Sample records for affordable private health

  1. Anonymous HIV workplace surveys as an advocacy tool for affordable private health insurance in Namibia

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    de Beer Ingrid


    Full Text Available Abstract Background With an estimated adult HIV prevalence of 15%, Namibia is in need of innovative health financing strategies that can alleviate the burden on the public sector. Affordable and private health insurances were recently developed in Namibia, and they include coverage for HIV/AIDS. This article reports on the efficacy of HIV workplace surveys as a tool to increase uptake of these insurances by employees in the Namibian formal business sector. In addition, the burden of HIV among this population was examined by sector. Methods Cross-sectional anonymous HIV prevalence surveys were conducted in 24 private companies in Namibia between November 2006 and December 2007. Non-invasive oral fluid-based HIV antibody rapid tests were used. Anonymous test results were provided to the companies in a confidential report and through presentations to their management, during which the advantages of affordable private health insurance and the available insurance products were discussed. Impact assessment was conducted in October 2008, when new health insurance uptake by these companies was evaluated. Results Of 8500 targeted employees, 6521 were screened for HIV; mean participation rate was 78.6%. Overall 15.0% (95% CI 14.2-15.9% of employees tested HIV positive (range 3.0-23.9% across companies. The mining sector had the highest percentage of HIV-positive employees (21.0%; the information technology (IT sector had the lowest percentage (4.0%. Out of 6205 previously uninsured employees, 61% had enrolled in private health insurance by October 2008. The majority of these new insurances (78% covered HIV/AIDS only. Conclusion The proportion of HIV-positive formal sector employees in Namibia is in line with national prevalence estimates and varies widely by employment sector. Following the surveys, there was a considerable increase in private health insurance uptake. This suggests that anonymous HIV workplace surveys can serve as a tool to motivate

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

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


    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. Aims 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. Methods 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. Results 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. Conclusion 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. PMID:25759452

  3. Affordability of Private Schools: Exploration of a Conundrum and towards a Definition of "Low-Cost" (United States)

    Tooley, James; Longfield, David


    The affordability of private education is a contentious issue. While the extent of "low-cost" private schooling is widely accepted, there is no agreement on what "low-cost" means in this context and how this relates to affordability for poor families. This paper addresses the lacuna in the literature by defining…

  4. Patient Protection and Affordable Care Act; establishment of exchanges and qualified health plans; exchange standards for employers. Final rule, Interim final rule. (United States)


    This final rule will implement the new Affordable Insurance Exchanges ("Exchanges"), consistent with title I of the Patient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which will become operational by January 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses.

  5. Harnessing Private-Sector Innovation to Improve Health Insurance Exchanges. (United States)

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


    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.


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    Full Text Available Frugal innovations are cost-conscious innovations developed to meet the needs in resource-poor settings, withoutcompromising quality. While there have been various innovations in the field of health care in the past decades, there is avast difference in the distribution and utilization of these innovations between developed and developing countries. Frugalinnovations can play a potential role in bridging the gap between countries and ensure affordable health care for all.

  7. Health Care Affordability: How to Make It a Reality. (United States)

    Rotarius, Timothy; Liberman, Aaron


    Health care is a big business. US health care expenditures reached $2.9 trillion in 2013. Patient spending accounted for 28% of the total, which means patients spent approximately $810 billion in 2013 for insurance premiums, deductibles, copays, coinsurance, and noncovered health care services. How are patients expected to pay almost a trillion dollars in health care expenses? There is a need to find a health care financing methodology that will make health care affordable for all patients and families. An alternative method for funding health care is discussed that includes creating a government-funded annuity during the first decade of one's life. When this annuity matures later in life, many individuals will have amassed a large pot of money with which to pay for their (and their family's) health care treatment and products.

  8. Implementing the Affordable Care Act: choosing an essential health benefits benchmark plan. (United States)

    Corlette, Sabrina; Lucia, Kevin W; Levin, Max


    To improve the adequacy of private health insurance, the Affordable Care Act requires insurers to cover a minimum set of medical benefits, known as "essential health benefits." In implementing this requirement, states were asked to select a "benchmark plan" to serve as a reference point. This issue brief examines state action to select an essential health benefits benchmark plan and finds that 24 states and the District of Columbia selected a plan. All but five states will have a small-group plan as their benchmark. Each state, whether or not it made a benchmark selection, will have a set of essential health benefits that reflects local, employer-based health insurance coverage currently sold in the state. States adopted a variety of approaches to selecting a benchmark, including intergov­ernmental collaboration, stakeholder engagement, and research on benchmark options.

  9. Investigating the affordability of key health services in South Africa. (United States)

    Cleary, Susan; Birch, Steve; Chimbindi, Natsayi; Silal, Sheetal; McIntyre, Di


    This paper considers the affordability of using public sector health services for three tracer conditions (obstetric care, tuberculosis treatment and antiretroviral treatment for HIV-positive people), based on research undertaken in two urban and two rural sites in South Africa. We understand affordability as the 'degree of fit' between the costs of seeking health care and a household's ability-to-pay. Exit interviews were conducted with over 300 patients for each of the three tracer conditions in each of the four sites (i.e. a total sample of over 3600). Total direct costs for the service used at the time of the interview, as well as other health related costs incurred during the preceding month either for self-care or the use of plural providers were assessed, as were a range of indicators of ability-to-pay. The percentage of households incurring direct costs exceeding 10% of household consumption expenditure and those borrowing money or selling assets as a mechanism for coping with the burden of direct costs were calculated. Logistic regressions were also conducted to identify factors that were significantly associated with these indicators of affordability. There were significant differences in affordability between rural and urban sites; costs were higher, ability-to-pay was lower and there was a greater proportion of households selling assets or borrowing money in rural areas. There were also significant differences across tracers, with a higher percentage of households receiving tuberculosis and antiretroviral treatment borrowing money or selling assets than those using obstetric services. As these conditions require expenses to be incurred on an ongoing basis, the sustainability of such coping strategies is questionable. Policy makers need to explore how to reduce direct costs for users of these key health services in the context of the particular characteristics of different treatment types. Affordability needs to be considered in relation to the dynamic

