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The quality of private and public primary health care management of children with diarrhoea and acute respiratory infections in Tlaxcala, Mexico

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HEALTH POLICY AND PLANNING 1998年第3期13卷 323-331页

作者： Bojalil, R Guiscafré, H Espinosa, P Martínez, H Palafox, M Romero, G Gutiérrez, G Cerro Macuiltepec 404 Col Campestre Churubusco Mexico City 04200 DF Mexico

In Tlaxcala, Mexico, 80% of the children who died from diarrhoea or acute respiratory infections (ARI) in 1992-1993 received medical care;in more than 70% of cases it was provided by a private general practitioner (GP). The present study evaluated the quality of case management by private and public GPs to children under Five years of age with diarrhoea and ARI. During the clinical observation, the treatment and counselling given to the mother were assessed with the WHO guidelines as reference standard. A total of 41 private and 40 public GPs were evaluated for the management of diarrhoea, and 59 private and 40 public GPs for the management of ARI. For diarrhoea, half of the private GPs gave inadequate rehydration therapy, 63% gave incorrect advice on diet, 66% and 49% made an incorrect decision in the prescription of antimicrobial and symptomatic drugs, respectively. Public GPs generally performed better in diarrhoea management: 7% gave inadequate rehydration therapy, 13% gave wrong advice on diet, 3% made a wrong decision in the prescription of symptomatic drugs and 28% gave a wrong decision in antimicrobial prescription. In the management of ARI, 66% and 58% of private GPs made a wrong decision in the prescription of antimicrobial and symptomatic drugs, respectively, compared to 30% and 20% of public GPs, respectively. Counselling to the mother given by both private and public GPs was considered inadequate in most cases of diarrhoea and ARI. These results clearly show that private doctors, as important providers of medical care, need to be included in the strategies to improve the quality of care of children with diarrhoea and ARI. Future research needs to address the determinants of the clinical practice of private doctors in countries like Mexico.

关键词：儿童保健服务/标准腹泻/死亡率腹泻/治疗家庭医学/标准家庭医学/统计学和数值数据墨西哥/流行病学私人开业/标准私人开业/统计学和数值数据公共卫生管理/标准公共卫生管理/统计学和数值数据卫生保健质量/统计学和数值数据呼吸道感染/死亡率呼吸道感染/治疗儿童儿童学龄前人类婴儿婴儿新生

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Researching the public/private mix in health care in a Thai urban area: methodological approaches

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HEALTH POLICY AND PLANNING 1998年第3期13卷 234-248页

作者： Pannarunothai, S Mills, A Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England Buddhachinaraj Hosp Phitsanulok Thailand

The private health sector has been growing rapidly in many low and middle income countries, yet not enough is known about its sources of finance or characteristics of its users. Moreover, health care reform measures are leading to alterations in the mix of public and private finance and provision, increasing further the need for information. This paper presents and evaluates some research methods which can be used to collect information relevant to considering policies on the public/private mix. They comprise a household survey, a health diary and interview survey, a bed census, and a health resource survey. Each method is described as it was used in a study in a large urban setting in Thailand, and strengths and weaknesses of the methods are identified. The use of data to estimate the shares of public and private finance and provision, and particularly private sources of finance of public hospitals and public sources of finance for private hospitals, is demonstrated. Policy issues highlighted by the data are identified.

关键词：卫生保健改革卫生保健调查/方法卫生经费支出/统计学和数值数据医院私立/经济学医院私立/统计学和数值数据医院私立/利用医院公立/经济学医院公立/统计学和数值数据医院公立/利用收入/统计学和数值数据模型经济计量学私营部门/经济学私营部门/统计学和数值数据公共卫生管理/经济学公共卫生管理/统计学和数值数据社会经济因素泰国

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How and why public sector doctors engage in private practice in Portuguese-speaking African countries

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HEALTH POLICY AND PLANNING 1998年第3期13卷 332-338页

作者： Ferrinho, P Van Lerberghe, W Julien, MR Fresta, E Gomes, A Dias, F Gonçalves, A Bäckström, B Univ Nova Lisboa Dept Saude Publ Inst Higiene & Med Trop Unidade Sistemas Saude P-1300 Lisbon Portugal Univ Nova Lisboa Inst Higiene & Med Trop Ctr Malaria & Outras Doencas Tropicais P-1300 Lisbon Portugal Inst Trop Med Prince Leopold Dept Publ Hlth B-2000 Antwerp Belgium Univ Eduardo Mondlane Fac Med Maputo Mozambique Minist de Saude Luanda Angola Minist da Saude Ctr Reg Desenvolvimento Sanitario Maputo Mozambique Minist Saude Lab Saude Publ Bissau Guinea Bissau

