCFC) and solid oxide fuel cell (SOFC) technologies for application in the utility, commercial and industrial sectors. Phosphoric acid fuel cell (PAFC) development was sponsored by the Office of Fossil Energy in previous years and is now being commercialized by the private sector. Private sector participants with the Department of Energy include the Electric Power Research Institute (EPRI), the Gas Research institute (GRI), electric and gas utilities, universities, manufacturing companies and their suppliers. through continued governmentmore » and private sector support, fuel cell systems are emerging power generation technologies which are expected to have significant worldwide impacts. An industry with annual sales of over a billion dollars is envisioned early in the 21st century. PAFC power plants have begun to enter the marketplace and MCFC and SOFC power plants are expected to be ready to enter the marketplace in the late 1990s. In support of the efficient and effective use of our natural resources, the fuel cell program seeks to increase energy efficiency and economic effectiveness of power generation. This is to be accomplished through effectiveness of power generation. This is accomplished through the development and commercialization of cost-effective, efficient and environmentally desirable fuel cell systems which will operate on fossil fuels in multiple and end use sectors.« less

Comparison of public and private care management agencies under public long-term care insurance in Japan: a cross-sectional study.

PubMed

Yoshioka, Yoji; Tamiya, Nanako; Kashiwagi, Masayo; Sato, Mikiya; Okubo, Ichiro

2010-01-01

Long-Term Care Insurance (LTCI), which started in April 2000, allowed private business corporations to provide long-term care services which had been provided by social welfare corporations or public agencies in the previous long-term care scheme. This study compared differences in care management plans for community-dwelling frail elderly people between public care management agencies and private care management agencies. The subjects were 309 community-dwelling frail elderly people living in a suburban city with a population of approximately 55,000 and who had been using community-based long-term care services of the LTCI for 6 months from April 2000. The characteristics of the care management agencies (public/private) were identified using a claims database. After comparing profiles of users and their care mix between those managed by public agencies and by private agencies, the effect of the characteristics of care management agencies on LTCI service use was examined. Public care management agencies favored younger subjects (P = 0.003), male subjects (P = 0.006) and people with a higher need for care (P = 0.02) than private agencies. The number of service items used was significantly larger in public agencies than in their private counterparts. In multivariate regression analysis, the utilization of community-based long-term care service was significantly greater among beneficiaries managed by private agencies than those managed by public agencies (P = 0.02). Private care management agencies play an important role in promoting the use of care services, but their quality of care plans might be questionable.

Health Resources in a 200,000 Urban Indian Population Argues the Need for a Policy on Private Sector Health Services

PubMed Central

Furtado, Kheya Melo; Kar, Anita

2014-01-01

Background: There are limited primary data on the number of urban health care providers in private practice in developing countries like India. These data are needed to construct and test models that measure the efficacy of public stewardship of private sector health services. Objective: This study reports the number and characteristics of health resources in a 200 000 urban population in Pune. Materials and Methods: Data on health providers were collected by walking through the 15.46 sq km study area. Enumerated data were compared with existing data sources. Mapping was carried out using a Global Positioning System device. Metrics and characteristics of health resources were analyzed using ArcGIS 10.0 and Statistical Package for the Social Sciences, Version 16.0 software. Results: Private sector health facilities constituted the majority (424/426, 99.5%) of health care services. Official data sources were only 39% complete. Doctor to population ratios were 2.8 and 0.03 per 1000 persons respectively in the private and public sector, and the nurse to doctor ratio was 0.24 and 0.71, respectively. There was an uneven distribution of private sector health services across the area (2-118 clinics per square kilometre). Bed strength was forty-fold higher in the private sector. Conclusions: Mandatory registration of private sector health services needs to be implemented which will provide an opportunity for public health planners to utilize these health resources to achieve urban health goals. PMID:24963226

Health resources in a 200,000 urban Indian population argues the need for a policy on private sector health services.

PubMed

Furtado, Kheya Melo; Kar, Anita

2014-04-01

There are limited primary data on the number of urban health care providers in private practice in developing countries like India. These data are needed to construct and test models that measure the efficacy of public stewardship of private sector health services. This study reports the number and characteristics of health resources in a 200 000 urban population in Pune. Data on health providers were collected by walking through the 15.46 sq km study area. Enumerated data were compared with existing data sources. Mapping was carried out using a Global Positioning System device. Metrics and characteristics of health resources were analyzed using ArcGIS 10.0 and Statistical Package for the Social Sciences, Version 16.0 software. Private sector health facilities constituted the majority (424/426, 99.5%) of health care services. Official data sources were only 39% complete. Doctor to population ratios were 2.8 and 0.03 per 1000 persons respectively in the private and public sector, and the nurse to doctor ratio was 0.24 and 0.71, respectively. There was an uneven distribution of private sector health services across the area (2-118 clinics per square kilometre). Bed strength was forty-fold higher in the private sector. Mandatory registration of private sector health services needs to be implemented which will provide an opportunity for public health planners to utilize these health resources to achieve urban health goals.

EPA Research in Sustainable Water Resources

EPA Science Inventory

The four goals addressed in this slide presentation are: (1) Address contaminants as groups, (2) Technology advancement: engage the private sector, universities, communities, and utilities, (3) Leverage all appropriate authorities, and (4) Improve information sharing with stake...

The Association of Health and Functional Status with Private and Public Religious Practice among Rural, Ethnically Diverse, Older Adults with Diabetes

ERIC Educational Resources Information Center

Arcury, Thomas A.; Stafford, Jeanette M.; Bell, Ronny A.; Golden, Shannon L.; Snively, Beverly M.; Quandt, Sara A.

2007-01-01

Purpose: This analysis describes the association of health and functional status with private and public religious practice among ethnically diverse (African American, Native American, white) rural older adults with diabetes. Methods: Data were collected using a population-based, cross-sectional, stratified, random sample survey of 701…

Logistics as a Competitive Warfighting Advantage

DTIC Science & Technology

2016-10-20

World Class Business Practices DoD Application 1 Focused on Core Functions Define and focus on core functions; Divest other...primes and lower cost timelines  DLA Leadership Model – Aligning DLA leadership to business standards  Defense Working Capital Fund - DLA...DLA’s leadership should incorporate private business sector structures – Leadership incentive structures are not reflective of private business best

Systematic literature review of integrated community case management and the private sector in Africa: Relevant experiences and potential next steps.

PubMed

Awor, Phyllis; Miller, Jane; Peterson, Stefan

2014-12-01

Despite substantial investments made over the past 40 years in low income countries, governments cannot be viewed as the principal health care provider in many countries. Evidence on the role of the private sector in the delivery of health services is becoming increasingly available. In this study, we set out to determine the extent to which the private sector has been utilized in providing integrated care for sick children under 5 years of age with community-acquired malaria, pneumonia or diarrhoea. We reviewed the published literature for integrated community case management (iCCM) related experiences within both the public and private sector. We searched PubMed and Google/Google Scholar for all relevant literature until July 2014. The search terms used were "malaria", "pneumonia", "diarrhoea", "private sector" and "community case management". A total of 383 articles referred to malaria, pneumonia or diarrhoea in the private sector. The large majority of these studies (290) were only malaria related. Most of the iCCM-related studies evaluated introduction of only malaria drugs and/or diagnostics into the private sector. Only one study evaluated the introduction of drugs and diagnostics for malaria, pneumonia and diarrhoea in the private sector. In contrast, most iCCM-related studies in the public sector directly reported on community case management of 2 or more of the illnesses. While the private sector is an important source of care for children in low income countries, little has been done to harness the potential of this sector in improving access to care for non-malaria-associated fever in children within the community. It would be logical for iCCM programs to expand their activities to include the private sector to achieve higher population coverage. An implementation research agenda for private sector integrated care of febrile childhood illness needs to be developed and implemented in conjunction with private sector intervention programs.

Systematic literature review of integrated community case management and the private sector in Africa: Relevant experiences and potential next steps

PubMed Central

Awor, Phyllis; Miller, Jane; Peterson, Stefan

2014-01-01

Background Despite substantial investments made over the past 40 years in low income countries, governments cannot be viewed as the principal health care provider in many countries. Evidence on the role of the private sector in the delivery of health services is becoming increasingly available. In this study, we set out to determine the extent to which the private sector has been utilized in providing integrated care for sick children under 5 years of age with community–acquired malaria, pneumonia or diarrhoea. Methods We reviewed the published literature for integrated community case management (iCCM) related experiences within both the public and private sector. We searched PubMed and Google/Google Scholar for all relevant literature until July 2014. The search terms used were “malaria”, “pneumonia”, “diarrhoea”, “private sector” and “community case management”. Results A total of 383 articles referred to malaria, pneumonia or diarrhoea in the private sector. The large majority of these studies (290) were only malaria related. Most of the iCCM–related studies evaluated introduction of only malaria drugs and/or diagnostics into the private sector. Only one study evaluated the introduction of drugs and diagnostics for malaria, pneumonia and diarrhoea in the private sector. In contrast, most iCCM–related studies in the public sector directly reported on community case management of 2 or more of the illnesses. Conclusions While the private sector is an important source of care for children in low income countries, little has been done to harness the potential of this sector in improving access to care for non–malaria–associated fever in children within the community. It would be logical for iCCM programs to expand their activities to include the private sector to achieve higher population coverage. An implementation research agenda for private sector integrated care of febrile childhood illness needs to be developed and implemented in conjunction with private sector intervention programs. PMID:25520804

Technology initiatives with government/business overlap

NASA Astrophysics Data System (ADS)

Knapp, Robert H., Jr.

2015-03-01

Three important present-day technology development settings involve significant overlap between government and private sectors. The Advanced Research Project Agency for Energy (ARPA-E) supports a wide range of "high risk, high return" projects carried out in academic, non-profit or private business settings. The Materials Genome Initiative (MGI), based in the White House, aims at radical acceleration of the development process for advanced materials. California public utilities such as Pacific Gas & Electric operate under a structure of financial returns and political program mandates that make them arms of public policy as much as independent businesses.

Economical assessment of private sector for power generation in Egypt

DOE Office of Scientific and Technical Information (OSTI.GOV)

El-Zeftawy, A.A.

1992-09-01

The objective of this paper is to develop a renewable energy source as a private generation system, PGS. A proposed approach is presented for this issue which includes economical model for deducing the rate of return on the capital invested under different utilization modes. These modes are; stand-alone system, distribution - PGS connection and PGS central power station. The proposed approach has been used for operating the photovoltaic and wind energy systems as PGSs at different sites in Egypt. A number of measures are developed concerning this point.

Quality choice in Medicaid markets. The case of nursing homes.

PubMed

McKay, N L

1989-01-01

This article examines whether private patients, who typically pay a price higher than the Medicaid reimbursement rate, receive the same or higher quality services than Medicaid patients in the same health care facility. Because the mix of patients will affect the firm's cost only when Medicaid and private patients receive different levels of quality, the cost function can be used to test for the presence of quality differences. Estimates of a cost function for Texas nursing home in 1983 indicate that the mix of patients does not affect the firm's cost. Thus, private and Medicaid patients in the same nursing home receive the same level of quality.

Energy optimization system

DOEpatents

Zhou, Zhi; de Bedout, Juan Manuel; Kern, John Michael; Biyik, Emrah; Chandra, Ramu Sharat

2013-01-22

A system for optimizing customer utility usage in a utility network of customer sites, each having one or more utility devices, where customer site is communicated between each of the customer sites and an optimization server having software for optimizing customer utility usage over one or more networks, including private and public networks. A customer site model for each of the customer sites is generated based upon the customer site information, and the customer utility usage is optimized based upon the customer site information and the customer site model. The optimization server can be hosted by an external source or within the customer site. In addition, the optimization processing can be partitioned between the customer site and an external source.

IT Challenges for Space Medicine or How do We Protect Medical Information and Still Get Useful Work Done?

NASA Technical Reports Server (NTRS)

Johnson-Throop, Kathy A.

2010-01-01

Space Medicine provides healthcare services of various types for astronauts throughout their lifetime starting from the time they are selected as astronauts. IT challenges include: protection of private medical information, access from locations both inside and outside NASA, nearly 24x7 access, access during disasters, international partner access, data archiving, off-region backup, secure communication of medical data to people outside the NASA system (e.g. expert consultants), efficient movement of medical record information between locations, search and retrieval of relevant information, and providing all of these services/capabilities within a limited budget. In Space Medicine, we have provided for these in various ways: limit the amount of private medical information stored locally, utilize encryption mechanisms that the international partners can also use, utilize 2-factor authentication, virtualize servers, employ concept-based search, and use of standardized terminologies (SNOMED) and messaging (HL7).

Practical design considerations for photovoltaic power station

NASA Astrophysics Data System (ADS)

Swanson, T. D.

Aspects of photovoltaic (PV) technology are discussed along with generic PV design considerations, taking into account the resource sunlight, PV modules and their reliability, questions of PV system design, the support structure subsystem, and a power conditioning unit subsystem. A description is presented of two recent projects which demonstrate the translation of an idea into actual working PV systems. A privately financed project in Denton, Maryland, went on line in early December, 1982, and began providing power to the local utility grid. It represents the first intermediate size, grid-connected, privately financed power station in the U.S. Based on firm quotes, the actual cost of this system is about $13/W peak. The other project, called the PV Breeder, is an energy independent facility which utilizes solar power to make new solar cells. It is also the first large industrial structure completely powered by the sun.

Universal Keyword Classifier on Public Key Based Encrypted Multikeyword Fuzzy Search in Public Cloud

PubMed Central

Munisamy, Shyamala Devi; Chokkalingam, Arun

2015-01-01

Cloud computing has pioneered the emerging world by manifesting itself as a service through internet and facilitates third party infrastructure and applications. While customers have no visibility on how their data is stored on service provider's premises, it offers greater benefits in lowering infrastructure costs and delivering more flexibility and simplicity in managing private data. The opportunity to use cloud services on pay-per-use basis provides comfort for private data owners in managing costs and data. With the pervasive usage of internet, the focus has now shifted towards effective data utilization on the cloud without compromising security concerns. In the pursuit of increasing data utilization on public cloud storage, the key is to make effective data access through several fuzzy searching techniques. In this paper, we have discussed the existing fuzzy searching techniques and focused on reducing the searching time on the cloud storage server for effective data utilization. Our proposed Asymmetric Classifier Multikeyword Fuzzy Search method provides classifier search server that creates universal keyword classifier for the multiple keyword request which greatly reduces the searching time by learning the search path pattern for all the keywords in the fuzzy keyword set. The objective of using BTree fuzzy searchable index is to resolve typos and representation inconsistencies and also to facilitate effective data utilization. PMID:26380364

Universal Keyword Classifier on Public Key Based Encrypted Multikeyword Fuzzy Search in Public Cloud.

PubMed

Munisamy, Shyamala Devi; Chokkalingam, Arun

2015-01-01

Cloud computing has pioneered the emerging world by manifesting itself as a service through internet and facilitates third party infrastructure and applications. While customers have no visibility on how their data is stored on service provider's premises, it offers greater benefits in lowering infrastructure costs and delivering more flexibility and simplicity in managing private data. The opportunity to use cloud services on pay-per-use basis provides comfort for private data owners in managing costs and data. With the pervasive usage of internet, the focus has now shifted towards effective data utilization on the cloud without compromising security concerns. In the pursuit of increasing data utilization on public cloud storage, the key is to make effective data access through several fuzzy searching techniques. In this paper, we have discussed the existing fuzzy searching techniques and focused on reducing the searching time on the cloud storage server for effective data utilization. Our proposed Asymmetric Classifier Multikeyword Fuzzy Search method provides classifier search server that creates universal keyword classifier for the multiple keyword request which greatly reduces the searching time by learning the search path pattern for all the keywords in the fuzzy keyword set. The objective of using BTree fuzzy searchable index is to resolve typos and representation inconsistencies and also to facilitate effective data utilization.

[Use of health services by a population of 60-year olds and older in Mexico].

PubMed

Borges-Yáñez, S A; Gómez-Dantés, H

1998-01-01

To describe the sociodemographic characteristics and determinants of health services utilization by the Mexican population of 60 years of age or more. Information obtained from the National Health Survey II (ENSA-II) allowed analysis of 4,628 elderly people. Prevalence of chronic diseases was analyzed and the determinants of individuals who had used the health services in the two weeks prior to the interview. The chronic diseases most frequently reported were: hypertension, diabetes and heart disease. The utilization and hospitalization rates of that age group were 11.4 and 5.5%, respectively. The services most frequently used were: the private physician, social security (IMSS, ISSSTE) welfare services (Ministry of Health--SSA- and IMSS-Solidaridad). Interestingly, 25 to 45% of social security insurance holders did not use the services, instead they consulted a private physician. The most important explanatory variables for health services utilization were: the perceived illness, not having worked for the previous week and being a social security insurance holder. Gender, area of residence and level of education were not significant in the explanation of health services utilization. This study demonstrates the need to strengthen preventive and support programs for the elderly population, since they only demand health services when they feel sick.

Government stewardship of the for-profit private health sector in Afghanistan

PubMed Central

Sayedi, Omarzaman; Irani, Laili; Archer, Lauren C.; Sears, Kathleen; Sharma, Suneeta

2017-01-01

Abstract Background: Since 2003, Afghanistan's largely unregulated for-profit private health sector has grown at a rapid pace. In 2008, the Ministry of Public Health (MoPH) launched a long-term stewardship initiative to oversee and regulate private providers and align the sector with national health goals. Aim: We examine the progress the MoPH has made towards more effective stewardship, consider the challenges and assess the early impacts on for-profit performance. Methods: We reviewed publicly available documents, publications and the grey literature to analyse the development, adoption and implementation of strategies, policies and regulations. We carried out a series of key informant/participant interviews, organizational capacity assessments and analyses of hospital standards checklists. Using a literature review of health systems strengthening, we proposed an Afghan-specific definition of six key stewardship functions to assess progress towards MoPH stewardship objectives. Results: The MoPH and its partners have achieved positive results in strengthening its private sector stewardship functions especially in generating actionable intelligence and establishing strategic policy directions, administrative structures and a legal and regulatory framework. Progress has also been made on improving accountability and transparency, building partnerships and applying minimum required standards to private hospitals. Procedural and operational issues still need resolution and the MoPH is establishing mechanisms for resolving them. Conclusions: The MoPH stewardship initiative is notable for its achievements to date under challenging circumstances. Its success is due to the focus on developing a solid policy framework and building institutions and systems aimed at ensuring higher quality private services, and a rational long-term and sustainable role for the private sector. Although the MoPH stewardship initiative is still at an early stage, the evidence suggests that enhanced stewardship functions in the MoPH are leading to a more efficient and effective for-profit private sector. These successful early efforts offer high-leverage potential to rapidly scale up going forward. PMID:27683341

Government stewardship of the for-profit private health sector in Afghanistan.

PubMed

Cross, Harry E; Sayedi, Omarzaman; Irani, Laili; Archer, Lauren C; Sears, Kathleen; Sharma, Suneeta

2017-04-01

Since 2003, Afghanistan's largely unregulated for-profit private health sector has grown at a rapid pace. In 2008, the Ministry of Public Health (MoPH) launched a long-term stewardship initiative to oversee and regulate private providers and align the sector with national health goals. We examine the progress the MoPH has made towards more effective stewardship, consider the challenges and assess the early impacts on for-profit performance. We reviewed publicly available documents, publications and the grey literature to analyse the development, adoption and implementation of strategies, policies and regulations. We carried out a series of key informant/participant interviews, organizational capacity assessments and analyses of hospital standards checklists. Using a literature review of health systems strengthening, we proposed an Afghan-specific definition of six key stewardship functions to assess progress towards MoPH stewardship objectives. The MoPH and its partners have achieved positive results in strengthening its private sector stewardship functions especially in generating actionable intelligence and establishing strategic policy directions, administrative structures and a legal and regulatory framework. Progress has also been made on improving accountability and transparency, building partnerships and applying minimum required standards to private hospitals. Procedural and operational issues still need resolution and the MoPH is establishing mechanisms for resolving them. The MoPH stewardship initiative is notable for its achievements to date under challenging circumstances. Its success is due to the focus on developing a solid policy framework and building institutions and systems aimed at ensuring higher quality private services, and a rational long-term and sustainable role for the private sector. Although the MoPH stewardship initiative is still at an early stage, the evidence suggests that enhanced stewardship functions in the MoPH are leading to a more efficient and effective for-profit private sector. These successful early efforts offer high-leverage potential to rapidly scale up going forward. © VC The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

The Typology and Function of Private Speech in a Young Man with Intellectual Disabilities: An Empirical Case Study

ERIC Educational Resources Information Center

Lechler, Suzanne; Hare, Dougal Julian

2015-01-01

A naturalistic observational single case study was carried out to investigate the form and function of private speech (PS) in a young man with Dandy-Walker variant syndrome and trisomy 22. Video recordings were observed, transcribed and coded to identify all combinations of type and form of PS. Through comparison between theories of PS and the…

Reliability as the big persuader to privatize the electrical system in Venezuela

DOE Office of Scientific and Technical Information (OSTI.GOV)

Alvarez B., C.E.

1998-12-31

Throughout the past five years, the Venezuelan authorities, especially the Fondo de Inversiones de Venezuela (FIV), have done a major effort to privatize many of the state owned industries, among them, the electrical public utilities and some important electrical power generation plants or systems based on thermal generation. Mainly along the recent past years, black and brownouts have become more frequent in the system. In other words, system reliability has been diminishing, as a consequence of investment capital and O and M expenses have been reduced to levels below the required by the system. Public opinion is exercising pressure onmore » politicians, so signals are that Congress will probably approve during the current or beginning of next years the required laws to expedite privatization and assure incentives and guaranties to investors. This paper deals with the insides of all these aspects, and with how soon privatization will be carried out. The FIV has been committed to implement this process.« less

On the international stability of health care expenditure functions: are government and private functions similar?

PubMed

Clemente, Jesús; Marcuello, Carmen; Montañés, Antonio; Pueyo, Fernando

2004-05-01

This paper studies the stability of health care expenditure functions in a sample of OECD countries. We adopt the cointegration approach and the results show that there is a long-term relationship between total health care expenditure (HCE) and gross domestic product (GDP). However, the existence of cointegration is only shown when we admit the presence of some changes in the elasticities of the model. Our results also provide evidence against the existence of a unique relationship between health and GDP for the sample. Thus, we can conclude that the differences in health systems may cause differences in the aggregate functions. Additionally, we examine aggregate health functions for government (GHCE) and private expenditures (PHCE), again finding evidence of different patterns of behaviour. Finally, we open a discussion on the character of health as a necessary or luxury good. In this context, we find differences between the government and the private function. In order to illustrate these findings, we propose a theoretical model as an example of the influence of political decisions on income elasticity. Copyright 2003 Elsevier B.V.

Shaping Collective Functions in Privatized Agricultural Knowledge and Information Systems: The Positioning and Embedding of a Network Broker in the Dutch Dairy Sector

ERIC Educational Resources Information Center

Klerkx, Laurens; Leeuwis, Cees

2009-01-01

This paper examines new organizational arrangements that have emerged in the context of a privatized extension system. It investigates the positioning and embedding of a network broker aimed at enhancing interaction in the privatized agricultural knowledge and information system (AKIS), to assess whether tensions reported in other sectors also…

Availability and utilization of obstetric and newborn care in Guinea: A national needs assessment.

PubMed

Baguiya, Adama; Meda, Ivlabèhiré Bertrand; Millogo, Tieba; Kourouma, Mamadou; Mouniri, Halima; Kouanda, Seni

2016-11-01

To assess the availability and utilization of emergency obstetric and neonatal care (EmONC) in Guinea given the high maternal and neonatal mortality rates. We used the Guinea 2012 needs assessment data collected via a national cross-sectional census of health facilities conducted from September to October 2012. All public, private, and faith-based health facilities that performed at least one delivery during the period of the study were included. A total of 502 health facilities were visited, of which 81 were hospitals. Only 15 facilities were classified as fully functioning EmONC facilities, all of which were reference hospitals. None of the first level health facilities were fully functioning EmONC facilities. The ratio of availability of EmONC was one fully functioning EmONC facility for 745 415 inhabitants. The institutional delivery rate was 32.3% and the proportion of all births in EmONC facilities was 7.1%. Met need for EmONC was 12.2%. Among 201 maternal deaths in EmONC facilities, 69 were due to indirect causes. The intrapartum and very early neonatal death rate was 39 deaths per 1000 live births. The study showed low availability of EmONC services and underutilization of the available services. Further investigation is needed to evaluate the effect of the current policy of user fees exemption for deliveries and prenatal care in Guinea. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Privacy preserving interactive record linkage (PPIRL).