  10. Health Migration: Crossing Borders for Affordable Health Care

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    Jennifer Miller-Thayer


    Full Text Available Approximately 45.7 million people in the United States are uninsured and unknown numbers of this population are underinsured, severely limiting their access to medical care. To address this problem, people use innovative strategies to increase their access through cross-border care options. The U.S.-Mexico border provides unique challenges and opportunities for health care in this context. The lower cost of medical and dental procedures and medications in Mexico makes that country an attractive alternative for low-income populations in the United States. Thus segments of the U.S. population practice transnational medical consumerism in an attempt to optimize their health by using the resources available in both countries. This practice has economic benefits for the people who access health care at an affordable rate and for the medical markets of the country providing the care. Drawing on data collected in the field in 2002, 2004, and 2005, this paper presents some of the complexities and dynamics of medical pluralism occurring at the U.S.-Mexico border.Environ 45,7 millions de personnes vivant aux Etats-Unis n’ont pas de couverture sociale et nombreux sont celles à être sous-assurées, ce qui limite considérablement leur accès aux soins. Face à ce problème, les Américains font preuve d'ingéniosité pour améliorer leur accès aux soins : ils se font soigner au-delà des frontières. Dans ce contexte, la frontière entre les Etats-Unis et le Mexique offre des opportunités uniques de soins. Le Mexique constitue en effet une alternative séduisante pour les Américains à faible revenu, car les tarifs des actes médicaux et dentaires, et des médicaments, sont nettement inférieurs à ceux en vigueur aux Etats-Unis. Ainsi, certains Américains pratiquent le consumérisme médical transnational et recourent aux ressources disponibles dans les deux pays afin d’optimiser leur santé. Cette pratique présente des avantages économiques

  11. Health care privatization in Latin America: comparing divergent privatization approaches in Chile, Colombia, and Mexico. (United States)

    Bustamante, Arturo Vargas; Méndez, Claudio A


    The public-private mix in Chile, Colombia, and Mexico was very similar until the early 1980s when Chile undertook health care privatization as part of comprehensive health care reform. Since then, health care privatization policies have diverged in these countries. In this study we characterize health care privatization in Latin America and identify the main factors that promoted and hindered privatization by comparing the experiences of these countries. We argue that policy elites took advantage of specific policy environments and the diffusion of privatization policies to promote health care privatization while political mobilization against privatization, competing policy priorities, weak market and government institutions, and efforts to reach universal health insurance hindered privatization. The privatization approaches of Chile and Colombia were classified as "big-bang," since these countries implemented health care privatization more rapidly and with a wider scope compared with the case of Mexico, which was classified as gradualist, since the privatization path followed by this country adopted a slower pace and became more limited and focalized over time. We conclude that the emphasis on policy-driven privatization diminished in the 1990s and 2000s because of increased public health care financing and a shift in health care reform priorities. Health care privatization in the region, however, continued as a consequence of demand-driven privatization.

  12. The Politics of Native American Health Care and the Affordable Care Act. (United States)

    Skinner, Daniel


    This article examines an important but largely overlooked dimension of the Patient Protection and Affordable Care Act (ACA), namely, its significance for Native American health care. The author maintains that reading the ACA against the politics of Native American health care policy shows that, depending on their regional needs and particular contexts, many Native Americans are well-placed to benefit from recent Obama-era reforms. At the same time, the kinds of options made available by the ACA constitute a departure from the service-based (as opposed to insurance-based) Indian Health Service (IHS). Accordingly, the author argues that ACA reforms--private marketplaces, Medicaid expansion, and accommodations for Native Americans--are best read as potential "supplements" to an underfunded IHS. Whether or not Native Americans opt to explore options under the ACA will depend in the long run on the quality of the IHS in the post-ACA era. Beyond understanding the ACA in relation to IHS funding, the author explores how Native American politics interacts with the key tenets of Obama-era health care reform--especially "affordability"--which is critical for understanding what is required from and appropriate to future Native American health care policy making.

  13. Do Catalan private hospitals enjoy financial health?

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    Judit Creixans Tenas


    Full Text Available Purpose: The present study reflects the economic and financial analysis of  private hospitals with non-charitable character in Catalonia 2008-2013. The private health sector is considered to be a service activity that develops an important social role. The study positions these analysed centers in the Catalan and Spanish health sector and presents the main economic and financial indicators to diagnose the situation of these companies during the period indicated by analysing short and long-term results and analysis of changes in equity and cash flows of the wineries. Design/methodology/approach: The data used comes from the statements of the Catalan hospital centers in the period 2008-2013 and in particular, it contains a sample of 94 Catalan private hospitals, that mostly are considered large-level accounting (according to the General Accounting Plan. The economic and financial  analysis has carried out using descriptive statistics and analysis results and conclusions have been reached. Findings: The study noted that enables private hospitals in this period have a healthy economic and financial status, although it should improve the management of assets. Most sales are concentrated with a small number of hospitals and, regarding the evolution of the results, produces two distinct stages, the first period of decrease (2008-2010 and the second period of growth and recovery from 2011.. Research limitations/implications: It would be desirable to perform the same study by the Spanish private hospitals in order to compare the economic and financial analysis of the Catalan private sector with the Spanish private sector. Practical implications: It allows us to assess the projection of this sector in recent years in Catalonia in order to take the appropriate economic decisions in this regard. Social implications: The results show the changes that have occurred over the years in the economic crisis of the period analysed. Originality / value: For

  14. Health Migration: Crossing Borders for Affordable Health Care


    Jennifer Miller-Thayer


    Approximately 45.7 million people in the United States are uninsured and unknown numbers of this population are underinsured, severely limiting their access to medical care. To address this problem, people use innovative strategies to increase their access through cross-border care options. The U.S.-Mexico border provides unique challenges and opportunities for health care in this context. The lower cost of medical and dental procedures and medications in Mexico makes that country an attracti...

