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 a...
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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.
Objectives: To compare open heart surgery services provided by public and private hospitals in Catalonia (Spain) according to case mix, procedures undergone and surgical mortality. Methods: Data on all adult patients ...
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Objectives: To compare open heart surgery services provided by public and private hospitals in Catalonia (Spain) according to case mix, procedures undergone and surgical mortality. Methods: Data on all adult patients undergoing open heart surgery procedures were collected prospectively in a sample of public and privately owned centres for a 6.5-month period in 1994. Sociodemographic, clinical and procedural variables were collected. A predictive model stratifying patients according to their surgical mortality risk was used to adjust for differences in case mix between providers. Results: Included were 1287 open heart surgery procedures. Public and private patients differed significantly in terms of gender, clinical history (e.g. hypertension, pulmonary disease, recent infarction) and procedural variables (e.g. reoperation, type of intervention). There were also statistically significant differences related to educational level, with better educated patients more likely to be treated in private centres. Crude surgical mortality rates differed between providers, although public centres operated on higher-risk patients. After adjusting for differences in case mix, the association between the type of provider and surgical mortality was not statistically significant (odds ratio 1.68;95% CI from 0.94 to 3.0). Conclusions: Although crude mortality rates differ between public and private providers, there is a significant trend towards higher surgical risk in public centres. After adjusting for surgical risk, differences between types of provider decreased and were no longer statistically significant. The importance of other social and health-related factors, such as educational level, may explain differences between providers in their patients' surgical risk and in their performance in open heart surgery.
To date there has been no research carried out in respect of the contribution being made by the independent sector to medium-secure psychiatric care. There are also no published studies comparing the provision of the ...
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To date there has been no research carried out in respect of the contribution being made by the independent sector to medium-secure psychiatric care. There are also no published studies comparing the provision of the independent sector with that of the public sector. As such this is a neglected field of study. This paper examines the characteristics of patients admitted to one independent medium-secure psychiatric hospital and two regional secure units in terms of their demographic characteristics, source, detention under the Mental Health Act, 1983, psychiatric diagnosis, criminal history and discharge. The results of the study are tested for their significance using the chi-square distribution. There is discussion of how the independent sector may be providing a service either unavailable within the National Health Service or for which the National Health Service is unsuitable in terms of patients tither requiring medium- to long-term hospital care in conditions of security or those who cannot live independently and therefore require 'asylum', which is no longer an option within the National Health Service. In this sense, the independent sector could be seen as meeting a national need by acting as a 'safety valve' for National Health Service facilities.
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