PubMed

Kum, Hye-Chung; Krishnamurthy, Ashok; Machanavajjhala, Ashwin; Reiter, Michael K; Ahalt, Stanley

2014-01-01

Record linkage to integrate uncoordinated databases is critical in biomedical research using Big Data. Balancing privacy protection against the need for high quality record linkage requires a human-machine hybrid system to safely manage uncertainty in the ever changing streams of chaotic Big Data. In the computer science literature, private record linkage is the most published area. It investigates how to apply a known linkage function safely when linking two tables. However, in practice, the linkage function is rarely known. Thus, there are many data linkage centers whose main role is to be the trusted third party to determine the linkage function manually and link data for research via a master population list for a designated region. Recently, a more flexible computerized third-party linkage platform, Secure Decoupled Linkage (SDLink), has been proposed based on: (1) decoupling data via encryption, (2) obfuscation via chaffing (adding fake data) and universe manipulation; and (3) minimum information disclosure via recoding. We synthesize this literature to formalize a new framework for privacy preserving interactive record linkage (PPIRL) with tractable privacy and utility properties and then analyze the literature using this framework. Human-based third-party linkage centers for privacy preserving record linkage are the accepted norm internationally. We find that a computer-based third-party platform that can precisely control the information disclosed at the micro level and allow frequent human interaction during the linkage process, is an effective human-machine hybrid system that significantly improves on the linkage center model both in terms of privacy and utility.

The road not taken: social vs. private comparisons in Asperger׳s syndrome and high functioning autism.

PubMed

Dvash, Jonathan; Ben-Zèev, Aaron; Noga, Adler; Shamay-Tsoory, Simone

2014-05-30

Evaluation of the outcomes of our decisions may instigate comparisons of our actual outcome with those of others (social comparisons) or comparisons with alternative outcomes of choices not made (private comparisons). Previous research has suggested a deficit in attention to social information among individuals with autism spectrum disorders. As social comparison involves the processing of social information, here we investigated the orientation towards and sensitivity to social vs. private comparisons in individuals with autism spectrum disorders. We compared the sensitivity to social vs. private comparisons among individuals diagnosed with Asperger's Syndrome (AS) or High Functioning Autism, using a task that entailed monetary rewards. Results showed that while individuals with AS generally demonstrate comparable sensitivity to absolute and relative rewards, they show less sensitivity to social comparison as compared to controls. Furthermore, they are characterized by a higher sensitivity to private rather than social comparison. These results suggest that low sensitivity to social comparisons is an important factor to consider in autism spectrum disorders. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Private sector surgical training: feasibility through the lens of appendicectomy.

PubMed

Yap, Raymond; Cullinan, Mark

2017-12-01

Training in medicine and surgery has been a public hospital responsibility in Australia. Increasing specialist training needs has led to pressure on speciality societies to find additional training posts, with one utilized solution being the establishment of private hospital training. This growing use has been despite no previously published evaluations of private hospital training in Australia. This article seeks to evaluate the feasibility of surgical training in private hospitals in appendicectomy. Data were prospectively collected on registrar involvement in appendicectomy cases at a single private tertiary institution over 1 year. These data were divided into groups according to registrar involvement and analysed, looking at training caseload, operating theatre time and complications. A total of 122 cases were analysed over the study period. Registrars were more likely to have increased primary operator responsibility if they were an accredited versus unaccredited registrar (P = 0.04) and if the case was open versus laparoscopic (P < 0.001). There was an increase of 15% in total procedure time when the registrar was involved (P = 0.04). There was no significant difference in complications whether the registrar was involved or not. Training in the private sector in Australia appears feasible, with a small loss of efficiency and no increase in complications. This article hopes to further encourage implementation and evaluation of private sector training programs to expand current training positions. Further studies, in different specialty and procedural domains, are needed to assess and evaluate the ongoing feasibility of private sector training. © 2016 Royal Australasian College of Surgeons.

Perceived outcomes of public health privatization: a national survey of local health department directors.

PubMed

Keane, C; Marx, J; Ricci, E

2001-01-01

Almost three quarters of the nation's local health departments (LHDs) have privatized some services. About half of LHD directors who privatized services reported cost savings and half reported that privatization had facilitated their performance of the core public health functions. Expanded access to services was the most commonly reported positive outcome. Of those privatizing, over two-fifths of LHDs reported a resulting increase in time devoted to management. Yet, one-third of directors reported difficulty monitoring and controlling services that have been contracted out. Communicable disease services was cited most often as a service that should not be privatized. There is a pervasive concern that by contracting out services, health departments can lose the capacity to respond to disease outbreaks and other crises.

Perceived Outcomes of Public Health Privatization: A National Survey of Local Health Department Directors

PubMed Central

Keane, Christopher; Marx, John; Ricci, Edmund

2001-01-01

Almost three quarters of the nation's local health departments (LHDs) have privatized some services. About half of LHD directors who privatized services reported cost savings and half reported that privatization had facilitated their performance of the core public health functions. Expanded access to services was the most commonly reported positive outcome. Of those privatizing, over two-fifths of LHDs reported a resulting increase in time devoted to management. Yet, one-third of directors reported difficulty monitoring and controlling services that have been contracted out. Communicable disease services was cited most often as a service that should not be privatized. There is a pervasive concern that by contracting out services, health departments can lose the capacity to respond to disease outbreaks and other crises. PMID:11286093

Disparate British Breast Reconstruction Utilization: Is Universal Coverage Sufficient to Ensure Expanded Care?

PubMed Central

Offodile, Anaeze C.

2016-01-01

Summary: Our intent is to improve the understanding of the ability of healthcare providers to deliver high-quality care as we approach an era of universal coverage. We adopted 2 unique vantage points in this article: (1) the mandated coverage for immediate breast reconstruction (IBR) surgery as a microcosmic surrogate for universal coverage overall and (2) we then scrutinized the respective IBR utilization rates in a contemporaneous system of 2 healthcare delivery models in the United Kingdom, that is, the public National Health Service trust versus private-sector hospitals. A literature review was performed for IBR rates across public trust and private-sector hospitals in the United Kingdom. The IBR rate among public trust hospitals was 17% compared with 43% in the private sector. In the trust hospital setting, the enactment of 2 government mandates, intended to increase the access to cancer care, seemed to fall short in maximizing the ability of surgical practitioners to deliver quality care to patients. Among women who did not receive IBR, 65% felt that they had received the sufficient amount of information to appropriately inform their decision. In addition, only 46% of this same cohort reported a consultation with a reconstructive surgeon preoperatively. Private-sector hospitals delivered better IBR care because of the likely presence of infrastructure and financial incentives for physicians. These results serve as a call for a better alignment between policy initiatives designed to expand care access and the perogatives of physicians to ensure an optimized delivery of the expanded care such policy mandates. PMID:27482486

[The influence of the type of insurance access on health and of education on health services utilization patterns].

PubMed

Rodríguez, Marisol; Stoyanova, Alexandrina

2004-05-01

This study analyses the utilisation of health services by gender, type of insurance access and the level of education. Descriptive and logistic regression analysis of the National Health Interview Survey, 1997, confirms that women go more often to the doctor than men. Differences are greater in the case of general practitioners (versus specialists) and public doctors (versus private). However, there are hardly any differences in hospitalisations and emergency visits. Having private access has no impact on hospitalisations, emergency visits or the probability of a visit (except for women), but it increases the probability of visits to specialists (mainly among women) and to private doctors (especially among men), confirming the existence of gender differences in the impact of this variable. In fact, the utilisation patterns by men and women with only public access resemble each other more than those of men and women with only private or dual coverage. Education is to a certain extent inversely related to the probability of a medical visit, visits to a GP and hospitalisations, but directly related to the utilisation of specialists and private doctors. Here, there are also gender disparities: differences in utilisation by educational level are more prominent among men.

Evidence from the Private Option: The Arkansas Experience.

PubMed

Maylone, Bethany; Sommers, Benjamin D

2017-02-01

Issue: Arkansas was the first state to receive approval to expand Medicaid under the Affordable Care Act through a Section 1115 waiver. This approach, known as the "private option," uses Medicaid funds to purchase private health plans on the state’s marketplace. It is intended to promote market competition, continuity of coverage, and greater access to care. Goal: To describe the key features of the private option and evaluate its impact on health care for low-income adults in the state after two years. Methods: Survey data from 2013–2015 that assessed health insurance coverage, access to care, utilization, and self-reported health among low-income adults in Arkansas compared to adults in two other states. Key findings and conclusions: Arkansas’s private option improved access to primary care and prescription medications, reduced reliance on the emergency department, increased use of preventive care, and improved perceptions of quality and health among low-income adults in the state, compared to Texas, which did not expand Medicaid. Arkansas’s benefits were similar to those observed in Kentucky’s traditional Medicaid expansion. Churning in coverage remained a challenge for nearly a quarter of low-income adults each year.

Two-MILP models for scheduling elective surgeries within a private healthcare facility.

PubMed

Khlif Hachicha, Hejer; Zeghal Mansour, Farah

2016-11-05

This paper deals with an Integrated Elective Surgery-Scheduling Problem (IESSP) that arises in a privately operated healthcare facility. It aims to optimize the resource utilization of the entire surgery process including pre-operative, per-operative and post-operative activities. Moreover, it addresses a specific feature of private facilities where surgeons are independent service providers and may conduct their surgeries in different private healthcare facilities. Thus, the problem requires the assignment of surgery patients to hospital beds, operating rooms and recovery beds as well as their sequencing over a 1-day period while taking into account surgeons' availability constraints. We present two Mixed Integer Linear Programs (MILP) that model the IESSP as a three-stage hybrid flow-shop scheduling problem with recirculation, resource synchronization, dedicated machines, and blocking constraints. To assess the empirical performance of the proposed models, we conducted experiments on real-world data of a Tunisian private clinic: Clinique Ennasr and on randomly generated instances. Two criteria were minimised: the patients' average length of stay and the number of patients' overnight stays. The computational results show that the proposed models can solve instances with up to 44 surgical cases in a reasonable CPU time using a general-purpose MILP solver.

Biobanks between common good and private interest: the example of umbilical cord blood private biobanks.

PubMed

Onisto, Maurizio; Ananian, Viviana; Caenazzo, Luciana

2011-12-01

Storage of human biological samples and personal data associated with them is organised in Biobanks. In spite of expectation given by biobanks in medicine, their management involved some ethical questions, for example, the need for policies to regulate economic interests, potential commercial use of data (including patents), private sector financing, ownership of samples and benefit sharing. In the context of contributing to the general public interest, we can consider the act of giving biological material to biobanks as a donation, in which the donation constitutes part of a generalised form of reciprocity in which the act of donation contributes to society's common good. Starting from this perspective, we move into a different situation represented by the biobanking of umbilical cord blood for personal use. We used the example of the private biobanking of umbilical cords to demonstrate the restrictive utility of the collection and preservation of cord blood for personal use in private biobanks, in the context of society's common good. In summary, a system based on solidarity seems to be able to guarantee necessary levels of supply for the donation of biological material to biobanks.

Differences in Attributions for Public and Private Face-to-face and Cyber Victimization Among Adolescents in China, Cyprus, the Czech Republic, India, Japan, and the United States.

PubMed

Wright, Michelle F; Yanagida, Takuya; Aoyama, Ikuko; Dědková, Lenka; Li, Zheng; Kamble, Shanmukh V; Bayraktar, Fatih; Ševčíková, Anna; Soudi, Shruti; Macháčková, Hana; Lei, Li; Shu, Chang

2017-01-01

The authors' aim was to investigate gender and cultural differences in the attributions used to determine causality for hypothetical public and private face-to-face and cyber victimization scenarios among 3,432 adolescents (age range = 11-15 years; 49% girls) from China, Cyprus, the Czech Republic, India, Japan, and the United States, while accounting for their individualism and collectivism. Adolescents completed a questionnaire on cultural values and read four hypothetical victimization scenarios, including public face-to-face victimization, public cyber victimization, private face-to-face victimization, and private cyber victimization. After reading the scenarios, they rated different attributions (i.e., self-blame, aggressor-blame, joking, normative, conflict) according to how strongly they believed the attributions explained why victimization occurred. Overall, adolescents reported that they would utilize the attributions of self-blame, aggressor-blame, and normative more for public forms of victimization and face-to-face victimization than for private forms of victimization and cyber victimization. Differences were found according to gender and country of origin as well. Such findings underscore the importance of delineating between different forms of victimization when examining adolescents' attributions.

Managed care and inpatient mortality in adults: effect of primary payer.

PubMed

Hines, Anika L; Raetzman, Susan O; Barrett, Marguerite L; Moy, Ernest; Andrews, Roxanne M

2017-02-08

Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor. This study provides a comprehensive assessment of the association between managed care and inpatient mortality for Medicare and privately insured patients. A cross-sectional design was used to examine the association between managed care and inpatient mortality for four common inpatient conditions. Data from the 2009 Healthcare Cost and Utilization Project State Inpatient Databases for 11 states were linked to data from the American Hospital Association Annual Survey Database. Hospital discharges were categorized as managed care or fee for service. A phased approach to multivariate logistic modeling examined the likelihood of inpatient mortality when adjusting for individual patient and hospital characteristics and for county fixed effects. Results showed different effects of managed care for Medicare and privately insured patients. Privately insured patients in managed care had an advantage over their fee-for-service counterparts in inpatient mortality for acute myocardial infarction, stroke, pneumonia, and congestive heart failure; no such advantage was found for the Medicare managed care population. To the extent that the study showed a protective effect of privately insured managed care, it was driven by individuals aged 65 years and older, who had consistently better outcomes than their non-managed care counterparts. Privately insured patients in managed care plans, especially older adults, had better outcomes than those in fee-for-service plans. Patients in Medicare managed care had outcomes similar to those in Medicare FFS. Additional research is needed to understand the role of patient selection, hospital quality, and differences among county populations in the decreased odds of inpatient mortality among patients in private managed care and to determine why this result does not hold for Medicare.

Impact of free delivery policy on utilization of maternal health services in county referral hospitals in Kenya.

PubMed

Njuguna, John; Kamau, Njoroge; Muruka, Charles

2017-06-21

Kenya has a high maternal mortality rate. Provision of skilled delivery plays a major role in reducing maternal mortality. Cost is a hindrance to the utilization of skilled delivery. The Government of Kenya introduced a policy of free delivery services in government facilities beginning June 2013. We sought to determine the impact of this intervention on facility based deliveries in Kenya. We compared deliveries and antenatal attendance in 47 county referral hospitals and 30 low cost private hospitals not participating in the free delivery policy for 2013 and 2014 respectively. The data was extracted from the Kenya Health Information System. Multiple regression was done to assess factors influencing increase in number of deliveries among the county referral hospitals. The number of deliveries and antenatal attendance increased by 26.8% and 16.2% in county referral hospitals and decreased by 11.9% and 5.4% respectively in low cost private hospitals. Increase in deliveries among county referral hospitals was influenced by population size of county and type of county referral hospital. Counties with level 5 hospitals recorded more deliveries compared to those with level 4 hospitals. This intervention increased the number of facility based deliveries. Policy makers may consider incorporating low cost private hospitals so as to increase the coverage of this intervention.

PEPFAR/DOD/Pharmaccess/Tanzania Peoples Defence Forces HIV/AIDS Program

DTIC Science & Technology

2007-10-01

institutions share many features of a private company, including a hierarchy of functions, investment in training and responsibility for the health status...institutions share many features of a private company, including a hierarchy of functions, investment in training and responsibility for the health...Decks of cards will be distributed to all TPDF Units, Intelligence, Navy and Air Force bases and schools. 2000 Decks will be shared (under the Global

Cumulative inequality and racial disparities in health: private insurance coverage and black/white differences in functional limitations.

PubMed

Kail, Ben Lennox; Taylor, Miles G

2014-09-01

To test different forms of private insurance coverage as mediators for racial disparities in onset, persistent level, and acceleration of functional limitations among Medicare age-eligible Americans. Data come from 7 waves of the Health and Retirement Study (1996-2008). Onset and progression latent growth models were used to estimate racial differences in onset, level, and growth of functional limitations among a sample of 5,755 people aged 65 and older in 1996. Employer-provided insurance, spousal insurance, and market insurance were next added to the model to test how differences in private insurance mediated the racial gap in physical limitations. In baseline models, African Americans had larger persistent level of limitations over time. Although employer-provided, spousal provided, and market insurances were directly associated with lower persistent levels of limitation, only differences in market insurance accounted for the racial disparities in persistent level of limitations. Results suggest private insurance is important for reducing functional limitations, but market insurance is an important mediator of the persistently larger level of limitations observed among African Americans. © The Author 2014. 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.

Case management lessons from a public/private partnership to finance long-term care.

PubMed

Mahoney, K

1992-01-01

In June of 1987, Connecticut's State Task Force on Private and Public Responsibilities for Financing Long-Term Care for the Elderly released its final report. This Governor's Commission, concluding that neither the private nor the public sector had much short-term hope of solving this difficult problem alone, recommended the creation of a public/private partnership. As this partnership was forged, some unique insights were gained into the functions of case management. This case study shows how case management can help coordinate the private and public roles, but it also raises some research questions which must be tackled before case management can fulfill its promise to help stretch and conserve scarce resources.

[Quality management: its use in nursing].

PubMed

Antunes, A V; Trevizan, M A

2000-01-01

The Quality Management has been used and it is a reality in the hospitals. Thus the authors comment about its importance for Nursing and analyse its utilization in a Nursing Service of a private hospital, with purpose to evaluate the implementation form, nurses' involvement and the Deming' Principles application. Data show that the implementation has brought good results, nurses are engaged in the process and the Deming's Principles have been utilized, adequate or inadequately.

Elisabeth Kubler-Ross and the Tradition of the Private Sphere: An Analysis of Symbols.

ERIC Educational Resources Information Center

Klass, Dennis

1981-01-01

Shows how Kubler-Ross' schema functions as a symbol system. Analyzes the symbol "acceptance." Shows how that symbol is part of a strong American tradition of symbols of the private sphere. (Author/JAC)

Comparing VA and private sector healthcare costs for end-stage renal disease.

PubMed

Hynes, Denise M; Stroupe, Kevin T; Fischer, Michael J; Reda, Domenic J; Manning, Willard; Browning, Margaret M; Huo, Zhiping; Saban, Karen; Kaufman, James S

2012-02-01

Healthcare for end-stage renal disease (ESRD) is intensive, expensive, and provided in both the public and private sector. Using a societal perspective, we examined healthcare costs and health outcomes for Department of Veterans Affairs (VA) ESRD patients comparing those who received hemodialysis care at VA versus private sector facilities. Dialysis patients were recruited from 8 VA medical centers from 2001 through 2003 and followed for 12 months in a prospective cohort study. Patient demographics, clinical characteristics, quality of life, healthcare use, and cost data were collected. Healthcare data included utilization (VA), claims (Medicare), and patient self-report. Costs included VA calculated costs, Medicare dialysis facility reports and reimbursement rates, and patient self-report. Multivariable regression was used to compare costs between patients receiving dialysis at VA versus private sector facilities. The cohort comprised 334 patients: 170 patients in the VA dialysis group and 164 patients in the private sector group. The VA dialysis group had more comorbidities at baseline, outpatient and emergency visits, prescriptions, and longer hospital stays; they also had more conservative anemia management and lower baseline urea reduction ratio (67% vs. 72%; P<0.001), although levels were consistent with guidelines (Kt/V≥1.2). In adjusted analysis, the VA dialysis group had $36,431 higher costs than those in the private sector dialysis group (P<0.001). Continued research addressing costs and effectiveness of care across public and private sector settings is critical in informing health policy options for patients with complex chronic illnesses such as ESRD.

Budget Savings Through the Responsible Use of Energy in Navy Privatized Housing Communities

DTIC Science & Technology

2014-12-01

provide a military family with housing, how they function, the pros and cons associated with these methods, and service members’ housing preferences...the private sector, specifically insurance companies and businessmen in each localized post area, to produce viable solutions to the military...build rental housing for military families and for insurance companies to insure these projects for private business ventures (Baldwin, 1996). C

Health care financing and utilization of maternal health services in developing countries.

PubMed

Kruk, Margaret E; Galea, Sandro; Prescott, Marta; Freedman, Lynn P

2007-09-01

The Millennium Development Goals call for a 75% reduction in maternal mortality between 1990 and 2015. Skilled birth attendance and emergency obstetric care, including Caesarean section, are two of the most important interventions to reduce maternal mortality. Although international pressure is rising to increase donor assistance for essential health services in developing countries, we know less about whether government or the private sector is more effective at financing these essential services in developing countries. We conducted a cross-national analysis to determine the association between government versus private financing of health services and utilization of antenatal care, skilled birth attendants and Caesarean section in 42 low-income and lower-middle-income countries. We controlled for possible confounding effects of total per capita health spending and female literacy. In multivariable analysis, adjusting for confounders, government health expenditure as a percentage of total health expenditure is significantly associated with utilization of skilled birth attendants (P = 0.05) and Caesarean section (P = 0.01) but not antenatal care. Total health expenditure is also significantly associated with utilization of skilled birth attendants (P < 0.01) and Caesarean section (P < 0.01). Greater government participation in health financing and higher levels of health spending are associated with increased utilization of two maternal health services: skilled birth attendants and Caesarean section. While government financing is associated with better access to some essential maternal health services, greater absolute levels of health spending will be required if developing countries are to achieve the Millennium Development Goal on maternal mortality.

Factors affecting utilization of dental health services and satisfaction among adolescent females in Riyadh City

PubMed Central

Al-Hussyeen, Al Johara A.

2009-01-01

Objectives This study was conducted to determine factors affecting utilization of dental health services among intermediate female school students in Riyadh. In addition to assessing their satisfaction with the dental care received during the last dental visit. Subjects and methods Self-administered questionnaires were distributed among students attending eight public and four private schools. These schools were selected randomly to represent the four different administrative zones in Riyadh. Results Of 600 questionnaires distributed, 531 were complete and suitable for analysis. Nearly three quarters of the students visited the dentist more than once during the last 2 years. A bout 75% had their treatment in private dental clinics and 63% made their visits for routine treatment. The quality of dental care was found to be the most encouraging factor for utilization of dental services, whereas, far geographic location of the dental clinics was the most discouraging factor. For those who received treatment in the government clinics, the most discouraging factor was post operative complications (P < 0.0001), while the most encouraging factor was the availability of friendly staff (P < 0.0001). The high cost of dental care was the most discouraging factor for utilizing the dental services for those who visited private clinics (P < 0.0001), while the high quality of dental care was the most encouraging factor (P < 0.009). Students who made their visits because of pain highly considered modern clinics and those recommended by friends as highly encouraging factors (P < 0.002), while they considered the high cost of dental care as discouraging factor for using dental services (P < 0.038). Students who visited the dentist for routine treatment gave the quality of dental care as encouraging for the use of dental clinics (P < 0.0001). Satisfaction with dental care was found to be significantly associated with high quality of dental care, convenient appointment, friendly staff, modern dental clinics and clinics recommended by friends. Conclusion Quality of dental care, reasonable fees for dental services and close location of dental clinics to students’ homes are encouraging factors for utilization of dental services. PMID:23960475

Factors affecting utilization of dental health services and satisfaction among adolescent females in Riyadh City.

PubMed

Al-Hussyeen, Al Johara A

2010-01-01

This study was conducted to determine factors affecting utilization of dental health services among intermediate female school students in Riyadh. In addition to assessing their satisfaction with the dental care received during the last dental visit. Self-administered questionnaires were distributed among students attending eight public and four private schools. These schools were selected randomly to represent the four different administrative zones in Riyadh. Of 600 questionnaires distributed, 531 were complete and suitable for analysis. Nearly three quarters of the students visited the dentist more than once during the last 2 years. A bout 75% had their treatment in private dental clinics and 63% made their visits for routine treatment. The quality of dental care was found to be the most encouraging factor for utilization of dental services, whereas, far geographic location of the dental clinics was the most discouraging factor. For those who received treatment in the government clinics, the most discouraging factor was post operative complications (P < 0.0001), while the most encouraging factor was the availability of friendly staff (P < 0.0001). The high cost of dental care was the most discouraging factor for utilizing the dental services for those who visited private clinics (P < 0.0001), while the high quality of dental care was the most encouraging factor (P < 0.009). Students who made their visits because of pain highly considered modern clinics and those recommended by friends as highly encouraging factors (P < 0.002), while they considered the high cost of dental care as discouraging factor for using dental services (P < 0.038). Students who visited the dentist for routine treatment gave the quality of dental care as encouraging for the use of dental clinics (P < 0.0001). Satisfaction with dental care was found to be significantly associated with high quality of dental care, convenient appointment, friendly staff, modern dental clinics and clinics recommended by friends. Quality of dental care, reasonable fees for dental services and close location of dental clinics to students' homes are encouraging factors for utilization of dental services.

7 CFR 23.1 - General.

Code of Federal Regulations, 2010 CFR

2010-01-01

... utilize and build upon the research, extension, and community service capability of public and private institutions of higher education in each State to expand scientific inquiry and education backup for rural... manner, scientific information, technical assistance, and feasibility studies required to improve the...

7 CFR 23.1 - General.

Code of Federal Regulations, 2011 CFR

2011-01-01

... utilize and build upon the research, extension, and community service capability of public and private institutions of higher education in each State to expand scientific inquiry and education backup for rural... manner, scientific information, technical assistance, and feasibility studies required to improve the...