  15. 76 FR 60788 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans... (United States)


    ... HUMAN SERVICES 45 CFR Parts 153, 155 and 156 Patient Protection and Affordable Care Act; Establishment... and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The other proposed rule would implement standards...

  16. 77 FR 18309 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans... (United States)


    ... Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards..., 156, and 157 RIN 0938-AQ67 Patient Protection and Affordable Care Act; Establishment of Exchanges and... collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for...

  17. 76 FR 41865 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans (United States)


    ... Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Proposed Rule #0... Exchanges (``Exchanges''), consistent with title I of the Patient Protection and Affordable Care Act of 2010...-152), referred to collectively as the Affordable Care Act. The Exchanges will provide...

  18. Personal Pensions with Risk Sharing, Affordable, Adequate and Stable Private Pensions in Europe

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    Bovenberg, Lans; Nijman, Theo


    Private pension provision faces the challenging task of providing stable income streams during retirement. The challenge has increased markedly in the last decades due to volatile financial markets, falling interest rates and the withdrawal of employers and external insurers as risk bearers of syste

  19. Public-Private Partnerships In Health

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    khalid BOUTI


    Full Text Available Extract:The current importance of public debt requires governments to increasingly shift towards Public-Private Partnerships (PPPs. They are long-term contracts of private financing method providing or contributing to public service. The payment is made by the public partner and/or users of the service.The World Health Organization (WHO defines this type of partnership as ‘‘a means to bring together a set of actors for the common goal of improving the health of populations based on mutually agreed roles and principles.’’Historically, the principle of PPP was established by the Private Finance Initiative (PFI, launched by the conservative government of John Major in 1992. It was from this moment that this model quickly spread to the rest of the world. In the mid-90s and from Australia, PPP agreement began to become part of the language of governments. In 1997, Labour with Tony Blair leading, strongly developed this management method, first and particularly in hospitals and then, in the entire public sector and spreading to the Royal Navy. Today, 10-15% of British public investments are made using PFI method....

  20. How to Keep Your Health Information Private and Secure (United States)

    ... health information technology and keeping your health information private and secure, visit our website at http: / / www. healthit. gov. For information and resources on HIPAA privacy and security issues, visit the Office for Civil Rights website ...

  1. Management of behavioral health provider networks in private health plans. (United States)

    Garnick, Deborah W; Horgan, Constance M; Reif, Sharon; Merrick, Elizabeth L; Hodgkin, Dominic


    We explored the techniques used by private health plans or by their contracted managed behavioral healthcare organizations (MBHOs) to maintain networks of behavioral health providers. In particular, we focused on differences by health plans' product types (health maintenance organization, point-of-service plan, or preferred provider organization) and contracting arrangements (MBHO contracts, comprehensive contracts, or no contracts). More than 94% of products selected providers using credentialing standards, particular specialists, or geographic coverage. To retain providers viewed as high quality, 54% offer reduced administrative burden and 44% higher fees. Only 16% reported steerage to a core group of highest-quality providers and few reported an annual bonus or guaranteed volume of referrals. Some standard activities are common, but some health plans are adopting other approaches to retain higher-quality providers.

  2. Availability, prices and affordability of the World Health Organization’s essential medicines for children in Guatemala (United States)


    Background Several World Health Organization (WHO) initiatives aim to improve the accessibility of safe and effective medicines for children. A first step in achieving this goal is to obtain a baseline measure of access to essential medicines. The objective of this project was to measure the availability, prices, and affordability of children’s medicines in Guatemala. Methods An adaption of the standardized methodology developed by the World Health Organization and Health Action International (HAI) was used to conduct a cross sectional survey to collect data on availability and final patient prices of medicines in public and private sector medicine outlets during April and May of 2010. Results A subset of the public sector, Programa de Accesibilidad a los Medicamentos (PROAM), had the lowest average availability (25%) compared to the private sector (35%). In the private sector, highest and lowest priced medicines were 22.7 and 10.7 times more expensive than their international reference price comparison. Treatments were generally unaffordable, costing as much as 15 days wages for a course of ceftriaxone. Conclusions Analysis of the procurement, supply and distribution of specific medicines is needed to determine reasons for lack of availability. Improvements to accessibility could be made by developing an essential medicines list for children and including these medicines in national purchasing lists. PMID:22747646

  3. Coverage, access, and affordability under health reform: learning from the Massachusetts model. (United States)

    Long, Sharon K; Stockley, Karen; Nordahl, Kate Willrich

    While the impacts of the Affordable Care Act will vary across the states given their different circumstances, Massachusetts' 2006 reform initiative, the template for national reform, provides a preview of the potential gains in insurance coverage, access to and use of care, and health care affordability for the rest of the nation. Under reform, uninsurance in Massachusetts dropped by more than 50%, due, in part, to an increase in employer-sponsored coverage. Gains in health care access and affordability were widespread, including a 28% decline in unmet need for doctor care and a 38% decline in high out-of-pocket costs.