Objective: To explore the type of private practice supplementary income-generating activities of public sector doctors in the Portuguese-speaking African countries, and also to discover the motivations and the reasons why doctors have not made a complete move out of public service. Design: cross-sectional qualitative survey. Subjects: In 1996, 28 Angolan doctors, 26 from Guinea-Bissau, 11 from Mozambique and three from S Tome and Principe answered a self-administered questionnaire. Results: All doctors, except one unemployed, were government employees. Forty-three of the 68 doctors that answered the questionnaire reported an income-generating activity other than the one reported as principal. Of all the activities mentioned, the ones of major economic importance were: public sector medical care, private medical care, commercial activities, agricultural activities and university teaching. The two outstanding reasons why they engage in their various side-activities are 'to meet the cost of living' and 'to support the extended family'. Public sector salaries are supplemented by private practice. Interviewees estimated the time a family could survive on their public sector salary at seven days (median value). The public sector salary still provides most of the interviewees income (median 55%) for the rural doctors, but has become marginal for those in the urban areas (median 10%). For the latter, private practice has become of paramount importance (median 65%). For 26 respondents, the median equivalent of one month's public sector salary could be generated by seven hours of private practice. Nevertheless, being a civil servant was important in terms of job security, and credibility as a doctor. The social contacts and public service gave access to power centres and resources, through which other coping strategies could be developed. The expectations regarding the professional future and regarding the health systems future were related mostly to health personnel issues.

关键词：非洲非洲西部安哥拉几内亚比绍卫生保健调查卫生服务研究收入/统计学和数值数据莫桑比克私人开业/经济学私人开业/统计学和数值数据公共卫生管理/人力公共卫生管理/统计学和数值数据问卷调查薪金和附加福利/统计学和数值数据

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Home health care industry growth and change: A study of one state's experience

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Home Health Care Services Quarterly 1995年第3期15卷 61-81页

作者： Rn, Carol Hall Ellenbecker College of Nursing University of Massachusetts-Boston Boston MA United States

Federal expenditures for home health care have been increasing at an annual rate of 30% per year since 1974, and are predicted to continue to increase more rapidly than expenditures for other health services in the future. This predication is based on: The aging population, increases in medical technology and the impact of government regulatory mechanisms which encourage growth and competition in the home health industry. In order to develop effective regulatory policies for the future it is necessary to understand the effect of past policies on home health care services. This is a descriptive study of one state's experience with a changing regulatory environment over a ten year period of time. Data from the Massachusetts Department of Public Health's Annual Reports for Home Health Agencies was used to describe industry growth and change and the effect these had on the accessibility, quality and efficiency of service delivery from 1980 to 1990. Results suggest dramatic changes in the industry, with strong evidence of agencies competitive behaviors, improved patient access to most services, changes in staffing patterns and concerns for quality of care. © 1995 Taylor & Francis Group, LLC.

关键词：数据收集经济竞争效率组织卫生经费支出卫生服务易得程度卫生服务研究家庭保健机构/经济学家庭保健机构/统计学和数值数据家庭保健机构/发展趋势马萨诸塞公共卫生管理/统计学和数值数据公共卫生管理/发展趋势卫生保健质量美国

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The role of private medical practitioners and their interactions with public health services in Asian countries

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HEALTH POLICY AND PLANNING 1995年第4期10卷 333-349页

作者： Aljunid, S LONDON SCH HYG & TROP MED HLTH ECON & FINANCING PROGRAMMEHLTH POLICY UNITLONDONENGLAND

This paper aims to review the role of private practitioners and their interactions with public health services in developing countries, focusing largely on the Asian region. Evidence on the distribution of health facilities. manpower, health expenditures and utilization rates shows that private practitioners are significant health care providers in many Asian countries. Limited information has been published on interactions between public and private providers despite their co-existence. Issues related to enforcement of regulations, human resources, patient referrals and disease notifications, are examined.

关键词：亚洲数据收集发展中国家疾病报告卫生服务/统计学和数值数据卫生服务/利用卫生服务研究机构间关系医师/统计学和数值数据医师/利用私营部门/统计学和数值数据私营部门/利用公共卫生管理/统计学和数值数据转诊和会诊人类

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