A Decision Making Analysis of Persuasive Argumentation and the Choice Shift Effect

ERIC Educational Resources Information Center

Vinokur, Amiram; And Others

1975-01-01

A subjective expected utility (SEU) decision-making analysis was performed on the content of arguments generated by subjects privately or during group discussion in response to choice-dilemmas shown to shift toward risk and caution. (Editor)

7 CFR 1794.17 - Mitigation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE... (FONSI) and the Record of Decision (ROD). (b) Water and waste program. (1) Mitigation measures which... land use issues shall recognize the rights and responsibilities of landholders in making private land...

An Integrated Framework for Analysis of Water Supply Strategies in a Developing City: Chennai, India

NASA Astrophysics Data System (ADS)

Srinivasan, V.; Gorelick, S.; Goulder, L.

2009-12-01

Indian cities are facing a severe water crisis: rapidly growing population, low tariffs, high leakage rates, inadequate reservoir storage, are straining water supply systems, resulting in unreliable, intermittent piped supply. Conventional approaches to studying the problem of urban water supply have typically considered only centralized piped supply by the water utility. Specifically, they have tended to overlook decentralized actions by consumers such as groundwater extraction via private wells and aquifer recharge by rainwater harvesting. We present an innovative integrative framework for analyzing urban water supply in Indian cities. The framework is used in a systems model of water supply in the city of Chennai, India that integrates different components of the urban water system: water flows into the reservoir system, diversion and distribution by the public water utility, groundwater flow in the urban aquifer, informal water markets and consumer behavior. Historical system behavior from 2002-2006 is used to calibrate the model. The historical system behavior highlights the buffering role of the urban aquifer; storing water in periods of surplus for extraction by consumers via private wells. The model results show that in Chennai, distribution pipeline leaks result in the transfer of water from the inadequate reservoir system to the urban aquifer. The systems approach also makes it possible to evaluate and compare a wide range of centralized and decentralized policies. Three very different policies: Supply Augmentation (desalination), Efficiency Improvement (raising tariffs and fixing pipe leaks), and Rainwater Harvesting (recharging the urban aquifer by capturing rooftop and yard runoff) were evaluated using the model. The model results suggest that a combination of Rainwater Harvesting and Efficiency Improvement best meets our criteria of welfare maximization, equity, system reliability, and utility profitability. Importantly, the study shows that combination policy emerges as optimal because of three conditions that are prevalent in Chennai: 1) widespread presence of private wells, 2) inadequate availability of reservoir storage to the utility, and 2) high cost of new supply sources.

An assessment of the cyber security legislation and its impact on the United States electrical sector

NASA Astrophysics Data System (ADS)

Born, Joshua

The purpose of this research was to examine the cyber-security posture for the United States' electrical grid, which comprises a major component of critical infrastructure for the country. The United States electrical sector is so vast, that the Department of Homeland Security (DHS) estimates, it contains more than 6,413 power plants (this includes 3,273 traditional electric utilities and 1,738 nonutility power producers) with approximately 1,075 gigawatts of energy produced on a daily basis. A targeted cyber-security attack against the electric grid would likely have catastrophic results and could even serve as a precursor to a physical attack against the United States. A recent report by the consulting firm Black and Veatch found that one of the top five greatest concerns for United States electric utilities is the risk that cybersecurity poses to their industry and yet, only one-third state they are currently prepared to meet the increasingly likely threat. The report goes on to state, "only 32% of electric utilities surveyed had integrated security systems with the proper segmentation, monitoring and redundancies needed for cyber threat protection. Another 48 % said they did not" Recent estimates indicate that a large-scale cyber-attack against this sector could cost the United States economy as much as a trillion dollars within a weeks' time. Legislative efforts in the past have primarily been focused on creating mandates that encourage public and private partnership, which have been not been adopted as quickly as desired. With 85 % of all electric utilities being privately owned, it is key that the public and private sector partner in order to mitigate risks and respond as a cohesive unit in the event of a major attack. Keywords: Cybersecurity, Professor Riddell, cyber security, energy, intelligence, outlook, electrical, compliance, legislation, partnerships, critical infrastructure.

Job Scheduling with Efficient Resource Monitoring in Cloud Datacenter

PubMed Central

Loganathan, Shyamala; Mukherjee, Saswati

2015-01-01

Cloud computing is an on-demand computing model, which uses virtualization technology to provide cloud resources to users in the form of virtual machines through internet. Being an adaptable technology, cloud computing is an excellent alternative for organizations for forming their own private cloud. Since the resources are limited in these private clouds maximizing the utilization of resources and giving the guaranteed service for the user are the ultimate goal. For that, efficient scheduling is needed. This research reports on an efficient data structure for resource management and resource scheduling technique in a private cloud environment and discusses a cloud model. The proposed scheduling algorithm considers the types of jobs and the resource availability in its scheduling decision. Finally, we conducted simulations using CloudSim and compared our algorithm with other existing methods, like V-MCT and priority scheduling algorithms. PMID:26473166

Job Scheduling with Efficient Resource Monitoring in Cloud Datacenter.

PubMed

Loganathan, Shyamala; Mukherjee, Saswati

2015-01-01

Cloud computing is an on-demand computing model, which uses virtualization technology to provide cloud resources to users in the form of virtual machines through internet. Being an adaptable technology, cloud computing is an excellent alternative for organizations for forming their own private cloud. Since the resources are limited in these private clouds maximizing the utilization of resources and giving the guaranteed service for the user are the ultimate goal. For that, efficient scheduling is needed. This research reports on an efficient data structure for resource management and resource scheduling technique in a private cloud environment and discusses a cloud model. The proposed scheduling algorithm considers the types of jobs and the resource availability in its scheduling decision. Finally, we conducted simulations using CloudSim and compared our algorithm with other existing methods, like V-MCT and priority scheduling algorithms.

Maternal and child health services in India with special focus on perinatal services.

PubMed

Singh, M; Paul, V K

1997-01-01

India has an excellent infrastructural layout for the delivery of MCH services in the community through a network of subcenters, primary health centers, community health centers, district hospitals, state medical college hospitals, and other hospitals in the public and private sectors. However, the health pyramid does not function effectively because of limited resources, communication delays, a lack of commitment on the part of health professionals, and, above all, a lack of managerial skills, supervision, and political will. The allocation of financial resources for the delivery of health care continues to be meager. Nevertheless, in spite of obvious constraints, the country has made laudable progress in reducing post-neonatal mortality in recent years. Indeed, the focus has shifted to the young infants and the perinates. Under the CSSM program, a massive expansion of MCH services has occurred at the sub-district and the district levels. The RCH program, to be launched shortly, aims at effective utilization of these facilities to ensure delivery of integrated services of assured quality through decentralized planning. Simultaneously, as a result of the ongoing economic liberalization, the MCH care in the private sector will also expand rapidly. Indeed, India is on the threshold of an extraordinary improvement in the status of its neonatal-perinatal health.

New EVSE Analytical Tools/Models: Electric Vehicle Infrastructure Projection Tool (EVI-Pro)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wood, Eric W; Rames, Clement L; Muratori, Matteo

This presentation addresses the fundamental question of how much charging infrastructure is needed in the United States to support PEVs. It complements ongoing EVSE initiatives by providing a comprehensive analysis of national PEV charging infrastructure requirements. The result is a quantitative estimate for a U.S. network of non-residential (public and workplace) EVSE that would be needed to support broader PEV adoption. The analysis provides guidance to public and private stakeholders who are seeking to provide nationwide charging coverage, improve the EVSE business case by maximizing station utilization, and promote effective use of private/public infrastructure investments.

An investigation of the international literature on nurse practitioner private practice models.

PubMed

Currie, J; Chiarella, M; Buckley, T

2013-12-01

To investigate and synthesize the international literature surrounding nurse practitioner (NP) private practice models in order to provide an exposition of commonalities and differences. NP models of service delivery have been established internationally and most are based in the public healthcare system. In recent years, opportunities for the establishment of NP private practice models have evolved, facilitated by changes in legislation and driven by identification of potential patient need. To date, NP private practice models have received less attention in the literature and, to the authors' knowledge, this is the first international investigation of NP private practice models. Integrative literature review. A literature search was undertaken in October 2012. Database sources utilized included Medical Literature Analyses and Retrieval (MEDLINE), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and the Cochrane Database of Systematic Reviews (CDSR). The grey literature was also searched. The following Medical Subject Headings (MeSH) and search terms used both individually and in combination included nurse practitioners; private practice; joint practice; collaboration; and insurance, health and reimbursement. Once literature had been identified, a thematic analysis was undertaken to extract themes. Thirty manuscripts and five publications from the grey literature were included in the final review. Private practice NP roles were identified in five countries, with the majority of the literature emanating from the USA. The thematic analysis resulted in the identification of five themes: reimbursement, collaborative arrangements, legislation, models of care and acceptability. Proportionally, there are very few NPs engaged in private practice internationally. The most common NP private practice models were community based, with NPs working in clinic settings, either alone or with other health professionals. Challenges in the context of legislation and financial reimbursement were identified in each country where private practice is being undertaken. © 2013 International Council of Nurses.

Getting to FP2020: Harnessing the private sector to increase modern contraceptive access and choice in Ethiopia, Nigeria, and DRC

PubMed Central

Garfinkel, Danielle; Thanel, Katherine; Esch, Keith; Workalemahu, Endale; Anyanti, Jennifer; Mpanya, Godéfroid; Binanga, Arsène; Pope, Jen; Longfield, Kim; Bertrand, Jane; Shaw, Bryan

2018-01-01

Background An estimated 214 million women have unmet need for family planning in developing regions. Improved utilization of the private sector is key to achieving universal access to a range of safe and effective modern contraceptive methods stipulated by FP2020 and SDG commitments. Until now, a lack of market data has limited understanding of the private sector’s role in increasing contraceptive coverage and choice. Methods In 2015, the FPwatch Project conducted representative outlet surveys in Ethiopia, Nigeria, and DRC using a full census approach in selected administrative areas. Every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, availability, and price. Findings Excluding general retailers, 96% of potential outlets in Ethiopia, 55% in Nigeria, and 41% in DRC had modern contraceptive methods available. In Ethiopia, 41% of modern contraceptive stocking outlets were in the private sector compared with approximately 80% in Nigeria and DRC where drug shops were dominant. Ninety-five percent of private sector outlets in Ethiopia had modern contraceptive methods available; 37% had three or more methods. In Nigeria and DRC, only 54% and 42% of private sector outlets stocked modern contraceptives with 5% and 4% stocking three or more methods, respectively. High prices in Nigeria and DRC create barriers to consumer access and choice. Discussion There is a missed opportunity to provide modern contraception through the private sector, particularly drug shops. Subsidies and interventions, like social marketing and social franchising, could leverage the private sector’s role in increasing access to a range of contraceptives. Achieving global FP2020 commitments depends on the expansion of national contraceptive policies that promote greater partnership and cooperation with the private sector and improvement of decisions around funding streams of countries with large populations and high unmet need like Ethiopia, Nigeria, and DRC. PMID:29444140

Getting to FP2020: Harnessing the private sector to increase modern contraceptive access and choice in Ethiopia, Nigeria, and DRC.

PubMed

Riley, Christina; Garfinkel, Danielle; Thanel, Katherine; Esch, Keith; Workalemahu, Endale; Anyanti, Jennifer; Mpanya, Godéfroid; Binanga, Arsène; Pope, Jen; Longfield, Kim; Bertrand, Jane; Shaw, Bryan

2018-01-01

An estimated 214 million women have unmet need for family planning in developing regions. Improved utilization of the private sector is key to achieving universal access to a range of safe and effective modern contraceptive methods stipulated by FP2020 and SDG commitments. Until now, a lack of market data has limited understanding of the private sector's role in increasing contraceptive coverage and choice. In 2015, the FPwatch Project conducted representative outlet surveys in Ethiopia, Nigeria, and DRC using a full census approach in selected administrative areas. Every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, availability, and price. Excluding general retailers, 96% of potential outlets in Ethiopia, 55% in Nigeria, and 41% in DRC had modern contraceptive methods available. In Ethiopia, 41% of modern contraceptive stocking outlets were in the private sector compared with approximately 80% in Nigeria and DRC where drug shops were dominant. Ninety-five percent of private sector outlets in Ethiopia had modern contraceptive methods available; 37% had three or more methods. In Nigeria and DRC, only 54% and 42% of private sector outlets stocked modern contraceptives with 5% and 4% stocking three or more methods, respectively. High prices in Nigeria and DRC create barriers to consumer access and choice. There is a missed opportunity to provide modern contraception through the private sector, particularly drug shops. Subsidies and interventions, like social marketing and social franchising, could leverage the private sector's role in increasing access to a range of contraceptives. Achieving global FP2020 commitments depends on the expansion of national contraceptive policies that promote greater partnership and cooperation with the private sector and improvement of decisions around funding streams of countries with large populations and high unmet need like Ethiopia, Nigeria, and DRC.

Importance of awareness in improving performance of emergency medical services (EMS) systems in enhancing traffic safety: A lesson from India.

PubMed

Vasudevan, Vinod; Singh, Preeti; Basu, Samyajit

2016-10-02

India has been slow in implementing a central emergency medical services (EMS) system across the country. "108 services" is one of the most popular services that is functional under the public-private partnership model. Limited available literature shows that despite access to services, many traffic crash victims are transported using private vehicles. The objective of this study is to understand the effectiveness of 108 services from a traffic safety perspective. A questionnaire survey is conducted to understand the awareness of EMS and their function. Using traffic-related fatalities as the dependent variable, a fixed effect panel data model is developed to analyze the effectiveness of the 108 services in improving the traffic safety. The results from the survey show that, in general, people are not aware of the 108 services. A majority of the population prefers taking victims to the hospital using their personal vehicles or any other vehicles available compared to calling an ambulance. Results from panel data analysis show that despite having an efficient system, these services failed to make significant improvement in the safety of road users in the states in which their services were subscribed. The lack of awareness of an important safety service is alarming. This could be a major reason for lower utilization of 108 services for transporting victims of traffic crashes. This article shows the importance of having efficient awareness campaigns to improve the efficiency of any similar programs that are aimed to enhance the safety of a region.

A Public/Private Extension of Conway's Accessor Model

NASA Technical Reports Server (NTRS)

McCann, Karen M.; Yarrow, Maurice

2000-01-01

We present a new object-oriented model for a Perl package, based on Damien Conway's 'accessor' model. Our model includes both public and private data; it uses strategies to reduce a package namespace, but still maintains a robust and error-trapped approach. With this extended model we can make any package data or functions 'private', as well as 'public'. (Note: 'namespace' in this context means all the names, variables and subs, associated with a package.)

The cost of energy from utility-owned solar electric systems. A required revenue methodology for ERDA/EPRI evaluations

NASA Technical Reports Server (NTRS)

1976-01-01

This methodology calculates the electric energy busbar cost from a utility-owned solar electric system. This approach is applicable to both publicly- and privately-owned utilities. Busbar cost represents the minimum price per unit of energy consistent with producing system-resultant revenues equal to the sum of system-resultant costs. This equality is expressed in present value terms, where the discount rate used reflects the rate of return required on invested capital. Major input variables describe the output capabilities and capital cost of the energy system, the cash flows required for system operation amd maintenance, and the financial structure and tax environment of the utility.

Electric utility pole yard training facility: Designing an effective learning environment

NASA Astrophysics Data System (ADS)

Topping, Robert P.

The primary responsibility of electric utilities is to supply consistent, dependable, and affordable energy to private customers, businesses, and industries. As with many businesses, electric utilities are experiencing the effects of an aging workforce and expending considerable resources to train their current and replacement workers. Community colleges can partner with electric utilities to provide effective learning environments for these workers, and gain access to new sources of revenue and community support for the colleges. The purpose of this study was to describe the functions, features, and major design issues of an effective learning environment for training electric utility industry workers, the electric utility line-worker pole yard. Case studies of three "state of the art" line-worker pole yard training environments provide the basis for the study's findings and implications. The study was guided by the following research questions: (1) What is the function of a line-worker pole yard in supporting effective training? (2) What are the features of present day ("state of the art") line-worker pole yard learning environments? and (3) What are the major issues that need to be addressed in designing a line-worker pole yard learning environment for the future? The study participants included industry representatives, training coordinators, instructors, and students from the three selected "state of the art" line-worker pole yard sites. The overall findings from the study resulted in composites of the desired features of learning outcomes, learning process, and learning environment for a line-worker pole yard training program and major issues that are affecting the future design of these training programs. Composite findings of a pole-yard training environment included unique features associated with: (a) outdoor, (b) indoor, (c) underground, (d) classroom, (e) gathering places, and (f) work-based learning components. Composite findings with regard to major issues that need to be considered in future designs of pole-yard training environments included: (a) available unrestricted land for expansion, (b) resource commitment level, (c) workforce demographics, (d) aging industrial infrastructure, (e) electronic information and communication capability, (f) quality and quantity of available instructors, and (g) environmental and economic impact.

[Care for the mentally ill in the Norwegian counties Troms and Finnmark 1891-1940].

PubMed

Fause, Ashild

2008-12-18

The article discusses care for the mentally ill, as it emerged and developed in Troms and Finnmark counties in 1891 - 1940. The main objective was to document how publicly supported private care functioned with respect to the well-being of the mentally ill and their situation. How mental illness was defined and perceived by close relatives, care providers, medical practitioners and public authorities was also assessed. Medical records written by district physicians have been central sources; other sources were records from the county council proceedings and public statistics on poverty and health. The private care arrangement was the dominant type of care for the mentally ill in the region throughout the period. This arrangement was subject to public supervision, but its functioning depended on periodic support from somatic institutions and even prisons. The study shows that private care was a well-functioning arrangement in many cases. The mentally ill were often included in the household work and daily-life practices on the farm. The private care system however displayed wide variations, as its quality depended on the care providers, district physicians and last but not least economic support from the local community.

48 CFR 225.7017-1 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... photovoltaic device, foreign photovoltaic device, Free Trade Agreement country photovoltaic device...— Covered contract means an energy savings performance contract, a utility service contract, or a private housing contract awarded by DoD, if such contract results in DoD ownership of photovoltaic devices, by...

48 CFR 225.7017-1 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... photovoltaic device, foreign photovoltaic device, Free Trade Agreement country photovoltaic device...— Covered contract means an energy savings performance contract, a utility service contract, or a private housing contract awarded by DoD, if such contract results in DoD ownership of photovoltaic devices, by...

48 CFR 225.7017-1 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... photovoltaic device, foreign photovoltaic device, Free Trade Agreement country photovoltaic device...— Covered contract means an energy savings performance contract, a utility service contract, or a private housing contract awarded by DoD, if such contract results in DoD ownership of photovoltaic devices, by...

7 CFR 1822.263 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Definitions. 1822.263 Section 1822.263 Agriculture..., Procedures, and Authorizations § 1822.263 Definitions. As used in this subpart: (a) A private nonprofit... including engineering and legal fees, streets, roads, utilities, minimum essential administrative costs...

Technology and the Future of Appalachian Education.

ERIC Educational Resources Information Center

Winters, R. Oakley

1999-01-01

Proposes that Appalachia pursue an economic development strategy based on exporting knowledge and training. Partnerships between governments, private utilities, and institutions of higher learning could improve the telecommunications infrastructure, establish new learning products companies, instruct adults at their home and work places, expand…

Neuropsychological assessment of decision making in alcohol-dependent commercial pilots.

PubMed

Georgemiller, Randy; Machizawa, Sayaka; Young, Kathleen M; Martin, Cynthia N

2013-09-01

The aim of this exploratory archival study was to discern the utility of the Iowa Gambling Task (IGT) in identifying adaptive decision-making capacities among pilots with a history of alcohol dependence both with and without Cluster B personality features. Participants included 18 male airmen at the rank of captain with a history of receiving alcohol dependence treatment and subsequent referral for a fitness-for-duty evaluation. Data from prior comprehensive neuropsychological evaluations conducted in a private practice setting at the mandate of the FAA utilizing criteria outlined in the HIMS program was used. ANOVA was conducted to compare pilots with (N = 4) and without Cluster B personality features (N = 14) on measures of decisionmaking capacities, intelligence, and executive functioning. Pilots with Cluster B personality features were found to have a significantly lower Total Net T-Score on IGT (M = 35.00, SD = 9.27) than pilots without features of Cluster B (M = 56.36, SD = 9.55). Furthermore, with the exception of the first 20 cards (i.e., Net 1); the groups significantly differed in their Net scores. No statistically significant difference was found on airmen's intelligence and executive functioning. The present study found that alcohol-dependent airmen with Cluster B personality features evidenced significantly poorer decisionmaking capacities as measured by the ICT in comparison to alcohol dependent airman without Cluster B personality features. Implications and limitations of the study are discussed.

Variation in exemptions to school immunization requirements among New York State private and public schools.

PubMed

Lai, Yun-Kuang; Nadeau, Jessica; McNutt, Louise-Anne; Shaw, Jana

2014-12-12

School immunization requirements have ensured high vaccination rates and have helped to control vaccine-preventable diseases. However, vaccine exemptions have increased in the last decade. This study compared New York State private versus public schools with respect to medical and religious exemption rates. This retrospective study utilizes New York State Department of Health Immunization Survey data from the 2003 through 2012 academic years. Schools were categorized as private or public, the former further categorized by religious affiliation. Rates of medical and religious vaccine exemptions were compared by school category. From 2003 to 2012, religious exemptions increased in private and public schools from 0.63% to 1.35% and 0.17% to 0.29% (Spearman's R: 0.89 and 0.81), respectively. Among private schools, increases in religious exemption rates during the study period were observed in Catholic/Eastern Orthodox, Protestant/Other Christian, Jewish, and secular schools (Spearman's R=0.66, 0.99, 0.89, and 0.93), respectively. Exemption rate ratios in private schools compared to public schools were 1.39 (95% CI 1.15-1.68) for medical and 3.94 (95% CI: 3.20-4.86) for religious exemptions. Among private school students, all school types except for Catholic/Eastern Orthodox and Episcopal affiliates were more likely to report religious exemptions compared to children in public schools. Medical and religious exemption rates increased over time and higher rates were observed among New York State private schools compared to public schools. Low exemption rates are critical to minimize disease outbreaks in the schools and their community. Copyright © 2014 Elsevier Ltd. All rights reserved.

Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil

PubMed Central

2014-01-01

Introduction Health system reforms are undertaken with the aim of improving equity of access to health care. Their impact is generally analyzed based on health care utilization, without distinguishing between levels of care. This study aims to analyze inequities in access to the continuum of care in municipalities of Brazil and Colombia. Methods A cross-sectional study was conducted based on a survey of a multistage probability sample of people who had had at least one health problem in the prior three months (2,163 in Colombia and 2,167 in Brazil). The outcome variables were dichotomous variables on the utilization of curative and preventive services. The main independent variables were income, being the holder of a private health plan and, in Colombia, type of insurance scheme of the General System of Social Security in Health (SGSSS). For each country, the prevalence of the outcome variables was calculated overall and stratified by levels of per capita income, SGSSS insurance schemes and private health plan. Prevalence ratios were computed by means of Poisson regression models with robust variance, controlling for health care need. Results There are inequities in favor of individuals of a higher socioeconomic status: in Colombia, in the three different care levels (primary, outpatient secondary and emergency care) and preventive activities; and in Brazil, in the use of outpatient secondary care services and preventive activities, whilst lower-income individuals make greater use of the primary care services. In both countries, inequity in the use of outpatient secondary care is more pronounced than in the other care levels. Income in both countries, insurance scheme enrollment in Colombia and holding a private health plan in Brazil all contribute to the presence of inequities in utilization. Conclusions Twenty years after the introduction of reforms implemented to improve equity in access to health care, inequities, defined in terms of unequal use for equal need, are still present in both countries. The design of the health systems appears to determine access to the health services: two insurance schemes in Colombia with different benefits packages and a segmented system in Brazil, with a significant private component. PMID:24479581

The use of reproductive healthcare at commune health stations in a changing health system in Vietnam.

PubMed

Ngo, Anh D; Hill, Peter S

2011-09-27

With health sector reform in Vietnam moving towards greater pluralism, commune health stations (CHSs) have been subject to growing competition from private health services and increasing numbers of patients bypassing CHSs for higher-level health facilities. This study describes the pattern of reproductive health (RH) and family planning (FP) service utilization among women at CHSs and other health facilities, and explores socio-demographic determinants of RH service utilization at the CHS level. This study was based on a cross-sectional survey conducted in Thua Thien Hue and Vinh Long provinces, using a multi-stage cluster sampling technique. Questionnaire-based interviews with 978 ever-married women at reproductive age provided data on socio-demographic characteristics, current use of FP methods, history of RH service use, and the health facility attended for their most recent services. Multiple logistic regression analyses were used to identify socio-demographic determinants of their use of CHS RH services. Eighty nine percent of ever-married women reported current use of birth control with 49% choosing intra-uterine device (IUD). Eighty nine percent of pregnant women attended facility-based antenatal care (ANC) with 62% having at least 3 check-ups during their latest pregnancy. Ninety one percent of mothers had their last delivery in a health facility. Seventy-one percent of respondents used CHS for IUD insertion, 55% for antenatal check-ups, and 77% gynecological examination. District and provincial/central hospitals dominated the provision of delivery service, used by 57% of mothers for their latest delivery. The percentage of women opting for private ANC services was reported at 35%, though the use of private delivery services was low (11%). Women who were farmers, earning a lower income, having more than 2 children, and living in a rural area were more likely than others to use ANC, delivery, and/or gynecological check-up services at the CHS. Women choice of providers for FP and RH services that help them plan and protect their pregnancies is driven by socio-economic factors. While the CHS retains significant utilization rates, it is under challenge by preferences for hospital-based delivery and the growing use of private ANC services.