  4. Access to health insurance and the use of inpatient medical care: evidence from the Affordable Care Act young adult mandate. (United States)

    Akosa Antwi, Yaa; Moriya, Asako S; Simon, Kosali I


    The Affordable Care Act of 2010 expanded coverage to young adults by allowing them to remain on their parent's private health insurance until they turn 26 years old. While there is evidence on insurance effects, we know very little about use of general or specific forms of medical care. We study the implications of the expansion on inpatient hospitalizations. Given the prevalence of mental health needs for young adults, we also specifically study mental health related inpatient care. We find evidence that compared to those aged 27-29 years, treated young adults aged 19-25 years increased their inpatient visits by 3.5 percent while mental illness visits increased 9.0 percent. The prevalence of uninsurance among hospitalized young adults decreased by 12.5 percent; however, it does not appear that the intensity of inpatient treatment changed despite the change in reimbursement composition of patients.

  5. Development of health biotechnology in developing countries: can private-sector players be the prime movers? (United States)

    Abuduxike, Gulifeiya; Aljunid, Syed Mohamed


    Health biotechnology has rapidly become vital in helping healthcare systems meet the needs of the poor in developing countries. This key industry also generates revenue and creates employment opportunities in these countries. To successfully develop biotechnology industries in developing nations, it is critical to understand and improve the system of health innovation, as well as the role of each innovative sector and the linkages between the sectors. Countries' science and technology capacities can be strengthened only if there are non-linear linkages and strong interrelations among players throughout the innovation process; these relationships generate and transfer knowledge related to commercialization of the innovative health products. The private sector is one of the main actors in healthcare innovation, contributing significantly to the development of health biotechnology via knowledge, expertise, resources and relationships to translate basic research and development into new commercial products and innovative processes. The role of the private sector has been increasingly recognized and emphasized by governments, agencies and international organizations. Many partnerships between the public and private sector have been established to leverage the potential of the private sector to produce more affordable healthcare products. Several developing countries that have been actively involved in health biotechnology are becoming the main players in this industry. The aim of this paper is to discuss the role of the private sector in health biotechnology development and to study its impact on health and economic growth through case studies in South Korea, India and Brazil. The paper also discussed the approaches by which the private sector can improve the health and economic status of the poor.

  6. Patient Protection and Affordable Care Act; health insurance market rules. Final rule. (United States)


    This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

  7. Private sector, human resources and health franchising in Africa. (United States)

    Prata, Ndola; Montagu, Dominic; Jefferys, Emma


    In much of the developing world, private health care providers and pharmacies are the most important sources of medicine and medical care and yet these providers are frequently not considered in planning for public health. This paper presents the available evidence, by socioeconomic status, on which strata of society benefit from publicly provided care and which strata use private health care. Using data from The World Bank's Health Nutrition and Population Poverty Thematic Reports on 22 countries in Africa, an assessment was made of the use of public and private health services, by asset quintile groups, for treatment of diarrhoea and acute respiratory infections, proxies for publicly subsidized services. The evidence and theory on using franchise networks to supplement government programmes in the delivery of public health services was assessed. Examples from health franchises in Africa and Asia are provided to illustrate the potential for franchise systems to leverage private providers and so increase delivery-point availability for public-benefit services. We argue that based on the established demand for private medical services in Africa, these providers should be included in future planning on human resources for public health. Having explored the range of systems that have been tested for working with private providers, from contracting to vouchers to behavioural change and provider education, we conclude that franchising has the greatest potential for integration into large-scale programmes in Africa to address critical illnesses of public health importance.

  8. The Impact of Electricity Sector Privatization on Public Health

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    Gonzalez-Eiras, Martin; Rossi, Martín


    We use province-level data for Argentina to test for the causal relation between electricity distribution and health. We are interested in the impact of privatization on two output measures, incidence of low birth weight and child mortality rates caused by food poisoning. Privatization improves s...

  9. The Impact of Electricity Sector Privatization on Public Health

    DEFF Research Database (Denmark)

    Gonzalez-Eiras, Martin; Rossi, Martín


    We use province-level data for Argentina to test for the causal relation between electricity distribution and health. We are interested in the impact of privatization on two output measures, incidence of low birth weight and child mortality rates caused by food poisoning. Privatization improves...

  10. Are Americans finding affordable coverage in the health insurance marketplaces? Results from the Commonwealth Fund Affordable Care Act Tracking Survey. (United States)

    Rasmussen, Petra W; Collins, Sara R; Doty, Michelle M; Beutel, Sophie


    By the end of the first open enrollment period for coverage offered through the Affordable Care Act's marketplaces, increasing numbers of people said they found it easy to find a plan they could afford, according to The Commonwealth Fund's Affordable Care Act Tracking Survey, April-June 2014. Adults with low or moderate incomes were more likely to say it was easy to find an affordable plan than were adults with higher incomes. Adults with low or moderate incomes who purchased a plan through the marketplaces this year have similar premium costs and deductibles as adults in the same income ranges with employer-provided coverage. A majority of adults with marketplace coverage gave high ratings to their insurance and were confident in their ability to afford the care they need when sick.

  11. Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States. (United States)

    Courtemanche, Charles; Marton, James; Ukert, Benjamin; Yelowitz, Aaron; Zapata, Daniela


    The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those without a college degree, non-whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.