Private Health Insurance Exchanges

PubMed Central

Buttorff, Christine; Nowak, Sarah; Syme, James; Eibner, Christine

2017-01-01

Abstract Private health insurance exchanges offer employer health insurance, combining online shopping, increased plan choice, benefit administration, and cost-containment strategies. This article examines how private exchanges function, how they may affect employers and employees, and the possible implications for the Affordable Care Act's (ACA's) Small Business Health Options Program (SHOP) Marketplaces. The authors found that private exchanges could encourage employees to select less-generous plans. This could expose employees to higher out-of-pocket costs, but premium contributions would drop substantially, so net spending would decrease. On the other hand, employee spending may increase if, in moving to private exchanges, employers decrease their health insurance contributions. Most employers can avoid the ACA's “Cadillac tax” by reducing the generosity of the plans they offer, regardless of whether they move to a private exchange. There is not yet enough evidence to determine whether the private exchanges will become prominent in the insurance market and how they will affect employers and their employees. PMID:28845340

34 CFR 601.21 - Code of conduct.

Code of Federal Regulations, 2011 CFR

2011-07-01

... for private education loans, including funds for an opportunity pool loan, to students in exchange for..., the term opportunity pool loan means a private education loan made by a lender to a student attending... functions during emergencies, including State-declared or Federally declared natural disasters, Federally...

Production and cost functions and their application to the port sector : a literature survey

DOT National Transportation Integrated Search

2003-08-25

Seaports provide multiple services to ships, cargo, and passengers. These services can be performed by a combination of public and private initiatives. Usually, the role of public sector institutions is to regulate and supervise private firms. In per...

Some Strategies for Environmental Remediation

ERIC Educational Resources Information Center

Peterson, Jerrold M.

1975-01-01

Analyzed are three strategies for reducing or eliminating environmental pollution: private market, legal, and effluent tax. Since private market solutions function well only with small numbers of parties and legal solutions oscillate too much, the author recommends effluent taxes. This strategy optimizes the abatement benefits and implementation…

The Academic Success of East Asian American Youth: The Role of Shadow Education

PubMed Central

Byun, Soo-yong; Park, Hyunjoon

2013-01-01

Using data from the Education Longitudinal Study, this study assessed the relevance of shadow education to the high academic performance of East Asian American students by examining how East Asian American students differed from other racial/ethnic students in the prevalence, purpose, and effects of using the two forms – commercial test preparation service and private one-to-one tutoring – of SAT coaching, defined as the American style of shadow education. East Asian American students were most likely to take a commercial SAT test preparation course for the enrichment purpose, and benefited most from taking this particular form of SAT coaching. However, this was not the case for private SAT one-to-one tutoring. While black students were most likely to utilize private tutoring for the remedial purpose, the impact of private tutoring was trivial for all racial/ethnic groups including East Asian American students. The authors discussed broader implications of the findings on racial/ethnic inequalities in educational achievement beyond the relevance of shadow education for the academic success of East Asian American students. PMID:24163483

Differences in the use of outsourcing in public and private institutions providing medical services.

PubMed

Czerw, Aleksandra I; Kowalska, Mariola; Religioni, Urszula

2014-06-29

The costs of health care in Poland are continuously increasing. Thus, almost every institution providing medical services aims at their limitation. One of the costs rationalisation methods in the health care sector is outsourcing. The study was conducted in 153 randomly selected institutions providing medical activities. The tool was a questionnaire, available via a web browser. Over 30% of public institutions identified the need for financial savings, as the main reason for outsourcing the cleaning function. Among private institutions, the dominant reason for this is too high maintenance cost of the cleaning staff (less than 40% of responses). The huge number of medical institutions use the services of an external company for laundering. Over 30% of public institutions identified as the most common reason for separation of functions laundering lack of resources to upgrade and modernize facilities. Less than 27% of public institutions indicate too high costs of kitchen staff as the main reason for ordering function of feeding. Another reason is the need for financial savings (22% response rate). Some institutions indicate a desire to focus on key areas (20% of responses) and lack of financial resources to upgrade and modernize the kitchen (20% response rate). Public and private institutions exercise control over the quality and method performed by an external service (71% of public institutions and 59% of private institutions). Private institutions often informally exercise external control (difference confirmed - Fisher's exact test). Less than 90% of public institutions indicated satisfaction with the services provided by external companies. The adaptation of outsourcing in medical facilities leads to financial efficiency improvement. Through the separation of some medical functions and entrusting their realisation to external companies, medical institutions can focus on their basic activity that is the provision of health services.

More Rhode Island Adults Have Dental Coverage After the Medicaid Expansion: Did More Adults Receive Dental Services? Did More Dentists Provide Services?

PubMed

Zwetchkenbaum, Samuel; Oh, Junhie

2017-10-02

Under the Affordable Care Act (ACA) Medicaid expansion since 2014, 68,000 more adults under age 65 years were enrolled in Rhode Island Medicaid as of December 2015, a 78% increase from 2013 enrollment. This report assesses changes in dental utilization associated with this expansion. Medicaid enrollment and dental claims for calendar years 2012-2015 were extracted from the RI Medicaid Management Information System. Among adults aged 18-64 years, annual numbers and percentages of Medicaid enrollees who received any dental service were summarized. Additionally, dental service claims were assessed by provider type (private practice or health center). Although 15,000 more adults utilized dental services by the end of 2015, the annual percentage of Medicaid enrollees who received any dental services decreased over the reporting periods, compared to pre-ACA years (2012-13: 39%, 2014: 35%, 2015: 32%). From 2012 to 2015, dental patient increases in community health centers were larger than in private dental offices (78% vs. 34%). Contrary to the Medicaid population increase, the number of dentists that submitted Medicaid claims decreased, particularly among dentists in private dental offices; the percentage of RI private dentists who provided any dental service to adult Medicaid enrollees decreased from 29% in 2012 to 21% in 2015. Implementation of Medicaid expansion has played a critical role in increasing the number of Rhode Islanders with dental coverage, particularly among low-income adults under age 65. However, policymakers must address the persistent and worsening shortage of dental providers that accept Medicaid to provide a more accessible source of oral healthcare for all Rhode Islanders. [Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].

A new arena for private practice in occupational therapy.

PubMed

Shriver, D J

1985-01-01

The "occupational therapist in private practice" during the last decade seems to be an expected topic for conventions, task forces and cocktail clutches among therapists. Manuals have been published, seminars given and a list of consultatns has been made available for those asking the big question "Should I set up my own practice?" Still, the letters and phone calls persist. "How do I start?" Occupational therapists' nonetheless now are numerous in the private sector and represent many different models of practice. The intent of this article is to introduce the role and function of the private practice occupational therapist in evaluation, treatment, consultation and testimony for worker's compensation or personal injury cases. The definition of private practice for this paper is a sole proprietorship, staffed by independent contracting therapists providing direct services in the private practice office. Certain aspects of business administration will also be included.

Risk Assessment Methodology for Water utilities (RAM-W) : the foundation for emergency response planning.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Danneels, Jeffrey John

2005-03-01

Concerns about acts of terrorism against critical infrastructures have been on the rise for several years. Critical infrastructures are those physical structures and information systems (including cyber) essential to the minimum operations of the economy and government. The President's Commission on Critical Infrastructure Protection (PCCIP) probed the security of the nation's critical infrastructures. The PCCIP determined the water infrastructure is highly vulnerable to a range of potential attacks. In October 1997, the PCCIP proposed a public/private partnership between the federal government and private industry to improve the protection of the nation's critical infrastructures. In early 2000, the EPA partnered withmore » the Awwa Research Foundation (AwwaRF) and Sandia National Laboratories to create the Risk Assessment Methodology for Water Utilities (RAM-W{trademark}). Soon thereafter, they initiated an effort to create a template and minimum requirements for water utility Emergency Response Plans (ERP). All public water utilities in the US serving populations greater than 3,300 are required to undertaken both a vulnerability assessment and the development of an emergency response plan. This paper explains the initial steps of RAM-W{trademark} and then demonstrates how the security risk assessment is fundamental to the ERP. During the development of RAM-W{trademark}, Sandia performed several security risk assessments at large metropolitan water utilities. As part of the scope of that effort, ERPs at each utility were reviewed to determine how well they addressed significant vulnerabilities uncovered during the risk assessment. The ERP will contain responses to other events as well (e.g. natural disasters) but should address all major findings in the security risk assessment.« less

42 CFR 136.313 - Evaluation and grant awards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... manpower deficiencies; (5) The soundness of the fiscal plan for assuring effective utilization of grant... following order or priority: (1) Indian tribes, (2) tribal organizations, (3) urban Indian organizations and other Indian health organizations, and (4) public and other nonprofit profit private health or...

National Environmental Manpower Planning Conference.

ERIC Educational Resources Information Center

Environmental Career Center, Inc., Washington, DC.

The national planning conference was held to acquaint State and local environmental agencies with available resources and Federal/State activities related to the development and utilization of an environmental workforce. The 200 participants and 48 speakers represented Federal, State, local, and private agencies as well as professional…

29 CFR 4.107 - Federal contracts.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Secretary of Labor LABOR STANDARDS FOR FEDERAL SERVICE CONTRACTS Application of the McNamara-O'Hara Service... to procure services desired by the Government, the method of procurement utilized by the contracting... Federal agency or through the exercise by another agency (whether governmental or private) of authority...

76 FR 59186 - Renewal of Rail Energy Transportation Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-23

... from coal producers; 5 representatives from electric utilities (including at least one rural electric... providers, and biofuel refiners, processors, and distributors; and 2 representatives from private car owners, car lessors, or car manufacturers. These members are serving in a representative capacity for this...

Procurement and utilization of radio equipment under UMTA's section 16(b)(2) program in Virginia.

DOT National Transportation Integrated Search

1982-01-01

The Virginia Department of Highways and Transportation has been designated the administering agency for UMTA's Section 16(b)(2) program of capital grants to private, nonprofit organizations for the provision of transportation to the elderly and handi...

Interdependent Utilities: How Social Ranking Affects Choice Behavior

PubMed Central

Bault, Nadège; Coricelli, Giorgio; Rustichini, Aldo

2008-01-01

Organization in hierarchical dominance structures is prevalent in animal societies, so a strong preference for higher positions in social ranking is likely to be an important motivation of human social and economic behavior. This preference is also likely to influence the way in which we evaluate our outcome and the outcome of others, and finally the way we choose. In our experiment participants choose among lotteries with different levels of risk, and can observe the choice that others have made. Results show that the relative weight of gains and losses is the opposite in the private and social domain. For private outcomes, experience and anticipation of losses loom larger than gains, whereas in the social domain, gains loom larger than losses, as indexed by subjective emotional evaluations and physiological responses. We propose a theoretical model (interdependent utilities), predicting the implication of this effect for choice behavior. The relatively larger weight assigned to social gains strongly affects choices, inducing complementary behavior: faced with a weaker competitor, participants adopt a more risky and dominant behavior. PMID:18941538

Cybersecurity in radiology: Access of public hot spots and public Wi-Fi and prevention of cybercrimes and HIPAA violations.

PubMed

Gerard, Perry; Kapadia, Neil; Acharya, Jay; Chang, Patricia T; Lefkovitz, Zvi

2013-12-01

The purpose of this article is to review the steps that can be taken to ensure secure transfer of information over public and home networks, given the increasing utilization of mobile devices in radiology. With the rapid technologic developments in radiology, knowledge of various technical aspects is crucial for any practicing radiologist. Utilization of mobile devices, such as laptops, tablets, and even cellular phones, for reading radiologic studies has become increasingly prevalent. With such usage comes a need to ensure that both the user's and the patient's private information is protected. There are several steps that can be taken to protect sensitive information while using public networks. These steps include being diligent in reviewing the networks to which one connects, ensuring encrypted connections to web-sites, using strong passwords, and using a virtual private network and a firewall. As the role of information technology in modern radiology practice becomes more critical, these safety mechanisms must be addressed when viewing studies on any mobile device.

A systematic tale of two differing reviews: evaluating the evidence on public and private sector quality of primary care in low and middle income countries.

PubMed

Coarasa, Jorge; Das, Jishnu; Gummerson, Elizabeth; Bitton, Asaf

2017-04-12

Systematic reviews are powerful tools for summarizing vast amounts of data in controversial areas; but their utility is limited by methodological choices and assumptions. Two systematic reviews of literature on the quality of private sector primary care in low and middle income countries (LMIC), published in the same journal within a year, reached conflicting conclusions. The difference in findings reflects different review methodologies, but more importantly, a weak underlying body of literature. A detailed examination of the literature cited in both reviews shows that only one of the underlying studies met the gold standard for methodological robustness. Given the current policy momentum on universal health coverage and primary health care reform across the globe, there is an urgent need for high quality empirical evidence on the quality of private versus public sector primary health care in LMIC.

Shaking up the dental safety-net: elimination of optional adult dental Medicaid benefits in California.

PubMed

Wides, Cynthia; Alam, Sonia Rab; Mertz, Elizabeth

2014-02-01

In July 2009, California eliminated funding for most adult non-emergency Medicaid dental benefits (Denti-Cal). This paper presents the findings from a qualitative assessment of the impacts of the Denti-Cal cuts on California's oral health safety-net. Interviews were conducted with dental safety-net providers throughout the state, including public health departments, community health centers, dental schools, Native American health clinics, and private providers, and were coded thematically using Atlas.ti. Safety-net providers reported decreased utilization by Denti-Cal-eligible adults, who now primarily seek emergency dental services, and reported shifting to focus on pediatric and privately-insured patients. Significant changes were reported in safety-net clinic finances, operations, and ability to refer. The impact of the Denti-Cal cuts has been distributed unevenly across the safety-net, with private providers and County Health Departments bearing the highest burden.

Privacy preserving interactive record linkage (PPIRL)

PubMed Central

Kum, Hye-Chung; Krishnamurthy, Ashok; Machanavajjhala, Ashwin; Reiter, Michael K; Ahalt, Stanley

2014-01-01

Objective Record linkage to integrate uncoordinated databases is critical in biomedical research using Big Data. Balancing privacy protection against the need for high quality record linkage requires a human–machine hybrid system to safely manage uncertainty in the ever changing streams of chaotic Big Data. Methods In the computer science literature, private record linkage is the most published area. It investigates how to apply a known linkage function safely when linking two tables. However, in practice, the linkage function is rarely known. Thus, there are many data linkage centers whose main role is to be the trusted third party to determine the linkage function manually and link data for research via a master population list for a designated region. Recently, a more flexible computerized third-party linkage platform, Secure Decoupled Linkage (SDLink), has been proposed based on: (1) decoupling data via encryption, (2) obfuscation via chaffing (adding fake data) and universe manipulation; and (3) minimum information disclosure via recoding. Results We synthesize this literature to formalize a new framework for privacy preserving interactive record linkage (PPIRL) with tractable privacy and utility properties and then analyze the literature using this framework. Conclusions Human-based third-party linkage centers for privacy preserving record linkage are the accepted norm internationally. We find that a computer-based third-party platform that can precisely control the information disclosed at the micro level and allow frequent human interaction during the linkage process, is an effective human–machine hybrid system that significantly improves on the linkage center model both in terms of privacy and utility. PMID:24201028

The privatization of environmental health services: a national survey of practices and perspectives in local health departments.

PubMed

Keane, Christopher; Marx, John; Ricci, Edmund

2002-01-01

This article presents nationally representative data on environmental health (EH) services privatized by local public health departments, enforcement and assurance mechanisms for privatized services, and administrators' views about EH services that should not be privatized. A national sample of 380 local public health departments, stratified by jurisdiction size, was drawn from a universe of 2,488 departments. Telephone interviews were conducted with 347 administrators of departments. Results were weighted to be nationally representative. Approximately one-quarter of departments had privatized at least one EH service, almost always to for-profit organizations. The two most common reasons given for privatizing EH services were cost savings or increased efficiency and lack of capacity or expertise to carry out the service. The most rigorous, although infrequent, technique of enforcement and assurance of EH standards when services were privatized was double-testing of samples. Departments more commonly relied on state licensing and certification of contractors. When asked what services should not be privatized, 27% of respondents cited EH services. Many respondents argued against privatizing environmental services that have inherent regulatory functions. They expressed concern that privatization would fragment the public health infrastructure by impairing communication, diminishing control over performance, or weakening health departments' capacity to respond to environmental and other health crises. These findings raise serious concerns about the privatization of EH.

75 FR 80947 - Conflict Minerals

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-23

... require any issuer for which conflict minerals are necessary to the functionality or production of a... measures would include, but would not be limited to, an independent private sector audit of the issuer's... obtained an independent private sector audit of its report, provide the audit report, and make its reports...

Polish Higher Education: Intersectoral Distinctiveness

ERIC Educational Resources Information Center

Musial, Joanna

2014-01-01

This study analyzes degrees of differences between the private and public sectors of Polish higher education. It finds them to be strong: Polish private institutions function very differently from Polish public institutions and these differences correspond with those found in the literature on higher education elsewhere in the world. Polish…

Environmental Assessment for the Expansion and Consolidation of the Base Exchange at Joint Base Andrews-Naval Air Facility Washington, Prince George’s County, Maryland

DTIC Science & Technology

2013-08-01

Wildlife Service VOC volatile organic compound WG/CC Wing, Commanding Officer WSSC Washington Suburban Sanitary Commission WWTP waste water...2009a). 3.3 Infrastructure and Utilities 3.3.1 Wastewater Collection and Treatment Sanitary Sewer The sanitary sewer system at JBA was privatized...in February 2006. Terrapin Utility Services, Inc., owns and operates the sanitary sewer system (JBA-NAFW 2013). The majority of the sanitary sewer

Future of corporate capitalism

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kristol, I.

1977-01-01

To help counter the new populist movement (fairly represented by Ralph Nader) toward overregulation of the private sector, privately owned public utilities and energy companies must publicly defend their institutions, advocates I. Kristol, editor of The Public Interest. To be accepted by the public, this defense must assume an adversary stance that includes a willingness to fight indefinitely - not to engage in conventional institutional approaches that merely (1) buy media advertising to merely assure the public that their corporation is concerned and involved, (2) set out to give the public an education in economics, or (3) undertake symbolic actionmore » in such projects as saving the inner city. All of the above may show that such companies are compassionate and concerned but will not give them a good reputation or change the climate of opinion with regard to business or the large corporation. Before politicians will accede to a reasonable request, they now have to be assured that it is acceptable to public opinion. Some strategies are especially useful for utilities. Stockholder-owned utilities are in an especially strong position to fight but have usually fought weakly, if at all. Even if the utility were to be municipalized or nationalized, the stockholders and bondholders are likely to get fairer treatment in the courts for compensation than historically under regultion. Utilities can have a lot of leverage on politicians and public opinion if they would mobilize their stockholder, itemize every government tax (including real-estate taxes) on customers' bills, and bridge the academic-business-world gulf by including college professors (not just college presidents) on corporate boards.« less

The development of a framework for high-quality, sustainable and accessible rural private therapy under the Australian National Disability Insurance Scheme.

PubMed

Dew, Angela; Barton, Rebecca; Ragen, Jo; Bulkeley, Kim; Iljadica, Alexandra; Chedid, Rebecca; Brentnall, Jennie; Bundy, Anita; Lincoln, Michelle; Gallego, Gisselle; Veitch, Craig

2016-12-01

The Australian National Disability Insurance Scheme (NDIS) will provide people with individual funding with which to purchase services such as therapy from private providers. This study developed a framework to support rural private therapists to meet the anticipated increase in demand. The study consisted of three stages utilizing focus groups, interviews and an online expert panel. Participants included private therapists delivering services in rural New South Wales (n = 28), disability service users (n = 9) and key representatives from a range of relevant consumer and service organizations (n = 16). We conducted a thematic analysis of focus groups and interview data and developed a draft framework which was subsequently refined based on feedback from stakeholders. The framework highlights the need for a 'rural-proofed' policy context in which service users, therapists and communities engage collaboratively in a therapy pathway. This collaborative engagement is supported by enablers, including networks, resources and processes which are influenced by the drivers of time, cost, opportunity and motivation. The framework identifies factors that will facilitate delivery of high-quality, sustainable, individualized private therapy services for people with a disability in rural Australia under the NDIS and emphasizes the need to reconceptualize the nature of private therapy service delivery. Implications for Rehabilitation Rural private therapists need upskilling to work with individuals with disability who have individual funding such as that provided by the Australian National Disability Insurance Scheme. Therapists working in rural communities need to consider alternative ways of delivering therapy to individuals with disability beyond the traditional one-on-one therapy models. Rural private therapists need support to work collaboratively with individuals with disability and the local community. Rural private therapists should harness locally available and broader networks, resources and processes to meet the needs and goals of individuals with disability.

District decision-making for health in low-income settings: a qualitative study in Uttar Pradesh, India, on engaging the private health sector in sharing health-related data

PubMed Central

Gautham, Meenakshi; Spicer, Neil; Subharwal, Manish; Gupta, Sanjay; Srivastava, Aradhana; Bhattacharyya, Sanghita; Avan, Bilal Iqbal; Schellenberg, Joanna

2016-01-01

Health information systems are an important planning and monitoring tool for public health services, but may lack information from the private health sector. In this fourth article in a series on district decision-making for health, we assessed the extent of maternal, newborn and child health (MNCH)-related data sharing between the private and public sectors in two districts of Uttar Pradesh, India; analysed barriers to data sharing; and identified key inputs required for data sharing. Between March 2013 and August 2014, we conducted 74 key informant interviews at national, state and district levels. Respondents were stakeholders from national, state and district health departments, professional associations, non-governmental programmes and private commercial health facilities with 3–200 beds. Qualitative data were analysed using a framework based on a priori and emerging themes. Private facilities registered for ultrasounds and abortions submitted standardized records on these services, which is compulsory under Indian laws. Data sharing for other services was weak, but most facilities maintained basic records related to institutional deliveries and newborns. Public health facilities in blocks collected these data from a few private facilities using different methods. The major barriers to data sharing included the public sector’s non-standardized data collection and utilization systems for MNCH and lack of communication and follow up with private facilities. Private facilities feared information disclosure and the additional burden of reporting, but were willing to share data if asked officially, provided the process was simple and they were assured of confidentiality. Unregistered facilities, managed by providers without a biomedical qualification, also conducted institutional deliveries, but were outside any reporting loops. Our findings suggest that even without legislation, the public sector could set up an effective MNCH data sharing strategy with private registered facilities by developing a standardized and simple system with consistent communication and follow up. PMID:27591205

United States Cybersecurity Strategy, Policy, and Organization: Poorly Postured to Cope with a Post-9/11 Security Environment?

DTIC Science & Technology

2012-12-14

maintain order and to deliver minimum essential public services; 3) The private sector to ensure the orderly functioning of the economy and the...the private sector’s capability to ensure the orderly functioning of the economy and delivery of essential services 5 Have a negative effect on the... economy through the cascading disruption of other critical infrastructure and key resources 6 Undermine the public’s morale and confidence in our

The Role of Organizational Culture in the Leadership of United States Air Force Services Squadrons

DTIC Science & Technology

1988-01-01

correlation to the private sector , while others, e.g., mortuary affairs and honor guard, are strictly military in nature. In any case, all functions and...similar to its private sector commercial hotel or motel counterpart. Air Force personnel traveling as * part of their duty requirement are required to stay...oriented management style prevalent in both the private and public sector ; this is not the case. The question becomes whether one -17 wants to push the

Alternative Fuels Data Center

Science.gov Websites

Light-Duty Alternative Fuel Vehicle Rebates Clean Vehicle and Infrastructure Grants Clean Fleet Grants Clean School Bus Program Clean Vehicle Replacement Vouchers Diesel Fuel Blend Tax Exemption Idle Reduction Weight Exemption Natural Gas Vehicle (NGV) Weight Exemption Utility/Private Incentives Plug-In

24 CFR 982.605 - SRO: Housing quality standards.

Code of Federal Regulations, 2013 CFR

2013-04-01

... an SRO unit without passing through any other unit. (4) Sprinkler system. A sprinkler system that protects all major spaces, hard wired smoke detectors, and such other fire and safety improvements as State... utilize an approvable public or private disposal system. (E) Sanitary facilities must be reasonably...

24 CFR 982.605 - SRO: Housing quality standards.

Code of Federal Regulations, 2012 CFR

2012-04-01

... an SRO unit without passing through any other unit. (4) Sprinkler system. A sprinkler system that protects all major spaces, hard wired smoke detectors, and such other fire and safety improvements as State... utilize an approvable public or private disposal system. (E) Sanitary facilities must be reasonably...