  12. Private medicine and the privatisation of health care in South Africa. (United States)

    Naylor, C D


    Health services in the Republic of South Africa (RSA) are provided by a mixture of public and private providers and institutions. Estimates of total health-related expenditure for 1985 range between 5.3% and 5.9% of gross national product (GNP), divided on approximately a 55:45 basis between public and private sectors. Basic preventive and curative services are provided by a hospital- and clinic-based public system. The public system does not adequately serve the rural areas and African tribal bantustans, and racial discrimination and/or segregation are obvious in its organisation and funding. The public sector's strength is the provision of state-subsidised care to many citizens who are unable to afford private medicine. The vast majority of hospitals are operated on a non-profit basis by government, industries, and voluntary agencies. Excluding hospitals that receive state subsidies, private investor-owned hospitals control about 10% of all hospital beds in the RSA. One-third of these investor-owned beds are held by state-dependent contractors providing long-term care. Two-thirds are wholly independent. Growth has been rapid in the independent hospital sector, and major corporations have entered the market. In 1985, over 85% of the white population was privately insured by a variety of prepayment programmes, including those organised through parastatal corporations and government departments. Despite major enrollment growth in the preceding decade, only 8% of blacks held private insurance by 1985; their coverage also tended to be less comprehensive. Faced with deficit financing, a sluggish economy, complaints from its white constituency about taxation levels, and pressure from private sector interest groups, the Nationalist government has endorsed the concept of privatisation of health care. Exponents of privatisation claim that it will permit differentiation by income to supplant discrimination by race. However, the direct links between disposable income and

  13. Tuberculosis treatment managed by providers outside the Public Health Department: lessons for the Affordable Care Act.

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    Melissa Ehman

    Full Text Available INTRODUCTION: Tuberculosis (TB requires at least six months of multidrug treatment and necessitates monitoring for response to treatment. Historically, public health departments (HDs have cared for most TB patients in the United States. The Affordable Care Act (ACA provides coverage for uninsured persons and may increase the proportion of TB patients cared for by private medical providers and other providers outside HDs (PMPs. We sought to determine whether there were differences in care provided by HDs and PMPs to inform public health planning under the ACA. METHODS: We conducted a retrospective, cross-sectional analysis of California TB registry data. We included adult TB patients with culture-positive, pulmonary TB reported in California during 2007-2011. We examined trends, described case characteristics, and created multivariate models measuring two standards of TB care in PMP- and HD-managed patients: documented culture conversion within 60 days, and use of directly observed therapy (DOT. RESULTS: The proportion of PMP-managed TB patients increased during 2007-2011 (p = 0.002. On univariable analysis (N = 4,606, older age, white, black or Asian/Pacific Islander race, and birth in the United States were significantly associated with PMP care (p<0.05. Younger age, Hispanic ethnicity, homelessness, drug or alcohol use, and cavitary and/or smear-positive TB disease, were associated with HD care. Multivariable analysis showed PMP care was associated with lack of documented culture conversion (adjusted relative risk [aRR] = 1.37, confidence interval [CI] 1.25-1.51 and lack of DOT (aRR = 8.56, CI 6.59-11.1. CONCLUSION: While HDs cared for TB cases with more social and clinical complexities, patients under PMP care were less likely to receive DOT and have documented culture conversion. This indicates a need for close collaboration between PMPs and HDs to ensure that optimal care is provided to all TB patients and TB transmission is

  14. The Affordable Care Act, health care reform, prescription drug formularies and utilization management tools. (United States)

    Ung, Brian L; Mullins, C Daniel


    The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on health care, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage toward cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall health care demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of health care costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online health care insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative health care delivery models or increased usage of health information technology will help alleviate problems of health care spending and affordability.

  15. Private health insurance and quality of life: perspectives of older Australians with multiple chronic conditions. (United States)

    Jeon, Yun-Hee; Black, Annie; Govett, Janelle; Yen, Laurann; McRae, Ian


    A qualitative study was conducted to explore in-depth issues relating to the health costs of chronic illness as identified in a previous study. A key theme that emerged from interviews carried out was the benefits and challenges of private health insurance (PHI) membership, and choices older Australians with multimorbidity make in accessing health services, with and without PHI. This is the focus of this paper. Semistructured interviews were conducted with 40 older people with multiple chronic conditions. Data were analysed using content analysis. Key motivators for maintaining PHI included: fear of an inability to access timely health care; the opportunity to exercise choice in service provider; a belief of being 'better off' both medically and financially, which was often ill-founded; and the core values of self reliance and independence. Most described financial pressure caused by rising PHI premiums as well as other out-of-pocket health related expenses. Many older people who can ill afford PHI still struggle to maintain it, potentially at the cost of their quality of life, based on beliefs about costs of health care that they have never properly assessed. The findings highlight the degree to which people whose resources are constrained are prepared to go to maintain access to private hospital care. Attention should be given to assisting older people to make informed and valid choices of health insurance derived from the facts, rather than being based on fear and assumptions.

  16. Accessibility, affordability and use of health services in an urban area in South Africa

    Directory of Open Access Journals (Sweden)

    Ethelwynn L. Stellenberg


    Full Text Available Background: Inequalities in healthcare between population groups of South Africa existed during the apartheid era and continue to exist both between and within many population groups. Accessibility and affordability of healthcare is a human right.Objectives: The aim of the study was to explore and describe accessibility, affordability and the use of health services by the mixed race (coloured population in the Western Cape, South Africa.Method: A cross-sectional descriptive, non-experimental study with a quantitative approach was applied. A purposive convenient sample of 353 participants (0.6% was drawn from a population of 63 004 economically-active people who lived in the residential areas as defined for the purpose of the study. All social classes were represented. The hypothesis set was that there is a positive relationship between accessibility, affordability and the use of health services. A pilot study was conducted which also supported the reliability and validity of the study. Ethics approval was obtained from the University of Stellenbosch and informed consent from respondents. A questionnaire was used to collect the data.Results: The hypothesis was accepted. The statistical association between affordability (p = < 0.01, accessibility (p = < 0.01 and the use of health services was found to be significant using the Chi-square (χ² test.Conclusion: The study has shown how affordability and accessibility may influence the use of healthcare services. Accessibility is not only the distance an individual must travel to reach the health service point but more so the utilisation of these services. Continuous Quality Management should be a priority in healthcare services, which should be user-friendly.