24 CFR 982.605 - SRO: Housing quality standards.

Code of Federal Regulations, 2014 CFR

2014-04-01

... an SRO unit without passing through any other unit. (4) Sprinkler system. A sprinkler system that protects all major spaces, hard wired smoke detectors, and such other fire and safety improvements as State... utilize an approvable public or private disposal system. (E) Sanitary facilities must be reasonably...

24 CFR 982.605 - SRO: Housing quality standards.

Code of Federal Regulations, 2011 CFR

2011-04-01

... an SRO unit without passing through any other unit. (4) Sprinkler system. A sprinkler system that protects all major spaces, hard wired smoke detectors, and such other fire and safety improvements as State... utilize an approvable public or private disposal system. (E) Sanitary facilities must be reasonably...

40 CFR 503.9 - General definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., sanitary district, utility district, drainage district, or similar entity, or an integrated waste... that can be applied to a unit area of land (e.g., gallons per acre). (v) Runoff is rainwater, leachate... owned, publicly owned, or privately owned device or system used to treat (including recycle and reclaim...

Better Housing Through Self-Help

ERIC Educational Resources Information Center

Opat, Ellen-Jane

1976-01-01

Three case studies describe successful squatter settlements in Panama City, Panama, San Salvador, El Salvador and Lusaka, Zambia and show how governments have improved the condition of squatters by utilizing government loans, sites and services projects, foreign technical and financial aid and private non-profit developers, instead of eliminating…

Report of the National Advisory Commission on Health Manpower. Volume 1.

ERIC Educational Resources Information Center

National Advisory Commission on Health Manpower, Washington, DC.

In 1966, the President established the National Advisory Commission on Health Manpower to "develop appropriate recommendations for action by government or by private institutions, organizations, or individuals for improving the availability and utilization of health manpower." Recommendations include: (1) federal funds to encourage…

75 FR 31463 - Comal County Regional Habitat Conservation Plan, Comal County, TX

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-03

... as school development, road construction and maintenance, and parkland. The ITP will cover Comal... activities including, but not limited to: Public or private construction and development, utility... Wildlife Service, 10711 Burnet Road, Suite 200, Austin, TX 78758 or 512-490-0057. SUPPLEMENTARY INFORMATION...

FloVis: Leveraging Visualization to Protect Sensitive Network Infrastructure

DTIC Science & Technology

2010-11-01

words, we are clustering the hourly web surfing patterns of users on a small private network. The data in this case is filtered NetFlow records...Entity-based NetFlow Visualization Utility for Identifying Intrusive Behavior. In Goodall et al. (eds.), Mathematics and Visualization (Proceedings

7 CFR 1717.858 - Lien subordination for rural development investments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... requirements on accounting, financial reporting, record keeping, and irregularities (see § 1717.854(c)(5)). RUS... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE POST-LOAN POLICIES AND PROCEDURES COMMON TO INSURED AND GUARANTEED ELECTRIC LOANS Lien Accommodations and Subordinations for 100 Percent Private Financing § 1717.858...

7 CFR 1717.858 - Lien subordination for rural development investments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... requirements on accounting, financial reporting, record keeping, and irregularities (see § 1717.854(c)(5)). RUS... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE POST-LOAN POLICIES AND PROCEDURES COMMON TO INSURED AND GUARANTEED ELECTRIC LOANS Lien Accommodations and Subordinations for 100 Percent Private Financing § 1717.858...

7 CFR 1717.858 - Lien subordination for rural development investments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... requirements on accounting, financial reporting, record keeping, and irregularities (see § 1717.854(c)(5)). RUS... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE POST-LOAN POLICIES AND PROCEDURES COMMON TO INSURED AND GUARANTEED ELECTRIC LOANS Lien Accommodations and Subordinations for 100 Percent Private Financing § 1717.858...

7 CFR 1717.858 - Lien subordination for rural development investments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... requirements on accounting, financial reporting, record keeping, and irregularities (see § 1717.854(c)(5)). RUS... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE POST-LOAN POLICIES AND PROCEDURES COMMON TO INSURED AND GUARANTEED ELECTRIC LOANS Lien Accommodations and Subordinations for 100 Percent Private Financing § 1717.858...

Secrets in the Bedroom: Adolescents' Private Use of Media.

ERIC Educational Resources Information Center

Larson, Reed

1995-01-01

The functions of solitary media use in the daily emotional lives of adolescents are discussed, suggesting that solitary television watching and music listening give adolescents an opportunity to explore and cultivate a newly discovered private self. Solitary media experiences provide an important context for dealing with stress and negative…

Challenges in Preparing Veterinarians for Global Animal Health: Understanding the Public Sector.

PubMed

Hollier, Paul J; Quinn, Kaylee A; Brown, Corrie C

Understanding of global systems is essential for veterinarians seeking to work in realms outside of their national domain. In the global system, emphasis remains on the public sector, and the current curricular emphasis in developed countries is on private clinical practice for the domestic employment market. There is a resulting lack of competency at graduation for effective engagement internationally. The World Organisation for Animal Health (OIE) has created standards for public sector operations in animal health, which must be functional to allow for sustainable development. This public sector, known as the Veterinary Services, or VS, serves to control public good diseases, and once effectively built and fully operational, allows for the evolution of a functional private sector, focused on private good diseases. Until the VS is fully functional, support of private good services is non-sustainable and any efforts delivered are not long lasting. As new graduates opt for careers working in the international development sector, it is essential that they understand the OIE guidelines to help support continuing improvement. Developing global veterinarians by inserting content into the veterinary curriculum on how public systems can operate effectively could markedly increase the potential of our professional contributions globally, and particularly in the areas most in need.

Photovoltaics as a terrestrial energy source. Volume 2: System value

NASA Technical Reports Server (NTRS)

Smith, J. L.

1980-01-01

Assumptions and techniques employed by the electric utility industry and other electricity planners to make estimates of the future value of photovoltaic (PV) systems interconnected with U.S. electric utilities were examined. Existing estimates of PV value and their interpretation and limitations are discussed. PV value is defined as the marginal private savings accruing to potential PV owners. For utility-owned PV systems, these values are shown to be the after-tax savings in conventional fuel and capacity displaced by the PV output. For non-utility-owned (distributed) systems, the utility's savings in fuel and capacity must first be translated through the electric rate structure (prices) to the potential PV system owner. Base-case estimates of the average value of PV systems to U.S. utilities are presented. The relationship of these results to the PV Program price goals and current energy policy is discussed; the usefulness of PV output quantity goals is also reviewed.

Satellite Cloud and Radiative Property Processing and Distribution System on the NASA Langley ASDC OpenStack and OpenShift Cloud Platform

NASA Astrophysics Data System (ADS)

Nguyen, L.; Chee, T.; Palikonda, R.; Smith, W. L., Jr.; Bedka, K. M.; Spangenberg, D.; Vakhnin, A.; Lutz, N. E.; Walter, J.; Kusterer, J.

2017-12-01

Cloud Computing offers new opportunities for large-scale scientific data producers to utilize Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) IT resources to process and deliver data products in an operational environment where timely delivery, reliability, and availability are critical. The NASA Langley Research Center Atmospheric Science Data Center (ASDC) is building and testing a private and public facing cloud for users in the Science Directorate to utilize as an everyday production environment. The NASA SatCORPS (Satellite ClOud and Radiation Property Retrieval System) team processes and derives near real-time (NRT) global cloud products from operational geostationary (GEO) satellite imager datasets. To deliver these products, we will utilize the public facing cloud and OpenShift to deploy a load-balanced webserver for data storage, access, and dissemination. The OpenStack private cloud will host data ingest and computational capabilities for SatCORPS processing. This paper will discuss the SatCORPS migration towards, and usage of, the ASDC Cloud Services in an operational environment. Detailed lessons learned from use of prior cloud providers, specifically the Amazon Web Services (AWS) GovCloud and the Government Cloud administered by the Langley Managed Cloud Environment (LMCE) will also be discussed.

Patient Smartphone Ownership and Interest in Mobile Apps to Monitor Symptoms of Mental Health Conditions: A Survey in Four Geographically Distinct Psychiatric Clinics.

PubMed

Torous, John; Chan, Steven Richard; Yee-Marie Tan, Shih; Behrens, Jacob; Mathew, Ian; Conrad, Erich J; Hinton, Ladson; Yellowlees, Peter; Keshavan, Matcheri

2014-01-01

Despite growing interest in mobile mental health and utilization of smartphone technology to monitor psychiatric symptoms, there remains a lack of knowledge both regarding patient ownership of smartphones and their interest in using such to monitor their mental health. To provide data on psychiatric outpatients' prevalence of smartphone ownership and interest in using their smartphones to run applications to monitor their mental health. We surveyed 320 psychiatric outpatients from four clinics around the United States in order to capture a geographically and socioeconomically diverse patient population. These comprised a state clinic in Massachusetts (n=108), a county clinic in California (n=56), a hybrid public and private clinic in Louisiana (n=50), and a private/university clinic in Wisconsin (n=106). Smartphone ownership and interest in utilizing such to monitor mental health varied by both clinic type and age with overall ownership of 62.5% (200/320), which is slightly higher than the average United States' rate of ownership of 58% in January 2014. Overall patient interest in utilizing smartphones to monitor symptoms was 70.6% (226/320). These results suggest that psychiatric outpatients are interested in using their smartphones to monitor their mental health and own the smartphones capable of running mental healthcare related mobile applications.

Exploring Faculty Members' Motivation and Persistence in Academic Service-Learning Pedagogy

ERIC Educational Resources Information Center

Darby, Alexa; Newman, Gabrielle

2014-01-01

This qualitative study provides a theoretical framework for understanding faculty members' motivation to persist in utilizing academic service-learning pedagogy. Twenty-four faculty members from a private liberal arts university in the southeastern United States were interviewed about the benefits and challenges of teaching academic…

Set. Research Information for Teachers. Number Two. 1991.

ERIC Educational Resources Information Center

Richards, Llyn, Ed.; And Others

This packet of educational research information is designed for everyone interested in education and may be utilized for a quick read, private study, staff meetings, inservice courses or small group discussions. The leaflets and brief reports are listed on a contents sheet as follows: "Twin Studies of Spelling"; "Moment-by-moment…

78 FR 59757 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-27

... continues to be available to consumers and businesses. As an essential part of restoring confidence, the... particularly interested in knowing how banks have used the money that Treasury has invested through the CPP... participants in the CPP are utilizing TARP capital. Affected public: Private Sector: Businesses or other for...

75 FR 34213 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-16

... participants in the CPP are utilizing TARP capital. Respondents: Private Sector: Businesses or other for-profit... continues to be available to consumers and businesses. As an essential part of restoring confidence, the... particularly interested in knowing how banks have used the money that Treasury has invested through the CPP...

23 CFR 645.107 - Eligibility.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Relocations, Adjustments, and Reimbursement § 645.107 Eligibility. (a) When requested by the STD, Federal... made under one or more of the following conditions when: (1) The STD certifies that the utility has the... occupies privately or publicly owned land, including public road or street right-of-way, and the STD...

23 CFR 645.107 - Eligibility.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Relocations, Adjustments, and Reimbursement § 645.107 Eligibility. (a) When requested by the STD, Federal... made under one or more of the following conditions when: (1) The STD certifies that the utility has the... occupies privately or publicly owned land, including public road or street right-of-way, and the STD...

23 CFR 645.107 - Eligibility.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Relocations, Adjustments, and Reimbursement § 645.107 Eligibility. (a) When requested by the STD, Federal... made under one or more of the following conditions when: (1) The STD certifies that the utility has the... occupies privately or publicly owned land, including public road or street right-of-way, and the STD...

23 CFR 645.107 - Eligibility.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Relocations, Adjustments, and Reimbursement § 645.107 Eligibility. (a) When requested by the STD, Federal... made under one or more of the following conditions when: (1) The STD certifies that the utility has the... occupies privately or publicly owned land, including public road or street right-of-way, and the STD...

South Korean Male Adolescents' Internal and External Influences in Academic Achievement

ERIC Educational Resources Information Center

Geesa, Rachel Louise

2014-01-01

South Korean adolescents' motivation for high academic achievement is strongly influenced by extraordinary parental support, pressures to achieve, and the practice of utilizing both public and private learning environments in South Korea. To remain competitive, educational leaders may benefit from observations of other countries' academic…

Becoming Resilient: Disaster Planning and Recovery: NREL Experts Assist Before and After a Disaster (Fact Sheet)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hotchkiss, E.

This fact sheet provides information on how private industry; federal, state, and local governments; non-profit organizations; and communities can utilize NREL's expertise, tools, and innovations to incorporate energy efficiency and renewable energy into the planning, recovery, and rebuilding stages of disaster.

78 FR 24752 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-26

... Care Practice Demonstration; Use: On September 16, 2009, the Department of Health and Human Services... the effects of advanced primary care practice when supported by Medicare, Medicaid, and private health... experience with care, patterns of utilization, Medicare and Medicaid expenditures, and budget neutrality...

Lack of concordance in microarray gene expression responses to Phenobarbital in companion aged FFPE and Frozen liver samples

EPA Science Inventory

Despite the immense potential value of public and private biorepositories, direct utilization of archival tissues for molecular profiling has been limited. A major reason for this limited use is the difficulty in obtaining reliable transcriptomic profiles from formalin-fixed par...

Entrepreneurs in the Public Library: Reinventing an Institution.

ERIC Educational Resources Information Center

Clay, Edwin S. III; Bangs, Patricia C.

2000-01-01

Presents a case study that describes how the Fairfax County Public (VA) has reinvented itself as a public service corporation by developing a public-private model for fund development using a top managerial committee. Discusses volunteer programs, partnerships with local utility companies, and staff training in managing patron problem behavior.…

Special Education Voucher Programs, Reflective Judgment, and Future Legislative Recommendations

ERIC Educational Resources Information Center

Bon, Susan C.; Decker, Janet R.; Strassfeld, Natasha

2016-01-01

As of 2015, 17 special education voucher programs (SVPs) existed in 13 states and proposals continue to emerge. Eligible parents utilize these vouchers to enroll their children in private schools and thereby relinquish special education services and protections provided under the Individuals with Disabilities Education Act (IDEA). Using a…

Universal(ly Bad) Service: Providing Infrastructure Services to Rural and Poor Urban Consumers. Policy Research Working Paper.

ERIC Educational Resources Information Center

Clarke, George R. G.; Wallsten, Scott J.

Utility services (telecommunications, power, water, and gas) throughout the world were traditionally provided by large, usually state-owned, monopolies. However, encouraged by technological change, regulatory innovation, and pressure from international organizations, many developing countries are privatizing state-owned companies and introducing…

National Response Framework

DTIC Science & Technology

2013-05-01

Infrastructure Critical infrastructure—such as privately owned transportation and transit, telecommunications , utilities, financial institutions...Food Incident Department of Agriculture ( USDA ) The Secretary of Agriculture has the authority to declare an extraordinary emergency and take...bilateral agreements are already established. For example, the USDA /Forest Service and Department of the Interior have joint bilateral agreements

Utilizing Local Partnerships to Enhance Workforce Development

ERIC Educational Resources Information Center

Whikehart, John

2009-01-01

The Indiana Center for the Life Sciences, an award-winning partnership between education, government, and the private sector, houses state-of-the-art science labs, classrooms, and industry training space for community college students and local employers. This innovative partnership prepares both the current and future workforce for careers in the…

Rural Health: The Story of Outreach. A Program of Cooperation in Health Care.

ERIC Educational Resources Information Center

Health Resources and Services Administration (DHHS), Rockville, MD. Office of Rural Health Policy.

Rural Health Outreach is a federal program of demonstration grants designed to encourage organizations to cooperate in delivering health care services to rural Americans. Thirteen programs utilizing innovative collaborations between state agencies, schools, nonprofit organizations, hospitals, volunteers, and the private sector are described a year…

47 CFR 80.514 - Marine VHF frequency coordinating committee(s).

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Marine VHF frequency coordinating committee(s... SPECIAL RADIO SERVICES STATIONS IN THE MARITIME SERVICES Private Coast Stations and Marine Utility Stations § 80.514 Marine VHF frequency coordinating committee(s). This section contains the names of...

77 FR 59615 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-28

...) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) the use... Public: Private Sector: Business or other for-profit and not- for-profit institutions; Public Sector... Identifier CMS-10408] Agency Information Collection Activities: Proposed Collection; Comment Request AGENCY...

75 FR 42727 - Implementing the National Broadband Plan; Comment Period Extension

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-22

..., state, and private entities seek to develop Smart Grid technologies. The second RFI requested information on the evolving needs of electric utilities as Smart Grid technologies are more broadly deployed... accept reply comments, data, and information regarding the National Broadband Plan RFI: Data Access and...

Teachers Perception and Implementation of Differentiated Instruction in the Private Elementary and Middle Schools

ERIC Educational Resources Information Center

Richards-Usher, Laurene

2013-01-01

The teachers' perception and implementation of differentiated instruction, the difference between novice and experience teachers' perception on differentiate instruction, and the predictive relationship between teachers' perceptions and teachers' implementation of differentiated instruction were studied. The study utilized a…

77 FR 24556 - Waiver of Acceptable Risk Restriction for Launch and Reentry

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-24

... designed to stimulate efforts by the private sector to demonstrate safe, reliable, and cost-effective space... ensure safe approach and berthing with the International Space Station, utilizing considerable fuel. In... economic growth and entrepreneurial activity through use of the space environment; (2) to encourage the...

Higher Education Tuition for Optimal Educational Returns.

ERIC Educational Resources Information Center

Correa, Hector

1998-01-01

An elementary mathematical model is used to analyze tuition and privatization policies for higher education institutions. One finding is that an appropriate tuition can increase the social income of alumni. Another salient finding is that some of the model's results are counterintuitive, suggesting its utility in decision making. Methodological…

47 CFR 80.501 - Supplemental eligibility requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SERVICES STATIONS IN THE MARITIME SERVICES Private Coast Stations and Marine Utility Stations § 80.501... ship arrival and departure service, and will employ the station only for the purpose of obtaining the information essential to that service; or is (4) A corporation proposing to furnish a nonprofit radio...

47 CFR 80.501 - Supplemental eligibility requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES STATIONS IN THE MARITIME SERVICES Private Coast Stations and Marine Utility Stations § 80.501... ship arrival and departure service, and will employ the station only for the purpose of obtaining the information essential to that service; or is (4) A corporation proposing to furnish a nonprofit radio...

47 CFR 80.501 - Supplemental eligibility requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES STATIONS IN THE MARITIME SERVICES Private Coast Stations and Marine Utility Stations § 80.501... ship arrival and departure service, and will employ the station only for the purpose of obtaining the information essential to that service; or is (4) A corporation proposing to furnish a nonprofit radio...

Alternative Financing of Alternative Energy.

ERIC Educational Resources Information Center

California Higher Education, 1982

1982-01-01

The University of San Francisco financed conversion of three dormitories to solar heat by having private investors purchase and install equipment through a limited partnership. A public utilities rebate and eventual donation of the equipment also resulted. Available from California Higher Education, P.O. Box 26541, Sacramento, CA 95826, $2.00.…

7 CFR 3555.201 - Site requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... contiguous to and have direct access from a street, road, or driveway. Streets and roads must be hard... needed maintenance will be provided. (4) The site must be supported by adequate utilities and water and wastewater disposal systems. Certain water and wastewater systems that are privately-owned may be acceptable...

Competition on the Georgia Education Marketplace

ERIC Educational Resources Information Center

Gagnidze, Archil; Maglakelidze, Shorena

2017-01-01

Georgia implemented a nationwide, full scale school voucher program in 2005. The new voucher plan was designed with the intent to provide equitable distribution and efficient utilization of financial and human resources. By introducing the voucher scheme, the government hoped to promote competition among public as well as private schools to push…

Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

PubMed Central

Shah, Nirali M; Wang, Wenjuan; Bishai, David M

2011-01-01

Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific. PMID:21729919

Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

PubMed

Shah, Nirali M; Wang, Wenjuan; Bishai, David M

2011-07-01

Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific.

Ego strengths, racial/ethnic identity, and well-being among North American Indian/First Nations adolescents.

PubMed

Gfellner, Barbara

2016-01-01

This study investigated associations between ego strengths (psychosocial development), racial/ethnic identity using Multi-Ethnic Identity Measure-Revised (exploration, commitment) and Multidimensional Measure of Racial Identity (centrality, private regard, public regard) dimensions, and personal adjustment/well-being among 178 North American Indian/First Nations adolescents who resided and attended school on reserves. As predicted, ego strengths related directly with centrality, private regard, and the adjustment measures; the moderation of ego strengths for exploration, commitment, and private regard reflected adverse functioning for those with less than advanced ego strengths. As well, ego strengths mediated associations between centrality and private regard with several measures of personal well-being. Practical and theoretical implications are considered.

A regional, market oriented governance for disaster management: A new planning approach.

PubMed

Blackstone, Erwin A; Hakim, Simon; Meehan, Brian

2017-10-01

This paper proposes a regional competitive governance and management of response and recovery from disasters. It presents problems experienced in major disasters, analyzes the failures, and suggests how a competitive system that relies on private and volunteer regional leaders, personnel, and capital can improve preparation, response and recovery efforts over the existing government system. A Public Choice approach is adopted to explain why government often fails, and how regional governance may be socially more efficient than the existing federal- state-local funded and managed disaster system. The paper suggests that the federal role might change from both funding and supplying aid in disasters to merely funding disaster recovery efforts. When a disaster occurs, available businesses and government resources in the region can be utilized under a competitive system. These resources could replace existing federal and state inventories and emergency personnel. An independent regionally controlled and managed council, which also develops its own financial resources, and local volunteer leaders are key for success. The paper suggests a new planning method that utilizes the statistical Factor Analysis methodology to derive an efficient organizational and functional model to confront disasters. Copyright © 2017 Elsevier Ltd. All rights reserved.

Characteristics associated with use of public and private web sites as sources of health care information: results from a national survey.

PubMed

Miller, Edward Alan; West, Darrell M

2007-03-01

We sought to determine the frequency with which Americans access health information from governmental (public sector) and nongovernmental (private sector) web sites and to identify similarities and differences in the characteristics associated with use of each type. Data derive from 928 individuals who responded to a November 2005 national survey. In addition to forms of health communication, we asked about age, gender, race, income, education, insurance, lifestyle, residence, satisfaction, literacy, and health. We report the extent of web site use stratified by sponsorship type-public and private. We also use chi tests to examine bivariate associations. Logistic regression and multiple imputation of missing data were used to examine the correlates of use in a multivariate context. More than twice as many respondents visited private web sites (29.6%) than public web sites (13.2%). However, just 23.6% and 18.9% of private and public web site visitors, respectively, reported doing so once a month or more. Both public and private web site visitors were more likely to be better-educated respondents (odds ratio [OR]=0.83, OR=1.57) reporting greater concerns about health care access (OR=1.28, OR=1.20) than nonvisitors. Younger individuals (OR=0.83) living in urban areas (OR=1.59) with stronger health literacy (OR=1.24) and reporting greater concerns about health care affordability (OR=1.59) were more likely to visit privately sponsored web sites but nonpublicly sponsored ones. Relatively low utilization levels necessitate a concerted effort to improve the quality, accessibility, and relevance of Internet health information. Efforts to close the digital divide must recognize differences in user characteristics across governmental and nongovernmental web site providers.

Results from different patient populations using combined therapy with alprostadil and sildenafil: predictors of satisfaction.

PubMed

Mydlo, J H; Volpe, M A; MacChia, R J

2000-09-01

To evaluate the outcome of combined therapy (using intraurethral alprostadil and oral sildenafil) in private and clinic patients with erectile dysfunction, and thus assess predictors of satisfaction. In all, 360 men were treated for erectile dysfunction using single and/or combined therapy, comprising 214 private-practice and 166 clinic patients. Responses were evaluated using the International Index for Erectile Function (IIEF) questionnaire before and after treatment. Serum testosterone levels, education and socio-economic status were also assessed. Group 1a consisted of 33 private patients and Group 1b of 24 clinic patients who tried the maximum dose of intraurethral alprostadil monotherapy initially, followed by the maximum dose of sildenafil monotherapy, and remained dissatisfied. Group 2a consisted of 32 private patients and group 2b of 31 clinic patients who tried the maximum dose of sildenafil monotherapy initially, followed by the maximum dose of alprostadil monotherapy, and were also dissatisfied. These two groups of 65 private and 55 clinic patients then underwent combined therapy. The mean (SD) score for erectile function was 24.1 (2) for combined therapy (a 123% improvement), and 19.8 (1. 8) (83% improvement) and 15.2 (1.6) (41% improvement) for sildenafil and alprostadil monotherapies (P < 0.05 for both patient groups). The men also reported an improvement in their satisfaction with intercourse. However, at 18 months, 60 of the 65 private patients but only 40 of the 55 clinic patients continued with combined therapy; thus, the discontinuation rate was three times greater among clinic than among private patients. Furthermore, the private patients had an overall improvement in the satisfaction score of 128%, compared with 51% for the clinic patients. Although there were no significant differences in erectile function improvement within the two satisfied combined therapy groups, the differences in overall satisfaction and long-term withdrawal rates suggests that other factors beside motivation must be involved for success, e.g. education, persistence, realistic expectations, and certain psychological factors. Combined therapy should be considered for those patients who have a suboptimal response to monotherapy and refuse or are not candidates for surgical options. Generally, those patients with a higher education, greater persistence and more realistic expectations were more satisfied with combined therapy.