  17. Quality health care for children and the Affordable Care Act: a voltage drop checklist. (United States)

    Cheng, Tina L; Wise, Paul H; Halfon, Neal


    The Affordable Care Act (ACA) introduces enormous policy changes to the health care system with several anticipated benefits and a growing number of unanticipated challenges for child and adolescent health. Because the ACA gives each state and their payers substantial autonomy and discretion on implementation, understanding potential effects will require state-by-state monitoring of policies and their impact on children. The "voltage drop" framework is a useful interpretive guide for assessing the impact of insurance market change on the quality of care received. Using this framework we suggest a state-level checklist to examine ACA statewide implementation, assess its impact on health care delivery, and frame policy correctives to improve child health system performance. Although children's health care is a small part of US health care spending, child health provides the foundation for adult health and must be protected in ACA implementation.

  18. Electronic Health Records: Permanent, Private, and Informative (United States)

    ... is the National Library of Medicine helping with electronic health records? The Library has been an early and enthusiastic supporter of research to advance electronic records. A special focus of ours is on ...

  19. Affordability as a discursive accomplishment in a changing National Health Service. (United States)

    Russell, Jill; Greenhalgh, Trisha


    Health systems worldwide face the challenges of rationing. The English National Health Service (NHS) was founded on three core principles: universality, comprehensiveness, and free at the point of delivery. Yet patients are increasingly hearing that some treatments are unaffordable on the NHS. We considered affordability as a social accomplishment and sought to explore how those charged with allocating NHS resources achieved this in practice. We undertook a linguistic ethnography to examine the work practices of resource allocation committees in three Primary Care Trusts (PCTs) in England between 2005 and 2012, specifically deliberations over 'individual funding requests' (IFRs)--requests by patients and their doctors for the PCT to support a treatment not routinely funded. We collected and analysed a diverse dataset comprising policy documents, legal judgements, audio recordings, ethnographic field notes and emails from PCT committee meetings, interviews and a focus group with committee members. We found that the fundamental values of universality and comprehensiveness strongly influenced the culture of these NHS organisations, and that in this context, accomplishing affordability was not easy. Four discursive practices served to confer legitimacy on affordability as a guiding value of NHS health care: (1) categorising certain treatments as only eligible for NHS funding if patients could prove 'exceptional' circumstances; (2) representing resource allocation decisions as being not (primarily) about money; (3) indexical labelling of affordability as an ethical principle, and (4) recontextualising legal judgements supporting refusal of NHS treatment on affordability grounds as 'rational'. The overall effect of these discursive practices was that denying treatment to patients became reasonable and rational for an organisation even while it continued to espouse traditional NHS values. We conclude that deliberations about the funding of treatments at the margins of NHS

  20. Private expenditure and the role of private health insurance in Greece: status quo and future trends. (United States)

    Siskou, Olga; Kaitelidou, Daphne; Economou, Charalampos; Kostagiolas, Peter; Liaropoulos, Lycourgos


    The health care system in Greece is financed in almost equal proportions by public and private sources. Private expenditure, consists mostly of out-of-pocket and under-the-table payments. Such payments strongly suggest dissatisfaction with the public system, due to under financing during the last 25 years. This gap has been filled rapidly by the private sector. From this point of view, one might suggest that the flourishing development of private provision may lead in turn to a corresponding growth in private health insurance (PHI). This paper aims to examine the role of PHI in Greece, to identify the factors influencing its development, and to make some suggestions about future policies and trends. In the decade of 1985-1995 PHI show increasing activity, reflecting the intention of some citizens to seek health insurance solutions in the form of supplementary cover in order to ensure faster access, better quality of services, and increased consumer choice. The benefits include programs covering hospital expenses, cash benefits, outpatient care expenses, disability income insurance, as well as limited managed care programs. However, despite recent interest, PHI coverage remains low in Greece compared to other EU countries. Economic, social and cultural factors such as low average household income, high unemployment, obligatory and full coverage by social insurance, lead to reluctance to pay for second-tier insurance. Instead, there is a preference to pay a doctor or hospital directly even in the form of under-the-table payments (which are remarkably high in Greece), when the need arises. There are also factors endogenous to the PHI industry, related to market policies, low organisational capacity, cream skimming, and the absence of insurance products meeting consumer requirements, which explain the relatively low state of development of PHI in Greece.

  1. Mapping private-public-partnership in health organizations: India experience

    Directory of Open Access Journals (Sweden)

    Nayan Chakravarty


    Full Text Available The dream of universal health care demands a much larger and wider approach, engaging not just the public but also the private sector. This paper has attempted mapping the present public-private partnership scenario in India using the WHO health system functions framework, giving an insight into the nature and extent of challenge of the present dominant model. A systematic review methodology was adopted to identify published literature on private-public partnership in India. From an initial pool of 785 articles were identified. Finally a total of 29 published articles meeting the inclusion criteria were included. The descriptive framework of Health system functions by WHO (2000, were used to analyze the data. All papers which were considered for the study were segregated based on the 4 prime health system functions: Financing; Management of non-financial inputs; Health service delivery and Oversight. The literature review reveals that more than half of the papers (51.72% selected for the study were focused on health service delivery functions and quite thin literature were available for other 3 functions, which includes financing, management of non-financial inputs and oversight functions as per WHO. This finding raise an important question if the genesis of most of the public-private partnerships is out of the inability of the public sector in reaching out to a particular target group by virtue of its geographical position or difficulty in working with high risk groups. Considering the limitations of the present model of engagement of private and public sectors, it demands for an alternative model of engagement where the mutual strength that exists with each one of the partners, could be harnessed and complemented. An alternate model is to engage in tri-partite partnership (TPP between the government, non-government and the corporates.