Private speech of learning disabled and normally achieving children in classroom academic and laboratory contexts.

PubMed

Berk, L E; Landau, S

1993-04-01

Learning disabled (LD) children are often targets for cognitive-behavioral interventions designed to train them in effective use of a self-directed speech. The purpose of this study was to determine if, indeed, these children display immature private speech in the naturalistic classroom setting. Comparisons were made of the private speech, motor accompaniment to task, and attention of LD and normally achieving classmates during academic seatwork. Setting effects were examined by comparing classroom data with observations during academic seatwork and puzzle solving in the laboratory. Finally, a subgroup of LD children symptomatic of attention-deficit hyperactivity disorder (ADHD) was compared with pure LD and normally achieving controls to determine if the presumed immature private speech is a function of a learning disability or externalizing behavior problems. Results indicated that LD children used more task-relevant private speech than controls, an effect that was especially pronounced for the LD/ADHD subgroup. Use of private speech was setting- and task-specific. Implications for intervention and future research methodology are discussed.

Social service robots to support independent living : Experiences from a field trial.

PubMed

Pripfl, J; Körtner, T; Batko-Klein, D; Hebesberger, D; Weninger, M; Gisinger, C

2016-06-01

Assistive robots could be a future means to support independent living for seniors. This article provides insights into the latest developments in social service robots (SSR) based on the recently finished HOBBIT project. The idea of the HOBBIT project was to develop a low-cost SSR which is able to reduce the risk of falling, to detect falls and handle emergencies in private homes. The main objective of the project was to raise the technology to a level that allows the robot to be fully autonomously deployed in the private homes of older users and to evaluate technology market readiness, utility, usability and affordability under real-world conditions. During the initial phase of the project, a first prototype (PT1) was developed. The results of laboratory tests with PT1 were used for the development of a second prototype (PT2), which was finally tested in seven households of senior adults (mean age 79 years) for 3 weeks each, i.e. in total more than 5 months. The results showed that PT2 is intuitive to handle and that the functions offered meet the needs of older users; however, the robot was considered more as a toy than a supportive device for independent living. Furthermore, despite an emergency function of the robot, perceived security did not increase. Reasons for this might be a lack of technological robustness and slow performance of the prototype and also the good health conditions of the users; however, users believed that a market-ready version of the robot would be vital for supporting people who are more fragile and more socially isolated. Thus, SSRs have the potential to support independent living of older people although the technology has to be considerably improved to reach market readiness.

Evaluating forest land development effects on private forestry in eastern Oregon.

Treesearch

Jeffrey D. Kline; David L. Azuma

2007-01-01

Research suggests that forest land development can reduce the productivity of remaining forest land because private forest owners reduce their investments in forest management. We developed empirical models describing forest stocking, thinning, harvest, and postharvest tree planting in eastern Oregon, as functions of stand and site characteristics, ownership, and...

Picturing Natural Girlhoods: Nature, Space and Femininity in Girls' School Promotions

ERIC Educational Resources Information Center

Wardman, Natasha; Gottschall, Kristina; Drew, Christopher; Hutchesson, Rachael; Saltmarsh, Sue

2013-01-01

This paper furthers a discussion about the ways in which idealised versions of gender permeate the aesthetic presentation and impression management strategies of elite private schools. Specifically, we consider how the written text, layout and images used in 12 Australian private girls school prospectuses function in constructing discourses of…

An Analysis of Globalization and Higher Education in Malaysia

ERIC Educational Resources Information Center

Arokiasamy, Anantha Raj A.

2011-01-01

This study aims to examine the impact of globalization on private higher education in Malaysia. The impact of globalization and the development of knowledge-based economy have caused much dramatic change to the character and functions of higher education in Malaysia. The major trend is the reforming and restructuring of private higher education in…

Private University Librarian's Experience on Procurement of Books in Bangladesh

ERIC Educational Resources Information Center

Chowdhury, Muhammad Hossam Haider

2011-01-01

The private universities in Bangladesh are playing an important role in modernizing the higher education system in the country and the role of librarians is also different and challenging. Specially, procuring books and monographs is an exigent function being this lost its demand very quickly. In some cases, titles bear only one semester…

Analysis of multi drug resistant tuberculosis (MDR-TB) financial protection policy: MDR-TB health insurance schemes, in Chhattisgarh state, India.

PubMed

Kundu, Debashish; Sharma, Nandini; Chadha, Sarabjit; Laokri, Samia; Awungafac, George; Jiang, Lai; Asaria, Miqdad

2018-01-27

There are significant financial barriers to access treatment for multi drug resistant tuberculosis (MDR-TB) in India. To address these challenges, Chhattisgarh state in India has established a MDR-TB financial protection policy by creating MDR-TB benefit packages as part of the universal health insurance scheme that the state has rolled out in their effort towards attaining Universal Health Coverage for all its residents. In these schemes the state purchases health insurance against set packages of services from third party health insurance agencies on behalf of all its residents. Provider payment reform by strategic purchasing through output based payments (lump sum fee is reimbursed as per the MDR-TB benefit package rates) to the providers - both public and private health facilities empanelled under the insurance scheme was the key intervention. To understand the implementation gap between policy and practice of the benefit packages with respect to equity in utilization of package claims by the poor patients in public and private sector. Data from primary health insurance claims from January 2013 to December 2015, were analysed using an extension of 'Kingdon's multiple streams for policy implementation framework' to explain the implementation gap between policy and practice of the MDR-TB benefit packages. The total number of claims for MDR-TB benefit packages increased over the study period mainly from poor patients treated in public facilities, particularly for the pre-treatment evaluation and hospital stay packages. Variations and inequities in utilizing the packages were observed between poor and non-poor beneficiaries in public and private sector. Private providers participation in the new MDR-TB financial protection mechanism through the universal health insurance scheme was observed to be much lower than might be expected given their share of healthcare provision overall in India. Our findings suggest that there may be an implementation gap due to weak coupling between the problem and the policy streams, reflecting weak coordination between state nodal agency and the state TB department. There is a pressing need to build strong institutional capacity of the public and private sector for improving service delivery to MDR-TB patients through this new health insurance mechanism.

Radius of Care in Secondary Schools in the Midwest: Are Automated External Defibrillators Sufficiently Accessible to Enable Optimal Patient Care?

PubMed

Osterman, Michael; Claiborne, Tina; Liberi, Victor

2018-04-01

  Sudden cardiac arrest is the leading cause of death among young athletes. According to the American Heart Association, an automated external defibrillator (AED) should be available within a 1- to 1.5-minute brisk walk from the patient for the highest chance of survival. Secondary school personnel have reported a lack of understanding about the proper number and placement of AEDs for optimal patient care.   To determine whether fixed AEDs were located within a 1- to 1.5-minute timeframe from any location on secondary school property (ie, radius of care).   Cross-sectional study.   Public and private secondary schools in northwest Ohio and southeast Michigan.   Thirty schools (24 public, 6 private) volunteered.   Global positioning system coordinates were used to survey the entire school properties and determine AED locations. From each AED location, the radius of care was calculated for 3 retrieval speeds: walking, jogging, and driving a utility vehicle. Data were analyzed to expose any property area that fell outside the radius of care.   Public schools (37.1% ± 11.0%) possessed more property outside the radius of care than did private schools (23.8% ± 8.0%; F 1,28 = 8.35, P = .01). After accounting for retrieval speed, we still observed differences between school types when personnel would need to walk or jog to retrieve an AED ( F 1.48,41.35 = 4.99, P = .02). The percentages of school property outside the radius of care for public and private schools were 72.6% and 56.3%, respectively, when walking and 34.4% and 12.2%, respectively, when jogging. Only 4.2% of the public and none of the private schools had property outside the radius of care when driving a utility vehicle.   Schools should strategically place AEDs to decrease the percentage of property area outside the radius of care. In some cases, placement in a centralized location that is publicly accessible may be more important than the overall number of AEDs on site.

The Effect of Antiretroviral Treatment on Health Care Utilization in Rural South Africa: A Population-Based Cohort Study.

PubMed

Hontelez, Jan A C; Tanser, Frank C; Naidu, Kevindra K; Pillay, Deenan; Bärnighausen, Till

2016-01-01

The effect of the rapid scale-up of vertical antiretroviral treatment (ART) programs for HIV in sub-Saharan Africa on the overall health system is under intense debate. Some have argued that these programs have reduced access for people suffering from diseases unrelated to HIV because ART programs have drained human and physical resources from other parts of the health system; others have claimed that the investments through ART programs have strengthened the general health system and the population health impacts of ART have freed up health care capacity for the treatment of diseases that are not related to HIV. To establish the population-level impact of ART programs on health care utilization in the public-sector health system, we compared trends in health care utilization among HIV-infected people receiving and not receiving ART with HIV-uninfected people during a period of rapid ART scale-up. We used data from the Wellcome Trust Africa Centre for Population Health, which annually elicited information on health care utilization from all surveillance participants over the period 2009-2012 (N = 32,319). We determined trends in hospitalization, and public-sector and private-sector primary health care (PHC) clinic visits for HIV-infected and -uninfected people over a time period of rapid ART scale-up (2009-2012) in this community. We regressed health care utilization on HIV status and ART status in different calendar years, controlling for sex, age, and area of residence. The proportion of people who reported to have visited a public-sector primary health care (PHC) clinic in the last 6 months increased significantly over the period 2009-2012, for both HIV-infected people (from 59% to 67%; p<0.001), and HIV-uninfected people (from 41% to 47%; p<0.001). In contrast, the proportion of HIV-infected people visiting a private-sector PHC clinic declined from 22% to 12% (p<0.001) and hospitalization rates declined from 128 to 82 per 1000 PY (p<0.001). For HIV-uninfected people, the proportion visiting a private-sector PHC clinic declined from 16% to 9%, and hospitalization rates declined from 78 to 44 per 1000 PY (p<0.001). After controlling for potential confounding factors, all trends remained of similar magnitude and significance. Our results indicate that the ART scale-up in this high HIV prevalence community has shifted health care utilization from hospitals and private-sector primary care to public-sector primary care. Remarkably, this shift is observed for both HIV-infected and -uninfected populations, supporting and extending hypotheses of 'therapeutic citizenship' whereby HIV-infected patients receiving ART facilitate primary care access for family and community members. One explanation of our findings is that ART has improved the capacity or quality of primary care in this community and, as a consequence, increasingly met overall health care needs at the primary care level rather than at the secondary level. Future research needs to confirm this causal interpretation of our findings using qualitative work to understand causal mechanisms or quasi-experimental quantitative studies to increase the strength of causal inference.

An impact evaluation of medical insurance for poor in Georgia: preliminary results and policy implications.

PubMed

Gotsadze, George; Zoidze, Akaki; Rukhadze, Natia; Shengelia, Natia; Chkhaidze, Nino

2015-03-01

The objective of this article is to assess the impact of the new health financing reform in Georgia-'medical insurance for the poor (MIP)'-which uses private insurance companies and delivers state-subsidized health benefits to the poorest groups of the Georgian population. To evaluate the reform we looked at access to health care services and financial protection against health care costs, which are two key dimensions proposed for the universal coverage plans. The data from two nationally representative Health Utilization and Expenditure Surveys (2007 and 2010) were used, and a difference-in-difference method of evaluation was applied. The MIP was not found to have a significant impact on service utilization growth nationwide, but in the capital city the MIP insured were 12% more likely to use formal health services and 7.6% more likely to use hospitals as compared with other areas of the country. The MIP impact on out-of-pocket health expenditures was greater in reducing costs of accessing services. The cost reductions were sizable and more pronounced among the poorest. Finally, the MIP significantly increased the odds of obtaining free benefits by insured individuals as compared with the control group. Such an increase was most noticeable for the poorest third of the population. Marginal changes in access to services and the geographically diverse impact of the MIP on service utilization points to other factors affecting health-seeking behaviour of the insured. These other factors include private insurer behaviour that may have used strategies for reducing claims and managing utilization. Equity impact of the MIP and improved financial protection, especially for the poor, are benefits to be retained by government policies when universal health coverage is rolled out nationwide and all citizens will be covered. The role of private insurance companies as financial intermediaries of the publicly funded programme needs further evaluation before moving forward. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2015; all rights reserved.

Use of health services by Brazilian older adults with and without functional limitation

PubMed Central

Silva, Alexandre Moreira de Melo; Mambrini, Juliana Vaz de Melo; Peixoto, Sérgio Viana; Malta, Deborah Carvalho; Lima-Costa, Maria Fernanda

2017-01-01

ABSTRACT OBJECTIVE To analyze the use of health services and the quality of medical care received by Brazilian older adults with and without functional limitation. METHODS The main analyses were based on a national sample representing 23,815 participants of the National Survey on Health (PNS) aged 60 years or older. Functional limitation was defined by the difficulty to perform at least one out of ten basic or instrumental activities of daily living. Potential confounding variables included predisposing and enabling factors of the use of health services. RESULTS The prevalence of functional limitation was 30.1% (95%CI 29.2–31.4). The number of doctor visits and hospitalizations in the past 12 months showed statistically significant associations with functional limitation, both for users of the public system (OR = 2.48 [95%CI 2.13–2.88] for three or more doctor visits and OR = 2.58 [95%CI 2.15–3.09] for one or more hospitalizations) and of the private system (OR = 2.56 [95%CI 1.50–4.36] and OR = 2.22 [95%CI 1.64–3.00], respectively). The propensity to use basic health units was higher among users of the private system with functional limitations (OR = 2.01 [95%CI 1.12–3.59]). Only two out of seven indicators of the quality of medical care received were associated with functional limitation, in the perception of users of public and private systems. The public system users with functional limitations did worse evaluation of the freedom for choosing the doctor and waiting time for an appointment, when compared with users of the same system without these limitations (OR = 0.81 [95%CI 0.67–0.99] and OR = 0.76 [95%CI 0.62–0.93], respectively). CONCLUSIONS Older adults with functional limitations use more health services in comparison with those without such limitations. The magnitude of the association between functional limitation and number of doctor visits and hospitalizations was similar in the public and private health systems. PMID:28591357

Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka.

PubMed

Pallegedara, Asankha; Grimm, Michael

2017-11-01

This paper examines healthcare utilization behaviour in Sri Lanka with special emphasis on the choice between costly private and free public healthcare services. We use a data set that combines nationwide household survey data and district level healthcare supply data. Our findings suggest that even with universal public healthcare policy, richer people tend to use private sector healthcare services rather than public services. We also find significant regional and ethnic discrepancies in healthcare access bearing the risk of social tensions if these are further amplified. Latent class analysis shows in addition that the choice between private and public sector healthcare significantly differs between people with and without chronic diseases. We find in particular that chronically ill people rely for their day-to-day care on the public sector, but for their inpatient care they turn more often than non-chronically ill people to the private sector, implying an additional financial burden for the chronically ill. If the observed trend continues it may not only increase further the health-income gradient in Sri Lanka but also undermine the willingness of the middle class to pay taxes to finance public healthcare. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Forest harvest patterns on private lands in the Cascade Mountains, Washington, USA

USGS Publications Warehouse

Soulard, Christopher E.; Walker, Jessica; Griffith, Glenn E.

2017-01-01

Forests in Washington State generate substantial economic revenue from commercial timber harvesting on private lands. To investigate the rates, causes, and spatial and temporal patterns of forest harvest on private tracts throughout the Cascade Mountains, we relied on a new generation of annual land-use/land-cover (LULC) products created from the application of the Continuous Change Detection and Classification (CCDC) algorithm to Landsat satellite imagery collected from 1985 to 2014. We calculated metrics of landscape pattern using patches of intact and harvested forest in each annual layer to identify changes throughout the time series. Patch dynamics revealed four distinct eras of logging trends that align with prevailing regulations and economic conditions. We used multiple logistic regression to determine the biophysical and anthropogenic factors that influence fine-scale selection of harvest stands in each time period. Results show that private lands forest cover became significantly reduced and more fragmented from 1985 to 2014. Variables linked to parameters of site conditions, location, climate, and vegetation greenness consistently distinguished harvest selection for each distinct era. This study demonstrates the utility of annual LULC data for investigating the underlying factors that influence land cover change.

Evaluation of the apparent losses caused by water meter under-registration in intermittent water supply.

PubMed

Criminisi, A; Fontanazza, C M; Freni, G; Loggia, G La

2009-01-01

Apparent losses are usually caused by water theft, billing errors, or revenue meter under-registration. While the first two causes are directly related to water utility management and may be reduced by improving company procedures, water meter inaccuracies are considered to be the most significant and hardest to quantify. Water meter errors are amplified in networks subjected to water scarcity, where users adopt private storage tanks to cope with the intermittent water supply. The aim of this paper is to analyse the role of two variables influencing the apparent losses: water meter age and the private storage tank effect on meter performance. The study was carried out in Palermo (Italy). The impact of water meter ageing was evaluated in laboratory by testing 180 revenue meters, ranging from 0 to 45 years in age. The effects of the private water tanks were determined via field monitoring of real users and a mathematical model. This study demonstrates that the impact on apparent losses from the meter starting flow rapidly increases with meter age. Private water tanks, usually fed by a float valve, overstate meter under-registration, producing additional apparent losses between 15% and 40% for the users analysed in this study.

Did contracting effect the use of primary health care units in Pakistan?

PubMed

Malik, Muhammad Ashar; Van de Poel, Ellen; Van Doorslaer, Eddy

2017-09-01

For many years, Pakistan has had a wide network of Basic Health Units spread across the country, but their utilization by the population in rural and peri-urban areas has remained low. As of 2004, in an attempt to improve the utilization and performance of these public primary healthcare facilities, the government has gradually started contracting-in intergovernmental organizations to manage these BHUs. Using five nationally representative household surveys conducted between 2001 and 2012, and exploiting the gradual roll-out of this reform to apply a difference-in-difference approach, we evaluate its impact on BHU utilization. We find that contracting of the BHU management did not have any effect on health care use generally in the population, but it did significantly increase the use of BHU for childhood diarrhoea for the poor (by 4% points) and rural (3% points) households. These increases were accompanied by lower rates of self-treatment and private facilities usage. We do not find any significant effects on the self-reported satisfaction with BHU utilization. Our findings contrast with earlier small-scale studies that reported larger effects of the contracting of primary care in Pakistan. We speculate that the modest additional budget, the limited management authority of the contracting agency and the lack of clear performance indicators are reasons for the small impact of the contracting reform. Apparently critical aspects of services delivery such as location of BHUs, ineffective referral system and medical practice variation in public and private sectors have contributed to the overall low utilization of BHUs, yet these were beyond the scope of the contracting reform. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Out-of-pocket expenditure and its determinants in the context of private healthcare sector expansion in sub-Saharan Africa urban cities: evidence from household survey in Ouagadougou, Burkina Faso.

PubMed

Beogo, Idrissa; Huang, Nicole; Gagnon, Marie-Pierre; Amendah, Djesika D

2016-01-21

Conventional wisdom suggests that out-of-pocket (OOP) expenditure reduces healthcare utilization. However, little is known about the expenditure borne in urban settings with the current development of the private health sector in sub-Saharan Africa. In an effort to update knowledge on medical expenditure, this study investigated the level and determinants of OOP among individuals reporting illness or injury in Ouagadougou, Burkina Faso and who either self-treated or received healthcare in either a private or public facility. A cross-sectional study was conducted with a representative sample of 1017 households (5638 individuals) between August and November 2011. Descriptive statistics and multivariate techniques including generalized estimating equations were used to analyze the data. Among the surveyed sample, 29.6% (n = 1666) persons reported a sickness or injury. Public providers were the single most important providers of care (36.3%), whereas private and informal providers (i.e.: self-treatment, traditional healers) accounted for 29.8 and 34.0%, respectively. Almost universally (96%), households paid directly for care OOP. The average expenditure per episode of illness was 8404XOF (17.4USD) (median 3750XOF (7.8USD). The total expenditure was higher for those receiving care in private facilities compared to public ones [14,613.3XOF (30.3USD) vs. 8544.1XOF (17.7USD); p < 0.001], and the insured patients' bill almost tripled uninsured (p < 0.001). Finally, medication was the most expensive component of expenditure in both public and private facilities with a mean of 8022.1XOF (16.7USD) and 12,270.5 (25.5USD), respectively. OOP was the principal payment mechanism of households. A significant difference in OOP was found between public and private provider users. Considering the importance of private healthcare in Burkina Faso, regulatory oversight is necessary. Furthermore, an extensive protection policy to shield households from catastrophic health expenditure is required.

Managing medical and insurance information through a smart-card-based information system.

PubMed

Lambrinoudakis, C; Gritzalis, S

2000-08-01

The continuously increased mobility of patients and doctors, in conjunction with the existence of medical groups consisting of private doctors, general practitioners, hospitals, medical centers, and insurance companies, pose significant difficulties on the management of patients' medical data. Inevitably this affects the quality of the health care services provided. The evolving smart card technology can be utilized for the implementation of a secure portable electronic medical record, carried by the patient herself/himself. In addition to the medical data, insurance information can be stored in the smart card thus facilitating the creation of an "intelligent system" supporting the efficient management of patient's data. In this paper we present the main architectural and functional characteristics of such a system. We also highlight how the security features offered by smart cards can be exploited in order to ensure confidentiality and integrity of the medical data stored in the patient cards.

Gratitude facilitates private conformity: A test of the social alignment hypothesis.

PubMed

Ng, Jomel W X; Tong, Eddie M W; Sim, Dael L Y; Teo, Samantha W Y; Loy, Xingqi; Giesbrecht, Timo

2017-03-01

Past research has established clear support for the prosocial function of gratitude in improving the well-being of others. The present research provides evidence for another hypothesized function of gratitude: the social alignment function, which enhances the tendency of grateful individuals to follow social norms. We tested the social alignment hypothesis of gratitude in 2 studies with large samples. Using 2 different conformity paradigms, participants were subjected to a color judgment task (Experiment 1) and a material consumption task (Experiment 2). They were provided with information showing choices allegedly made by others, but were allowed to state their responses in private. Supporting the social alignment hypothesis, the results showed that induced gratitude increased private conformity. Specifically, participants induced to feel gratitude were more likely to conform to the purportedly popular choice, even if the option was factually incorrect (Experiment 1). This effect appears to be specific to gratitude; induction of joy produced significantly less conformity than gratitude (Experiment 2). We discuss whether the social alignment function provides a behavioral pathway in the role of gratitude in building social relationships. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

[The common issues of health policy in Russia concerning private system].

PubMed

Kasimovskii, K K

2016-01-01

The article considers main principles of national policy specified in the constitution of the Russian Federation and other legislative acts concerning health care of population and development of private health care of Russia. The public policy intends wholeness and unity of national health care system and also state control of its functioning. All official documents and normative legislative acts relate to all sectors of national health care that substantiates unity of public policy. The important emphasis in actual policy is made on development of involvement of private sector in activities related to mandatory health insurance programs and implementation of various forms ofpublic-private partnership in health care. It is pointed out that omnipresent is delay of federal legislation from legislative base of regions, including its vagueness and incompleteness. The principle of self-regulation is described that is more and more implemented in private health care.

Barriers of mistrust: public and private health sectors' perceptions of each other in Madhya Pradesh, India.

PubMed

De Costa, Ayesha; Johansson, Eva; Diwan, Vinod K

2008-06-01

India has one of the most highly privatized health care systems in the world. The dominant private health sector functions alongside a traditional tiered public health sector. There has been an overall lack of collaboration between the two sectors despite international policy recommendations and local initiatives. It has been postulated that "conflicting perceptions" might contribute to the uncooperative attitude between the two sectors. But there has been little empirical exploration of the existing perceptions that the private and public health sectors have of each other. We explored these perceptions among key stakeholders (who influence the direction of health policy) in the public and private health sectors in the province of Madhya Pradesh, India. The barriers of mistrust, which hinder true dialogue, are complex, and have social, moral, and economic bases. They can be best addressed by necessary structural change before any significant long-term partnership between the two sectors is possible.

Scalable privacy-preserving data sharing methodology for genome-wide association studies.

PubMed

Yu, Fei; Fienberg, Stephen E; Slavković, Aleksandra B; Uhler, Caroline

2014-08-01

The protection of privacy of individual-level information in genome-wide association study (GWAS) databases has been a major concern of researchers following the publication of "an attack" on GWAS data by Homer et al. (2008). Traditional statistical methods for confidentiality and privacy protection of statistical databases do not scale well to deal with GWAS data, especially in terms of guarantees regarding protection from linkage to external information. The more recent concept of differential privacy, introduced by the cryptographic community, is an approach that provides a rigorous definition of privacy with meaningful privacy guarantees in the presence of arbitrary external information, although the guarantees may come at a serious price in terms of data utility. Building on such notions, Uhler et al. (2013) proposed new methods to release aggregate GWAS data without compromising an individual's privacy. We extend the methods developed in Uhler et al. (2013) for releasing differentially-private χ(2)-statistics by allowing for arbitrary number of cases and controls, and for releasing differentially-private allelic test statistics. We also provide a new interpretation by assuming the controls' data are known, which is a realistic assumption because some GWAS use publicly available data as controls. We assess the performance of the proposed methods through a risk-utility analysis on a real data set consisting of DNA samples collected by the Wellcome Trust Case Control Consortium and compare the methods with the differentially-private release mechanism proposed by Johnson and Shmatikov (2013). Copyright © 2014 Elsevier Inc. All rights reserved.