  2. The U.S. Health Care Crisis Five Years After Passage of the Affordable Care Act: A Data Snapshot. (United States)

    Hellander, Ida


    Despite passage of the Affordable Care Act in 2010, the U.S. health care crisis continues. While coverage has been expanded, the reform will leave 27 million people uninsured in 2024, according to the Congressional Budget Office. Much of the new coverage is of low actuarial value with high cost-sharing requirements, creating barriers to access. Choice of physician is restricted to narrow networks of providers. Recent measures of uninsurance, underinsurance, access to care, and health care costs are given. Changes in Medicare, particularly privatization and the rise of specialty drug tiers that limit access to medically necessary medications, are reviewed. Data on a new wave of consolidation among hospitals, medical groups, insurers, and drug companies are presented. The rise of ultra-high-price drugs, such as Solvadi, is raising pharmaceutical costs, particularly in Medicaid, the program for low-income Americans. International health comparisons continue to show the United States performing poorly in relation to other countries. Recent polling data are presented, showing support for more fundamental reform.

  3. Health literacy and the Affordable Care Act: a policy analysis for children with special health care needs in the USA

    Directory of Open Access Journals (Sweden)

    Keim-Malpass J


    Full Text Available Jessica Keim-Malpass,1 Lisa C Letzkus,1,2 Christine Kennedy1 1University of Virginia School of Nursing, 2University of Virginia Children’s Hospital, Charlottesville, VA, USA Abstract: Children with special health care needs (CSHCN represent populations with chronic health conditions that are often high utilizers of health care. Limited health literacy has emerged as a key indicator of adverse health outcomes, and CSHCN from limited health literacy families are particularly vulnerable. The purpose of this policy analysis is to outline key provisions in the Affordable Care Act (ACA that incorporate health literacy approaches for implementation and have implications for CSHCN in the USA. Several key provisions are incorporated in the ACA that involve health literacy and have implications for CSHCN. These include: expansion of public insurance coverage and simplifying the enrollment process, provisions assuring equity in health care and communication among all populations, improving access to patient-centered medical homes that can offer care coordination, ensuring enhanced medication safety by changing liquid medication labeling requirements, and provisions to train health care providers on literacy issues. More research is needed to determine how provisions pertaining to health literacy in the ACA are implemented in various states. Keywords: children, special health care needs, health literacy, Affordable Care Act, health policy  

  4. Public and private donor financing for health in developing countries. (United States)

    Howard, L M


    Among the many variables that influence the outcome of national health status in both developed and developing countries, the availability and efficiency of financing is critical. For 148 developing countries, annual public and private expenditures from domestic sources (1983) were estimated to be approximately $100 billion. For the United States alone, annual public and private costs for medical care are almost five times larger ($478 billion, 1988). In contrast to domestic expenditures, the total flow of donor assistance for health in 1986 was estimated to be $4 billion, approximately 5% of total current domestic expenditures by developing countries. Direct donor assistance for development purposes by the United States Government approximates 0.5% of the US federal budget (1988). Approximately 10% of all United States development assistance is allocated for health, nutrition, and population planning purposes. While the total health sector contribution is on the order of $500 million annually, the US contribution represents about 13% of health contributions by all external donors. In sub-Saharan Africa, all donor health allocations only reach 3.4% of total development assistance. While available data suggest that private and voluntary organizations contribute approximately 20% of total global health assistance, data reporting methods from private agencies are not sufficiently specific to provide accurate global estimates. Clearly, developing countries as a whole are dependent on the efficient use of their own resources because external financing remains a small fraction of total domestic financing. Nevertheless, improvement in health sector performance often depends on the sharing of western experience and technology, services available through external donor cooperation. In this effort, the available supply of donor financing for health is not restricted entirely by donor policy, but also by the official demand for external financing as submitted by developing

  5. The child health implications of privatizing Africa's urban water supply. (United States)

    Kosec, Katrina


    Can private sector participation (PSP) in the piped water sector improve child health? I use child-level data from 39 African countries during 1986-2010 to show that PSP decreases diarrhea among urban-dwelling, under-five children by 2.6 percentage points, or 16% of its mean prevalence. Children from the poorest households benefit most. PSP is also associated with a 7.8 percentage point increase in school attendance of 7-17 year olds. Importantly, PSP increases usage of piped water by 9.7 percentage points, suggesting a possible causal channel explaining health improvements. To attribute causality, I exploit time-variation in the private water market share controlled by African countries' former colonizers. A placebo analysis reveals that PSP does not affect respiratory illness, nor does it affect a control group of rural children.