Changing patterns of psychiatric inpatient care for children and adolescents in general hospitals, 1988-1995.

PubMed

Pottick, K J; McAlpine, D D; Andelman, R B

2000-08-01

The authors examine patterns in utilization of psychiatric inpatient services by children and adolescents in general hospitals during 1988-1995. National Hospital Discharge Survey data were used to describe utilization patterns for children and adolescents with primary psychiatric diagnoses in general hospitals from 1988 to 1995. During the study period, there was a 36% increase in hospital discharges and a 44% decline in mean length of stay, resulting in a 23% decline in the number of bed-days, from more than 3 million to about 2.5 million. The number of nonpsychotic major depressive disorders increased significantly. Discharges from public hospitals have declined, and those from proprietary hospitals have risen. Concurrently, the role of private insurance declined and the role of Medicaid increased. During the period of study, the mean and median length of stay declined most for children and adolescents who were hospitalized in private facilities and those covered by private insurance. Across the United States, the mean length of stay declined significantly; this decline was almost 60% in the West. Discharges also declined in the West, in contrast to the Midwest and the South, where they significantly increased. Increased numbers of discharges and decreased length of stay may reflect evolving market forces and characteristics of hospitals. Further penetration by managed care into the public insurance system or modifications in existing Medicaid policy could have a profound impact on the availability of inpatient resources.

Assessment of health needs and willingness to utilize health care resources of adolescents in a suburban population.

PubMed

Marks, A; Malizio, J; Hoch, J; Brody, R; Fisher, M

1983-03-01

We investigated whether adolescents living in a middle-class suburb believed that their health needs were being met, and the extent to which they were willing to utilize local health care resources for a range of problems. Self-administered, anonymous questionnaires were completed by 649 students in grades 9 through 12. The mean age of respondents was 15.4 years; 52% were female, and 95% white. They had ready access to medical care: 90% used a specific private physician. From a list of 15 health problems, 60% indicated that they had seen a health provider for at least one of them, most often for stomach pains (22%), headaches (18%), and coughing (16%). From an identical list, 48% indicated that there was at least one problem for which they had never seen a health provider but would like to, most often for a weight problem (14%), birth control (10%), and emotional upset (9%). Although 20% regularly used illegal drugs, 24% were sexually active, and 38% thought they had a weight problem, only 1%, 4%, and 10%, respectively, had sought care for these matters. A majority of students would not choose to go to a private physician for care related to sexuality, substance abuse, or emotional upset, and would not be willing to seek care for these problems with their parents' knowledge. Ready access to private primary care did not assure attention to important health needs among these suburban adolescents.

Direct-to-consumer genetic testing in Slovenia: availability, ethical dilemmas and legislation.

PubMed

Vrecar, Irena; Peterlin, Borut; Teran, Natasa; Lovrecic, Luca

2015-01-01

Over the last few years, many private companies are advertising direct-to-consumer genetic testing (DTC GT), mostly with no or only minor clinical utility and validity of tests and without genetic counselling. International professional community does not approve provision of DTC GT and situation in some EU countries has been analysed already. The aim of our study was to analyse current situation in the field of DTC GT in Slovenia and related legal and ethical issues. Information was retrieved through internet search, performed independently by two authors, structured according to individual private company and the types of offered genetic testing. Five private companies and three Health Insurance Companies offer DTC GT and it is provided without genetic counselling. Available tests include testing for breast cancer, tests with other health-related information (complex diseases, drug responses) and other tests (nutrigenetic, ancestry, paternity). National legislation is currently being developed and Council of Experts in Medical Genetics has issued an opinion about Genetic Testing and Commercialization of Genetic Tests in Slovenia. Despite the fact that Slovenia has signed the Additional protocol to the convention on human rights and biomedicine, concerning genetic testing for health purposes, DTC GT in Slovenia is present and against all international recommendations. There is lack of or no medical supervision, clinical validity and utility of tests and inappropriate genetic testing of minors is available. There is urgent need for regulation of ethical, legal, and social aspects. National legislation on DTC GT is being prepared.

Use of a public-private partnership in malaria elimination efforts in Sri Lanka; a case study.

PubMed

Fernando, Deepika; Wijeyaratne, Pandu; Wickremasinghe, Rajitha; Abeyasinghe, Rabindra R; Galappaththy, Gawrie N L; Wickremasinghe, Renu; Hapugoda, M; Abeywickrema, W A; Rodrigo, Chaturaka

2018-03-23

In special circumstances, establishing public private partnerships for malaria elimination may achieve targets faster than the state sector acting by itself. Following the end of the separatist war in Sri Lanka in 2009, the Anti Malaria Campaign (AMC) of Sri Lanka intensified malaria surveillance jointly with a private sector partner, Tropical and Environmental Diseases and Health Associates Private Limited (TEDHA) with a view to achieving malaria elimination targets by 2014. This is a case study on how public private partnerships can be effectively utilized to achieve malaria elimination goals. TEDHA established 50 Malaria Diagnostic Laboratories and 17 entomology surveillance sentinel sites in consultation with the AMC in areas difficult to access by government officials (five districts in two provinces affected by war). TEDHA screened 994,448 individuals for malaria, of which 243,867 were screened at mobile malaria clinics as compared to 1,102,054 screened by the AMC. Nine malaria positives were diagnosed by TEDHA, while the AMC diagnosed 103 malaria cases in the same districts in parallel. Over 13,000 entomological activity days were completed. Relevant information was shared with AMC and the data recorded in the health information system. A successful public-private partnership model for malaria elimination was initiated at a time when the health system was in disarray in war ravaged areas of Sri Lanka. This ensured a high annual blood examination rate and screening of vulnerable people in receptive areas. These were important for certification of malaria-free status which Sri Lanka eventually received in 2016.

Service functions of private community health stations in China: A comparison analysis with government-sponsored community health stations.

PubMed

Hou, Wanli; Fan, Hong; Xu, Jing; Wang, Fang; Chai, Yun; Xu, Hancheng; Li, Yongbin; Liu, Liqun; Wang, Bin; Jin, Jianqiang; Lu, Zuxun

2012-04-01

In China, with the restructuring of health care system moving forward, private community health facilities have been playing a complementary but increasingly important role in providing public health and basic medical care services in urban areas. However, only limited evidence is available concerning the service functions of private community health facilities in China. The aim of this study was to explore the functions of private community health stations (PCHSs) to provide evidence-based recommendations for policy-making and practice in the development of urban community health services systems. A total of 818 PCHSs and 4320 government-sponsored community health stations (GCHSs) located in 28 cities of China were investigated in 2008. The percentages of stations that provided health services and the annual workload per community health worker (CHW) were compared between the two types of institutions. The results showed that the percentages of PCHSs providing public health services were significantly higher than those of GCHSs (P<0.05); but no significant differences were found in the percentages of basic medical services providing between PCHSs and GCHSs (P>0.05). The annual workloads of all the public health services and basic medical services per CHW in PCHSs were lighter than those in GCHSs (P<0.05), except for resident health records establishment and health education materials distribution (P>0.05). At present, the GCHSs are still the mainstream in urban China, which will last for a long period in future. However, our findings showed that the annual workloads of CHWs in PCHSs were no heavier than those in GCHSs, and the PCHSs were willing to provide public health services. In view of current inadequacy of health resources in China, it is feasible to further develop PCHSs under the guidance of the government, given that PCHSs can perform the basic functions of community health services, which is useful for the formation of public-private partnerships (PPP) and the improvement of community health services.

Differences in the use of outsourcing in public and private institutions providing medical services

PubMed Central

Kowalska, Mariola; Religioni, Urszula

2014-01-01

Introduction The costs of health care in Poland are continuously increasing. Thus, almost every institution providing medical services aims at their limitation. One of the costs rationalisation methods in the health care sector is outsourcing. Material and methods The study was conducted in 153 randomly selected institutions providing medical activities. The tool was a questionnaire, available via a web browser. Results Over 30% of public institutions identified the need for financial savings, as the main reason for outsourcing the cleaning function. Among private institutions, the dominant reason for this is too high maintenance cost of the cleaning staff (less than 40% of responses). The huge number of medical institutions use the services of an external company for laundering. Over 30% of public institutions identified as the most common reason for separation of functions laundering lack of resources to upgrade and modernize facilities. Less than 27% of public institutions indicate too high costs of kitchen staff as the main reason for ordering function of feeding. Another reason is the need for financial savings (22% response rate). Some institutions indicate a desire to focus on key areas (20% of responses) and lack of financial resources to upgrade and modernize the kitchen (20% response rate). Public and private institutions exercise control over the quality and method performed by an external service (71% of public institutions and 59% of private institutions). Private institutions often informally exercise external control (difference confirmed – Fisher's exact test). Less than 90% of public institutions indicated satisfaction with the services provided by external companies. Conclusions The adaptation of outsourcing in medical facilities leads to financial efficiency improvement. Through the separation of some medical functions and entrusting their realisation to external companies, medical institutions can focus on their basic activity that is the provision of health services. PMID:25097595

Error recovery in shared memory multiprocessors using private caches

NASA Technical Reports Server (NTRS)

Wu, Kun-Lung; Fuchs, W. Kent; Patel, Janak H.

1990-01-01

The problem of recovering from processor transient faults in shared memory multiprocesses systems is examined. A user-transparent checkpointing and recovery scheme using private caches is presented. Processes can recover from errors due to faulty processors by restarting from the checkpointed computation state. Implementation techniques using checkpoint identifiers and recovery stacks are examined as a means of reducing performance degradation in processor utilization during normal execution. This cache-based checkpointing technique prevents rollback propagation, provides rapid recovery, and can be integrated into standard cache coherence protocols. An analytical model is used to estimate the relative performance of the scheme during normal execution. Extensions to take error latency into account are presented.

The use of reproductive healthcare at commune health stations in a changing health system in Vietnam

PubMed Central

2011-01-01

Background With health sector reform in Vietnam moving towards greater pluralism, commune health stations (CHSs) have been subject to growing competition from private health services and increasing numbers of patients bypassing CHSs for higher-level health facilities. This study describes the pattern of reproductive health (RH) and family planning (FP) service utilization among women at CHSs and other health facilities, and explores socio-demographic determinants of RH service utilization at the CHS level. Methods This study was based on a cross-sectional survey conducted in Thua Thien Hue and Vinh Long provinces, using a multi-stage cluster sampling technique. Questionnaire-based interviews with 978 ever-married women at reproductive age provided data on socio-demographic characteristics, current use of FP methods, history of RH service use, and the health facility attended for their most recent services. Multiple logistic regression analyses were used to identify socio-demographic determinants of their use of CHS RH services. Results Eighty nine percent of ever-married women reported current use of birth control with 49% choosing intra-uterine device (IUD). Eighty nine percent of pregnant women attended facility-based antenatal care (ANC) with 62% having at least 3 check-ups during their latest pregnancy. Ninety one percent of mothers had their last delivery in a health facility. Seventy-one percent of respondents used CHS for IUD insertion, 55% for antenatal check-ups, and 77% gynecological examination. District and provincial/central hospitals dominated the provision of delivery service, used by 57% of mothers for their latest delivery. The percentage of women opting for private ANC services was reported at 35%, though the use of private delivery services was low (11%). Women who were farmers, earning a lower income, having more than 2 children, and living in a rural area were more likely than others to use ANC, delivery, and/or gynecological check-up services at the CHS. Conclusions Women choice of providers for FP and RH services that help them plan and protect their pregnancies is driven by socio-economic factors. While the CHS retains significant utilization rates, it is under challenge by preferences for hospital-based delivery and the growing use of private ANC services. PMID:21943073

Higher Education: The Online Teaching and Learning Experience

ERIC Educational Resources Information Center

Barr, Betty A.; Miller, Sonya F.

2013-01-01

Globally, higher education, as well as K-12, utilizes online teaching to ensure that a wide array of learning opportunities are available for students in a highly competitive technological arena. The most significant influence in education in recent years is the increase and recognition of private for-profit adult distance and online education…

Personal travel : the long and short of it : issues involved in analysis using the NPTS and the ATS

DOT National Transportation Integrated Search

1996-05-01

A study was conducted of the availability and need for truck parking at public rest areas and private truck stops along the Interstate highway system. The goal of the study was to assess the supply, utilization, parking statutes and practices, and de...

Dueling Scorecards: How Two Colleges Utilize the Popular Planning Method

ERIC Educational Resources Information Center

Ballentine, Howard; Eckles, Jay

2009-01-01

The Balanced Scorecard is a planning model used extensively in business to provide direction and accountability to an organization. Despite the demonstrated success of the model, it has not been widely used in higher education. This article compares and contrasts the use of the Balanced Scorecard by two small, private colleges. The article…

7 CFR Exhibit C to Subpart G of... - Implementation Procedures for the Farmland Protection Policy Act; Executive Order 11988...

Code of Federal Regulations, 2011 CFR

2011-01-01

... Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE (CONTINUED) PROGRAM... government, and private programs and policies to protect farmland. The Soil Conservation Service (SCS), as...

Design for a Study of American Youth.

ERIC Educational Resources Information Center

Flanagan, John C.; And Others

Project TALENT is a large-scale, long-range educational research effort aimed at developing methods for the identification, development, and utilization of human talents, which has involved some 440,000 students in 1,353 public, private, and parochial secondary schools in all parts of the country. Data collected through teacher-administered tests,…

ResStock Analysis Tool | Buildings | NREL

Science.gov Websites

Energy and Cost Savings for U.S. Homes Contact Eric Wilson to learn how ResStock can benefit your approach to large-scale residential energy analysis by combining: Large public and private data sources uncovered $49 billion in potential annual utility bill savings through cost-effective energy efficiency

Educational Foundations--Alternative Development Strategies: Insurance for a Solvent Community College System.

ERIC Educational Resources Information Center

Luck, Michael F.

Educational foundations for raising and allocating private funds have a legitimate place in the community college. They allow a college to chart its growth, anticipate emergencies, and meet the needs of all sectors of the institution. Foundations must utilize an active development program for planning and executing a conscious, continuous effort…

Utilizing Independent Colleges and Universities to Fulfill States' College Degree Attainment Goals

ERIC Educational Resources Information Center

Zumeta, William; Huntington-Klein, Nick

2017-01-01

America's diverse higher education landscape includes more than 700 four-year nonprofit colleges and universities that focus on baccalaureate education. These private nondoctoral (PND) institutions are located in almost every state and collectively enroll about 1.6 million students and award nearly 150,000 degrees annually, with the majority of…

SUNY Contracts for Cogeneration.

ERIC Educational Resources Information Center

Freeman, Laurie

1996-01-01

The State University of New York-Stony Brook forged a public-private partnership to fund a new plan for cogeneration, a two-step process that uses one fuel source--natural gas--to make two forms of energy. The agreement is designed to free the university from the need to make ongoing capital investment in its utility infrastructure. (MLF)

Gender Gap in Returns to Schooling in Palestine

ERIC Educational Resources Information Center

Daoud, Yousef

2005-01-01

This study provides estimates of the private returns to schooling in Palestine utilizing eight quarterly labor force surveys for 1999 and 2001. This period was chosen to investigate the differential impact of the Israeli closure policy on Palestinian male and female workers. Although gross enrollment ratios for males and females reveal little to…

78 FR 57651 - Habitat Conservation Plan for the Community of Los Osos, San Luis Obispo County, CA; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-19

..., management, maintenance, and monitoring of conservation lands used to mitigate the effects of the other.... The LOHCP is a comprehensive plan designed to provide long-term conservation and management of... Maintenance: Public and private utility company activities to operate and maintain, including repair and...

3D engineered fiberboard : a new structural building product

Treesearch

John F. Hunt; Jerrold E. Winandy

2002-01-01

To help meet the need for sustainable forest management tools, the USDA Forest Products Laboratory is developing an economically viable process to produce three-dimensional structural fibreboard products that can utilize a wide range of lignocellulosic fibres contained in the forest undergrowth and in underutilized timber. This will encourage the public and private...

Understanding Customer Product Choices: A Case Study Using the Analytical Hierarchy Process

Treesearch

Robert L. Smith; Robert J. Bush; Daniel L. Schmoldt

1996-01-01

The Analytical Hierarchy Process (AHP) was used to characterize the bridge material selection decisions of highway officials across the United States. Understanding product choices by utilizing the AHP allowed us to develop strategies for increasing the use of timber in bridge construction. State Department of Transportation engineers, private consulting engineers, and...

Islamic Education in a Multicultural Society: The Case of a Muslim School in Canada

ERIC Educational Resources Information Center

Ali, Faisal Mohamed; Bagley, Carl

2015-01-01

The case study explores the ways in which a prominent, private Canadian Muslim school provides an Islamic education while negotiating its place in an integrated, socially cohesive, multicultural society. The data are derived from an in-depth qualitative investigation utilizing documentary analysis, participant observation, and interviews (N = 22).…

42 CFR 431.55 - Waiver of other Medicaid requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... restrictions on free choice of providers do not apply to family planning services. (3) No waiver under this..., or State. (2) A locality may use any agency or agent, public or private, profit or nonprofit, to act..., utilization review, medical social services, or administrative services. (B) Any entity described in paragraph...

Pricing Policy and the College Choice Process. AIR Forum Paper 1978.

ERIC Educational Resources Information Center

Chapman, Randall G.

A presentation of a conceptual framework for viewing the admissions management process in higher education institutions and a discussion of the pricing policy process, particularly of private colleges and universities, precedes an examination of the stochastic utility model, a statistical model of the college choice process. Using student choice…

Space Station commercial user development

NASA Technical Reports Server (NTRS)

1984-01-01

The commercial utilization of the space station is investigated. The interest of nonaerospace firms in the use of the space station is determined. The user requirements are compared to the space station's capabilities and a feasibility analysis of a commercial firm acting as an intermediary between NASA and the private sector to reduce costs is presented.

A Causal Model of Teacher Acceptance of Technology

ERIC Educational Resources Information Center

Chang, Jui-Ling; Lieu, Pang-Tien; Liang, Jung-Hui; Liu, Hsiang-Te; Wong, Seng-lee

2012-01-01

This study proposes a causal model for investigating teacher acceptance of technology. We received 258 effective replies from teachers at public and private universities in Taiwan. A questionnaire survey was utilized to test the proposed model. The Lisrel was applied to test the proposed hypotheses. The result shows that computer self-efficacy has…

Technology survey of computer software as applicable to the MIUS project

NASA Technical Reports Server (NTRS)

Fulbright, B. E.

1975-01-01

Existing computer software, available from either governmental or private sources, applicable to modular integrated utility system program simulation is surveyed. Several programs and subprograms are described to provide a consolidated reference, and a bibliography is included. The report covers the two broad areas of design simulation and system simulation.

The Effectiveness and Feasibility of a TRISNET Regional Center in Information Transfer. Final Report.

ERIC Educational Resources Information Center

Rath, Gustave J.; And Others

A study was conducted to assess the feasibility of establishing a regional information transfer center within the context of the National Network of Transportation Research Information Services (TRISNET). The principle areas of investigation were: (1) the transportation information needs of the public and private sectors; (2) the utility of…

Application of Small-Scale Systems: Evaluation of Alternatives

Treesearch

John Wilhoit; Robert Rummer

1999-01-01

Large-scale mechanized systems are not well-suited for harvesting smaller tracts of privately owned forest land. New alternative small-scale harvesting systems are needed which utilize mechanized felling, have a low capital investment requirement, are small in physical size, and are based primarily on adaptations of current harvesting technology. This paper presents...

Tracking Community College Transfers Using National Student Clearinghouse Data.

ERIC Educational Resources Information Center

Romano, Richard M.; Wisniewski, Martin

This study shows how community colleges can track almost all of their own students who transfer into both public and private colleges and across state lines using the National Student Clearinghouse (NSC) database. It utilizes data from the student information systems of Broome Community College, New York; Cayuga Community College, New York; the…

Integrating livestock production and wildlife in a sagebrush-grass ecosystem

Treesearch

Michael L. Wolfe; Gregg E. Simonds; Rick Danvir; William J. Hopkin

1996-01-01

Management of a 775-km2, privately-owned ranch in northeastern Utah exemplifies a progressive approach to utilizing domestic livestock and wild ungulates, elk (Cervus elaphus), mule deer (Odocoileus hemionus), and pronghorn (Antilocapra americana), for economic return while maintaining or enhancing land health. The management program on the Deseret Ranch includes the...

24 CFR 882.405 - Financing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Financing. 882.405 Section 882.405... § 882.405 Financing. (a) Types. Any type of public or private financing may be utilized with the... Contract as security for financing. An Owner may pledge, or offer as security for any loan or obligation...

Using Classic Literature To Reduce Violence and Aggression in Emotionally Handicapped Adolescents.

ERIC Educational Resources Information Center

Reganick, Karol A.

A 12-week program was developed and implemented with the purpose of utilizing classical literature to encourage prosocial skills in eight students, with aggressive and violent behaviors, residing in a private residential treatment center. The program was initiated in response to the increasingly high numbers of student attacks on mental health…

Regional variation in post-stroke multidisciplinary rehabilitation care among veteran residents in community nursing homes.

PubMed

Jia, Huanguang; Pei, Qinglin; Sullivan, Charles T; Cowper Ripley, Diane C; Wu, Samuel S; Vogel, W Bruce; Wang, Xinping; Bidelspach, Douglas E; Hale-Gallardo, Jennifer L; Bates, Barbara E

2017-01-01

Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors' functional recovery and daily living activities. The US Department of Veterans Affairs (VA) places veterans needing post-acute institutional care in private community nursing homes (CNHs). These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans' health services as well as the geographic variation of the service utilization. The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care. This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents) for the study CNHs was linked with veterans' inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation therapy and restorative nursing care utilization by veterans during their CNH stays. The study comprised 6,206 veterans at 2,511 CNHs. Rates for utilization of rehabilitation therapy and restorative nursing care were 75.7% and 30.1%, respectively. Veterans in North Atlantic and Southeast CNHs were significantly ( p <0.001) more likely to receive rehabilitation therapies than veterans from other regions. However, veterans in Southeast CNHs were significantly ( p <0.001) less likely to receive restorative nursing care compared with veterans in all other regions, before and after risk adjustment. The majority of veterans with stroke received rehabilitation therapy, and about one-third had restorative nursing care during their stay at VA-contracted CNHs. Significant regional variations in weekly days for rehabilitation therapy and restorative nursing care utilization were observed even after adjusting for potential risk factors.

Psychiatric Morbidity and Social Functioning among Adults with Borderline Intelligence Living in Private Households

ERIC Educational Resources Information Center

Hassiotis, A.; Strydom, A.; Hall, I.; Ali, A.; Lawrence-Smith, G.; Meltzer, H.; Head, J; Bebbington, P.

2008-01-01

Background: Approximately one-eighth of the population will have DSM-IV borderline intelligence. Various mental disorders and social disability are associated with it. Method: The paper uses data (secondary analysis) from a UK-wide cross-sectional survey of 8450 adults living in private households. Data were collected on psychiatric disorders,…

The Personal as Political: The Function of the Private Space in Contextualizing the "Other" in Jewish-Palestinian Encounters

ERIC Educational Resources Information Center

Markovich, Dalya Yafa

2015-01-01

The private/personal sphere is perceived to be a channel of empowerment that fosters processes of acknowledgment and recognition during encounters between participants from different cultural groups. Drawing on ethnographic research at an inter-cultural program that offered a space for engagement for Palestinian and Jewish educational trainees',…

Student Tuition Models in Private and Public Higher Education.

ERIC Educational Resources Information Center

Weathersby, George B.

This paper presents a mathematical model for use in determining student tuition charges at public and private institutions. This model treats higher education as an economic commodity, with the price to the consumer--in the form of tuition--as an algebraic function of supply, demand, and quality. The model provides one set of solutions to such…

The Neglected Educative Function of Public Space on Preadolescent Development

ERIC Educational Resources Information Center

Giardiello, Mauro

2017-01-01

The crisis of public spaces implies a closure to the private sphere and, as a consequence, the inanity of the education processes. Space privatization involves the supremacy of the "?????" (house) on the "a???a" (public space), so that the house assumes the role of an enclosed community. The effect of this closure is a…

Control of power: the political economy of electric-utility development in the US

DOE Office of Scientific and Technical Information (OSTI.GOV)

McGuire, P.W.

1986-01-01

This work examines the processes by which the dominant relations of production are reproduced and the dominant social order maintained amidst the conflicts and contradictions of capitalism. The specific subject of analysis is the changing relationships and dynamics of the various electric utility firms and associated organizations. The development of the industry is traced from the initial development of commodifiable electric devices through regulation, consolidation, and the Great Crash. The work relies on secondary sources drawn from numerous disciplines, government agencies, industry sources, and the accounts of central social actors. This consideration of the early history of an industry whichmore » is such a crucial underpinning of 20th century economic development, provides a springboard for reevaluation of the prevailing instrumental and structural theories of social-economic control and change. There are 4 basic concerns in each time frame: (1) competition among privately-owned firms; (2) competition between privately - and publicly-owned firms; (3) interactions between industry and political agencies; and (4) interactions between industry and economic institutions.« less

[Prescribed and reported drug use during pregnancy].

PubMed

Osorio-de-Castro, Claudia Garcia Serpa; Pepe, Vera Lucia Edais; Luiza, Vera Lucia; Cosendey, Marly Aparecida Elias; Freitas, Aline Matias de; Miranda, Frederico Fonseca; Bermudez, Jorge Antonio Zepeda; Leal, Maria do Carmo

2004-01-01

Few studies describe drug utilization in pregnancy focusing on prescribing practices. This study is part of a larger survey on perinatal care in the City of Rio de Janeiro, Brazil. The type of hospital (public, contracted out by the Unified National Health System, or private) determined the stratification of 10,072 hospitalized post-partum women, who were asked about medication used during pregnancy. Hospital records supplied information on drugs prescribed during labor. Drugs were classified according to the Anatomical Therapeutic Chemical (ATC) system. Another system was used for specific cases of referred use. A mean of 2.08 drugs was prescribed during labor, and a mean of 2.3 was reported during pregnancy. Anesthetics, antibiotics, oxytocin, and analgesics were the most frequently prescribed during labor, with significant differences between strata. Ferrous sulfate, vitamins, scopolamine, and acetaminophen were the main drugs reported during pregnancy. Women who had attempted abortion referred use of various kinds of tea (49.7%) and misoprostol (9.2%). The drug utilization pattern was consistent with the literature. This study offers knowledge on prescribing patterns during labor and self-reported use during pregnancy in both the public and private sectors.

The Process of Privatization of Health Care Provision in Poland.

PubMed

Kaczmarek, Krzysztof; Flynn, Hannah; Letka-Paralusz, Edyta; Krajewski-Siuda, Krzysztof; Gericke, Christian A

In January 1999, a new institutional structure for Poland's health care system was laid out, instigated by the dramatic change in both the political and economic system. Following the dissolution of state socialism, private financing of health care services was encouraged to fill an important role in meeting rising consumer demand and to encourage a more efficient use of resources through competition and private initiative. However, from the outset of the intended transformations, systemic limitations to the privatization process hindered progression, resulting in varying rates of privatization amongst the distinct health care sectors. The aim of this paper is to describe the privatization process and to analyze its pace and differences in strategic approach in all major health care sectors. Policy analysis of legislation, government directives, and published national and international scientific literature on Polish health reforms between 1999 and 2012 was conducted. The analysis demonstrates a clear disparity in privatization rates in different sectors. The pharmaceutical industry is fully privatized in 2012, and the ambulatory and dental sectors both systematically increased their private market shares to around 70% of all services provided. However, despite a steady increase in the number of private hospitals in Poland since 1999, their overall role in the health care system is comparatively limited. Unclear legal regulations have resulted in a gray area between public and private health care, where informal payments impede the intended function of the system. If left unchanged, official health care in Poland is likely to become an increasingly residual service for the worst-off population segments that are unable to afford the legal private sector or the informal payments which guarantee a higher quality service in the public sector. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

Medical resource utilization and costs associated with autosomal dominant polycystic kidney disease in the USA: a retrospective matched cohort analysis of private insurer data

PubMed Central

Knight, Tyler; Schaefer, Caroline; Krasa, Holly; Oberdhan, Dorothee; Chapman, Arlene; Perrone, Ronald D

2015-01-01

Background Autosomal dominant polycystic kidney disease (ADPKD) results in kidney cyst development and enlargement, resulting in chronic kidney disease (CKD) leading to renal failure. This study sought to determine if ADPKD patients in the early stages of CKD contribute to a sizable economic burden for the US health care system. Methods This was a retrospective, matched cohort study, reviewing medical resource utilization (MRU) and costs for adults in a US private-payer claims database with a diagnosis code of ADPKD (ICD-9-CM 753.13). ADPKD patients were matched by age grouping (0–17, 18–34, 35–44, 45–54, 55–64, and 65+ years) and sex to controls to understand the burden of ADPKD. Descriptive statistics on 6-month MRU and costs were assessed by CKD stages, dialysis use, or previous renal transplant. Results The analysis included ADPKD patients in CKD stages 1–5 (n=316 to n=860), dialysis (n=586), and post-transplant (n=615). Mean ages did not differ across CKD stages (range 43–56 years). Men were the majority in the later stages but the minority in the early stages. The proportion of patients with at least one hospitalization increased with CKD stage, (12% to >40% CKD stage 2 to stage 5, dialysis or post-transplant). The majority had at least one hospital outpatient visit and at least one pharmacy claim. Total 6-month per-patient costs were greater among ADPKD patients than in age-matched and sex-matched healthy non-ADPKD controls (P<0.001 for all comparisons). Conclusion ADPKD patients with normal kidney function are associated with a significant economic burden to the health care system relative to the general population. Any treatments that delay progression to later stages of CKD may provide potential health care cost offsets. PMID:25759590

The determinants of health care expenditure toward the end of life: evidence from Taiwan.

PubMed

Chang, Simon; He, Yang; Hsieh, Chee-Ruey

2014-08-01

This paper empirically investigates the relationship between the health care expenditure of end-of-life patients and hospital characteristics in Taiwan where (i) hospitals of different ownership differ in their financial incentives; (ii) patients are free to choose their providers; and (iii) health care services are paid for by a single public payer on a fee-for-services basis with a global budget cap. Utilizing insurance claims for 11 863 individuals who died during 2005-2007, we trace their hospital expenditures over the last 24 months of their lives. We find that end-of-life patients who are treated by private hospitals in general are associated with higher inpatient expenditures than those treated by public hospitals, while there is no significant difference in days of hospital stay. This finding is consistent with the difference in financial incentives between public and private hospitals in Taiwan. Nevertheless, we also find that the public-private differences vary across accreditation levels. Copyright © 2013 John Wiley & Sons, Ltd.

[On the issues of private-public partnership in health care: the case of organization of optometric service)].

PubMed

2011-01-01

The article deals with the issue of private-public partnership in health care. It is demonstrated that in many countries health care system condition is characterized by increase of problems in organization, financing and provision of medical sanitary care. The exponent up growth of aggregate costs of health care, medical services financing occurs. The system of public and municipal health care has no adequate resources to efficiently function without interaction with private organizations. The reason is that most of the suppliers of medical services are not public or municipal belonging. It is necessary to provide inter-financing of curative preventive care at the expense of funds of public and private economic sectors within a framework of full-scale implementation health care the mechanisms of private-public partnership. The studies in this field are to be organized on the example of organizational specificity of optometric service which is positioned concurrently in public and private sectors. This approach makes it possible to reveal feasible ways of implementation of the private-public partnership institution to enhance quality and accessibility of medical care to population in the conditions of concurrent model of health care and globalization challenges.

Neural correlates of informational cascades: brain mechanisms of social influence on belief updating

PubMed Central

Klucharev, Vasily; Rieskamp, Jörg

2015-01-01

Informational cascades can occur when rationally acting individuals decide independently of their private information and follow the decisions of preceding decision-makers. In the process of updating beliefs, differences in the weighting of private and publicly available social information may modulate the probability that a cascade starts in a decisive way. By using functional magnetic resonance imaging, we examined neural activity while participants updated their beliefs based on the decisions of two fictitious stock market traders and their own private information, which led to a final decision of buying one of two stocks. Computational modeling of the behavioral data showed that a majority of participants overweighted private information. Overweighting was negatively correlated with the probability of starting an informational cascade in trials especially prone to conformity. Belief updating by private information was related to activity in the inferior frontal gyrus/anterior insula, the dorsolateral prefrontal cortex and the parietal cortex; the more a participant overweighted private information, the higher the activity in the inferior frontal gyrus/anterior insula and the lower in the parietal-temporal cortex. This study explores the neural correlates of overweighting of private information, which underlies the tendency to start an informational cascade. PMID:24974396

District decision-making for health in low-income settings: a qualitative study in Uttar Pradesh, India, on engaging the private health sector in sharing health-related data.

PubMed

Gautham, Meenakshi; Spicer, Neil; Subharwal, Manish; Gupta, Sanjay; Srivastava, Aradhana; Bhattacharyya, Sanghita; Avan, Bilal Iqbal; Schellenberg, Joanna

2016-09-01

Health information systems are an important planning and monitoring tool for public health services, but may lack information from the private health sector. In this fourth article in a series on district decision-making for health, we assessed the extent of maternal, newborn and child health (MNCH)-related data sharing between the private and public sectors in two districts of Uttar Pradesh, India; analysed barriers to data sharing; and identified key inputs required for data sharing. Between March 2013 and August 2014, we conducted 74 key informant interviews at national, state and district levels. Respondents were stakeholders from national, state and district health departments, professional associations, non-governmental programmes and private commercial health facilities with 3-200 beds. Qualitative data were analysed using a framework based on a priori and emerging themes. Private facilities registered for ultrasounds and abortions submitted standardized records on these services, which is compulsory under Indian laws. Data sharing for other services was weak, but most facilities maintained basic records related to institutional deliveries and newborns. Public health facilities in blocks collected these data from a few private facilities using different methods. The major barriers to data sharing included the public sector's non-standardized data collection and utilization systems for MNCH and lack of communication and follow up with private facilities. Private facilities feared information disclosure and the additional burden of reporting, but were willing to share data if asked officially, provided the process was simple and they were assured of confidentiality. Unregistered facilities, managed by providers without a biomedical qualification, also conducted institutional deliveries, but were outside any reporting loops. Our findings suggest that even without legislation, the public sector could set up an effective MNCH data sharing strategy with private registered facilities by developing a standardized and simple system with consistent communication and follow up. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

A comparison of private and public sector intensive care unit infrastructure in South Africa.

PubMed

Mahomed, S; Sturm, A W; Moodley, P

2017-11-27

Intensive care units (ICUs) are designed to care for patients who are often at increased risk of acquiring healthcare-associated infections. The structure of ICUs should be optimally designed to facilitate the care of these critically ill patients, and minimise their risk of infection. National regulations (R158) were developed to govern the building and registration of private hospitals, and until recently equivalent regulations were not available for public hospitals. To assess and compare the compliance of ICUs in the private and public sectors with the R158 regulations. A cross-sectional study design was used to assess the infrastructure of 25 private sector and 6 public sector ICUs in eThekwini Health District, KwaZulu-Natal Province, South Africa. We used the R158 checklist, which was developed by the KwaZulu-Natal Department of Health Private Licensing Unit and Infection Prevention and Control Unit. The aspects covered in the R158 checklist were categorised into the design, general safety and patient services of the ICUs. Most of the ICUs in both sectors met the general safety requirements. There were varying levels of compliance with the design criteria. Only 7 (28.0%) and 1 (16.7%) of the private and public ICUs, respectively, had sufficient space around the beds. Twenty-two private ICUs (88.0%) and 4 public ICUs (66.7%) had isolation rooms, but only some of these isolation rooms (15 private and 2 public) had appropriate mechanical ventilation. None of the ICUs had clinical hand-wash basins in the nurse stations and dirty utility rooms. The majority of the ICUs had the required number of oxygen and electric outlets at the bedside. None of the public ICUs met the light intensity requirement over the bed area. Adequate spacing in ICUs is an issue in many cases. Interventions need to be put in place to ensure that ICUs meet the relevant design standards. There is an urgent need to revise the R158 regulations to reflect current best practices, particularly with regard to infection control. The same standards should be applied to ICUs in the private and public health sectors to maintain quality of care to patients.

The role and uptake of private health insurance in different health care systems: are there lessons for developing countries?

PubMed

Odeyemi, Isaac Ao; Nixon, John

2013-01-01

Social and national health insurance schemes are being introduced in many developing countries in moving towards universal health care. However, gaps in coverage are common and can only be met by out-of-pocket payments, general taxation, or private health insurance (PHI). This study provides an overview of PHI in different health care systems and discusses factors that affect its uptake and equity. A representative sample of countries was identified (United States, United Kingdom, The Netherlands, France, Australia, and Latvia) that illustrates the principal forms and roles of PHI. Literature describing each country's health care system was used to summarize how PHI is utilized and the factors that affect its uptake and equity. In the United States, PHI is a primary source of funding in conjunction with tax-based programs to support vulnerable groups; in the UK and Latvia, PHI is used in a supplementary role to universal tax-based systems; in France and Latvia, complementary PHI is utilized to cover gaps in public funding; in The Netherlands, PHI is supplementary to statutory private and social health insurance; in Australia, the government incentivizes the uptake of complementary PHI through tax rebates and penalties. The uptake of PHI is influenced by age, income, education, health care system typology, and the incentives or disincentives applied by governments. The effect on equity can either be positive or negative depending on the type of PHI adopted and its role within the wider health care system. PHI has many manifestations depending on the type of health care system used and its role within that system. This study has illustrated its common applications and the factors that affect its uptake and equity in different health care systems. The results are anticipated to be helpful in informing how developing countries may utilize PHI to meet the aim of achieving universal health care.

Changes in health care inequity in Brazil between 2008 and 2013.

PubMed

Mullachery, Pricila; Silver, Diana; Macinko, James

2016-11-17

Brazil has made progress towards a more equitable distribution of health care, but gains may be threatened by economic instability resulting from the 2008 global financial crisis. This study measured predictors of health care utilization and changes in horizontal inequity between 2008 and 2013. Data were from two nationally representative surveys that measured a variety of sociodemographic, health behaviors and health care indicators. We used Poisson regression models to estimate adjusted prevalence ratios and the Horizontal Equity Index (HEI) standardized by health needs to measure inequity in the utilization of doctor and dentist visits, hospitalizations and reporting of a usual source of care (USC) for those 18 and older. To estimate the HEI, we ranked the population from the poorest to the richest using a wealth index. We also decomposed the HEI into its different components and assessed changes from 2008 to 2013. The population proportion with doctor and dentist visits in the past year and a USC increased between 2008 and 2013, while hospitalizations declined. In 2013, pro-rich inequity in doctor visits increased significantly while the distribution of hospitalizations shifted from pro-rich in 2008 to neutral in 2013. Dentist visits were highly pro-rich and USC was slightly pro-rich; the distribution of dentist visits and USC did not change over time. Health need was a strong predictor of health care utilization regardless of the type of coverage (public or private). Education, wealth, and private health plans were associated with the pro-rich orientation of doctor and dentist visits. Private health plans contributed to the pro-rich orientation of all outcomes, while the Family Health Strategy contributed to the pro-poor orientation of all outcomes. The results of this study support the claim that Brazil's population continued to see absolute gains in access to care despite recent economic crises. However, gains in equity have slowed and may even decline if investments are not maintained as the country enters deeper financial and political crises.

Racial, Ethnic, and Gender Disparities in Health Care Access and Use Among U.S. Adults With Serious Psychological Distress.

PubMed

Weissman, Judith; Russell, David; Jay, Melanie; Malaspina, Dolores

2018-05-01

This study compared health care access and utilization among adults with serious psychological distress by race-ethnicity and gender in years surrounding implementation of the Affordable Care Act. Data for adults ages 18 to 64 with serious psychological distress in the 2006-2015 National Health Interview Survey (N=8,940) were analyzed by race-ethnicity and gender on access and utilization indicators: health insurance coverage, insufficient money to buy medications, delay in health care, insufficient money for health care, visited a doctor more than ten times in the past 12 months, change in place of health care, change in place of health care because of insurance, saw a mental health provider in the past 12 months, and insufficient money for mental health care. The proportions of white and black adults with serious psychological distress were largest in the South, the region with the largest proportion of persons with serious psychological distress and no health coverage. Multivariate models that adjusted for health coverage, sociodemographic characteristics, health conditions, region, and year indicated that whites were more likely than blacks to report insufficient money for medications and mental health care and delays in care. A greater proportion of whites used private coverage, compared with blacks and Hispanics, and blacks were more likely than all other racial-ethnic groups to have Medicaid. More research is needed on health care utilization among adults with serious psychological distress. In this group, whites and those with private coverage reported poor utilization, compared with other racial-ethnic groups and those with Medicaid, respectively.

A cross-sectional review of the prevalence of integrative medicine in pediatric pain clinics across the United States.

PubMed

Bodner, Kristen; D'Amico, Salvatore; Luo, Man; Sommers, Elizabeth; Goldstein, Laura; Neri, Caitlin; Gardiner, Paula

2018-06-01

This project assesses the prevalence of integrative medicine (IM) in pediatric pain clinics (PPCs) across the United States. PPCs were identified through the American Pain Society and cross referenced through the International Association for the Study of Pain (IASP). A cross-sectional review using each PPC's website was then utilized for further information. We collected data regarding each program's target population, non-profit status (where non-profits were designated as hospitals that do not operate for-profit purpose, and private as institutions receiving private funding), location, services provided and participating providers. Descriptive statistics were used for data analysis. Of the 53 PPCs identified, 43 (81%) were part of a non-profit healthcare organization, and 10 (19%) were within a private hospital; 85% were located in urban settings, 15% in rural settings; 83% were located in free-standing children's hospitals. Thirty-two (60%) PPCs utilized IM, including acupuncture (38%), mind-body (21%), massage (21%), aromatherapy (19%), nutrition counseling (17%) and/or art/music therapy (11%). The most prevalent providers within PPCs offering IM were yoga instructors (84%), nutritionists (56%) and mind-body specialists (44%). IM was offered in 63% of programs in non-profit organizations and 50% in private hospitals; 58% of urban sites and 75% of rural sites. Within each region, 91% (n = 10) of PPCs in the West offer IM, 53% of PPCs in the Midwest (n = 10) and Northeast (n = 8) offer IM and 50% (n = 4) of PPCs in the South offer IM compared to PPCs who do not. Of 53 current identified PPCs, over half offer IM services. While children in the US are more likely to find a PPC offering IM services, access to do so is more limited in rural and southern regions. Published by Elsevier Ltd.

PRIVATE SECTOR IN HEALTH CARE DELIVERY: A REALITY AND A CHALLENGE IN PAKISTAN.

PubMed

Shaikh, Babar Tasneem

2015-01-01

Under performance of the public sector health care system in Pakistan has created a room for private sector to grow and become popular in health service delivery, despite its questionable quality, high cost and dubious ethics of medical practice. Private sector is no doubt a reality; and is functioning to plug many weaknesses and gaps in health care delivery to the poor people of Pakistan. Yet, it is largely unregulated and unchecked due to the absence of writ of the state. In spite of its inherent trait of profit making, the private sector has played a significant and innovative role both in preventive and curative service provision. Private sector has demonstrated great deal of responsiveness, hence creating a relation of trust with the consumers of health in Pakistan, majority of who spend out of their pocket to buy 'health'. There is definitely a potential to engage and involve private and non-state entities in the health care system building their capacities and instituting regulatory frameworks, to protect the poor's access to health care system.

Patient Smartphone Ownership and Interest in Mobile Apps to Monitor Symptoms of Mental Health Conditions: A Survey in Four Geographically Distinct Psychiatric Clinics

PubMed Central

Chan, Steven Richard; Yee-Marie Tan, Shih; Behrens, Jacob; Mathew, Ian; Conrad, Erich J; Hinton, Ladson; Yellowlees, Peter; Keshavan, Matcheri

2014-01-01

Background Despite growing interest in mobile mental health and utilization of smartphone technology to monitor psychiatric symptoms, there remains a lack of knowledge both regarding patient ownership of smartphones and their interest in using such to monitor their mental health. Objective To provide data on psychiatric outpatients’ prevalence of smartphone ownership and interest in using their smartphones to run applications to monitor their mental health. Methods We surveyed 320 psychiatric outpatients from four clinics around the United States in order to capture a geographically and socioeconomically diverse patient population. These comprised a state clinic in Massachusetts (n=108), a county clinic in California (n=56), a hybrid public and private clinic in Louisiana (n=50), and a private/university clinic in Wisconsin (n=106). Results Smartphone ownership and interest in utilizing such to monitor mental health varied by both clinic type and age with overall ownership of 62.5% (200/320), which is slightly higher than the average United States’ rate of ownership of 58% in January 2014. Overall patient interest in utilizing smartphones to monitor symptoms was 70.6% (226/320). Conclusions These results suggest that psychiatric outpatients are interested in using their smartphones to monitor their mental health and own the smartphones capable of running mental healthcare related mobile applications. PMID:26543905

"Hospital utilization by Mexican migrants returning to Mexico due to health needs".

PubMed

González-Block, Miguel A; de la Sierra-de la Vega, Luz A

2011-04-18

A total of 12.7 million Mexicans reside as migrants in the United States, of whom only 45% have health insurance in this country while access to health insurance by migrants in Mexico is fraught with difficulties. Health insurance has been shown to impact the use of health care in both countries. This paper quantifies hospitalizations by migrants who return from the US seeking medical care in public and private hospitals in the US-Mexico border area and in communities of origin. The proportion of bed utilization and the proportion of hospitalizations in Mexico out of the total expected by migrants in the US were estimated. The universe included 48 Ministry of Health and 47 private hospitals serving municipalities of high or very high migration in Mexico, where 17% of remittance-receiving households are located, as well as 15 public and 159 private hospitals in 10 Mexican cities along the border with the US. Hospitals were sampled through various methods to include 27% of beds. Patients and staff were interviewed and data triangulated to quantify migrants that returned to Mexico seeking medical care. Official hospital discharge statistics and secondary data from migration databases and published statistics were analyzed to identify bed occupancy, general migrant hospitalization rates and the size of the migrant population that maintains close relationships with households in communities of origin. Up to 1609 migrants were admitted to public hospitals (76.6%) and 492 to private hospitals (23.4%) serving municipalities of high and very high migration intensity in 2008. Up to 0.90% of public hospital capacity was used. In the border area up to 908 and 2416 migrants were admitted to public (27.3%) and private (72.7%) hospitals, respectively. Up to 1.18% of public hospital capacity was used. Between 2.4% and 20.4% of the expected hospitalization needs of migrants with dependent households are satisfied through these services. The most common diagnostic categories mentioned across hospitals were traumatisms, complications of diabetes and elective surgery, in that order. Private hospitals mention elective surgeries as the main diagnostic category followed by complications of diabetes. Hospitals in communities of origin in Mexico are devoting few resources to respond to hospitalization needs of migrants in the US. Currently no hospital programs exist to stimulate migrant demand or to cater to their specific needs. Registering migratory history in clinical and administrative records can be readily implemented. Developing bi-national referral networks and insuring migrants in the US within current Mexican federal programs could greatly increase migrant access to hospitals.

"Hospital utilization by Mexican migrants returning to Mexico due to health needs"

PubMed Central

2011-01-01

Background A total of 12.7 million Mexicans reside as migrants in the United States, of whom only 45% have health insurance in this country while access to health insurance by migrants in Mexico is fraught with difficulties. Health insurance has been shown to impact the use of health care in both countries. This paper quantifies hospitalizations by migrants who return from the US seeking medical care in public and private hospitals in the US-Mexico border area and in communities of origin. The proportion of bed utilization and the proportion of hospitalizations in Mexico out of the total expected by migrants in the US were estimated. Methods The universe included 48 Ministry of Health and 47 private hospitals serving municipalities of high or very high migration in Mexico, where 17% of remittance-receiving households are located, as well as 15 public and 159 private hospitals in 10 Mexican cities along the border with the US. Hospitals were sampled through various methods to include 27% of beds. Patients and staff were interviewed and data triangulated to quantify migrants that returned to Mexico seeking medical care. Official hospital discharge statistics and secondary data from migration databases and published statistics were analyzed to identify bed occupancy, general migrant hospitalization rates and the size of the migrant population that maintains close relationships with households in communities of origin. Results Up to 1609 migrants were admitted to public hospitals (76.6%) and 492 to private hospitals (23.4%) serving municipalities of high and very high migration intensity in 2008. Up to 0.90% of public hospital capacity was used. In the border area up to 908 and 2416 migrants were admitted to public (27.3%) and private (72.7%) hospitals, respectively. Up to 1.18% of public hospital capacity was used. Between 2.4% and 20.4% of the expected hospitalization needs of migrants with dependent households are satisfied through these services. The most common diagnostic categories mentioned across hospitals were traumatisms, complications of diabetes and elective surgery, in that order. Private hospitals mention elective surgeries as the main diagnostic category followed by complications of diabetes. Conclusions Hospitals in communities of origin in Mexico are devoting few resources to respond to hospitalization needs of migrants in the US. Currently no hospital programs exist to stimulate migrant demand or to cater to their specific needs. Registering migratory history in clinical and administrative records can be readily implemented. Developing bi-national referral networks and insuring migrants in the US within current Mexican federal programs could greatly increase migrant access to hospitals. PMID:21501516