  6. Trends in Health Care Spending by the Private Sector (United States)


    trends in employment-based premiums. One such study by Jon Gabel and colleagues compared results from the Peat Marwick/Wayne State University 1993 survey...shift from indemnity to managed care plans during that period. 18. Jon Gabel and others, "The Health Insurance Picture in 1993: Some Rare Good News...Jonathan M. Gruber , Does Public Insurance Crowd Out Private Insurance? Working Paper No. 5082 (Cambridge, Mass.: National Bureau of Economic Research

  7. Financial health and customer satisfaction in private health care providers in Brazil. (United States)

    Schiozer, Rafael Felipe; Saito, Cristiana Checchia; Saito, Richard


    This paper analyzes the relationship between the financial health and organizational form of private health care providers in Brazil. It also examines the major determinants of customer satisfaction associated with the provider's organizational form. An adjusted Altman's z-score is used as an indicator of financial health. A proxy variable based on customer complaints filed at the Brazilian National Agency for Supplementary Health is used as an indicator for customer satisfaction. The study uses a sample of 270 private health care providers and their operations over the period 2003-2005. Panel data analysis includes control variables related to market, operations, and management. Principal results indicate that: (1) private health care providers benefit from economies of scale; (2) self-funded health plans have better financial health; (3) spending on marketing does not have a significant impact on customer satisfaction in Brazil; (4) weak empirical evidence exists showing that good financial performance enhances customer's satisfaction.

  8. Systems-Level Smoking Cessation Activities by Private Health Plans

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    Sharon Reif, PhD


    Full Text Available IntroductionThe US Public Health Service urges providers to screen patients for smoking and advise smokers to quit. Yet, these practices are not widely implemented in clinical practice. This study provides national estimates of systems-level strategies used by private health insurance plans to influence provider delivery of smoking cessation activities.MethodsData are from a nationally representative survey of health plans for benefit year 2003, across product types offered by insurers, including health maintenance organizations (HMOs, preferred provider organizations, and point-of-service products, regarding alcohol, tobacco, drug, and mental health services. Executive directors of 368 health plans responded to the administrative module (83% response rate. Medical directors of 347 of those health plans, representing 771 products, completed the clinical module in which health plan respondents were asked about screening for smoking, guideline distribution, and incentives for guideline adherence.ResultsOnly 9% of products require, and 12% verify, that primary care providers (PCPs screen for smoking. HMOs are more likely than other product types to require screening. Only 17% of products distribute smoking cessation guidelines to PCPs, and HMOs are more likely to do this. Feedback to PCPs was most frequently used to encourage guideline adherence; financial incentives were rarely used. Furthermore, health plans that did require screening often conducted other cessation activities.ConclusionFew private health plans have adopted techniques to encourage the use of smoking cessation activities by their providers. Increasing health plan involvement is necessary to reduce tobacco use and concomitant disease in the United States.

  9. Performance of private sector health care: implications for universal health coverage. (United States)

    Morgan, Rosemary; Ensor, Tim; Waters, Hugh


    Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers-including their size, objectives, and technical competence-the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole.

  10. How Has the Affordable Care Act Affected Health Insurers' Financial Performance? (United States)

    Hall, Mark A; McCue, Michael J


    Starting in 2014, the Affordable Care Act transformed the market for individual health insurance by changing how insurance is sold and by subsidizing coverage for millions of new purchasers. Insurers, who had no previous experience under these market conditions, competed actively but faced uncertainty in how to price their products. This issue brief uses newly available data to understand how health insurers fared financially during the ACA's first year of full reforms. Overall, health insurers' financial performance began to show some strain in 2014, but the ACA's reinsurance program substantially buffered the negative effects for most insurers. Although a quarter of insurers did substantially worse than others, experience under the new market rules could improve the accuracy of pricing decisions in subsequent years.

  11. Landscape and Health: Connecting Psychology, Aesthetics, and Philosophy through the Concept of Affordance. (United States)

    Menatti, Laura; Casado da Rocha, Antonio


    In this paper we address a frontier topic in the humanities, namely how the cultural and natural construction that we call landscape affects well-being and health. Following an updated review of evidence-based literature in the fields of medicine, psychology, and architecture, we propose a new theoretical framework called "processual landscape," which is able to explain both the health-landscape and the medical agency-structure binomial pairs. We provide a twofold analysis of landscape, from both the cultural and naturalist points of view: in order to take into account its relationship with health, the definition of landscape as a cultural product needs to be broadened through naturalization, grounding it in the scientific domain. Landscape cannot be distinguished from the ecological environment. For this reason, we naturalize the idea of landscape through the notion of affordance and Gibson's ecological psychology. In doing so, we stress the role of agency in the theory of perception and the health-landscape relationship. Since it is the result of continuous and co-creational interaction between the cultural agent, the biological agent and the affordances offered to the landscape perceiver, the processual landscape is, in our opinion, the most comprehensive framework for explaining the health-landscape relationship. The consequences of our framework are not only theoretical, but ethical also: insofar as health is greatly affected by landscape, this construction represents something more than just part of our heritage or a place to be preserved for the aesthetic pleasure it provides. Rather, we can talk about the right to landscape as something intrinsically linked to the well-being of present and future generations.

  12. [Private health insurance systems, constitution and the right to receive an equitable health care]. (United States)

    Zúñiga F, Alejandra


    This paper analyzes the constitutional problems that the private health system has faced as a result of the recent decisions of the Constitutional Court and the Supreme Court of Chile in defense of the right to health care and nondiscrimination. It also reviews the comparative literature on health systems that have been successful in the task of reconciling the demands of equity and efficiency in the delivery of health care in the private health sector, in accordance with the constitutional principles of equality and nondiscrimination.

  13. Comparing Individual Health Coverage On and Off the Affordable Care Act's Insurance Exchanges. (United States)

    McCue, Michael J; Hall, Mark A


    The new health insurance exchanges are the core of the Affordable Care Act's (ACA) reforms, but how the law improves the nonsubsidized portion of the individual market is also important. This issue brief compares products sold on and off the exchanges to gain insight into how the ACA's market reforms are functioning. Initial concerns that insurers might seek to enroll lower-risk customers outside the exchanges have not been realized. Instead, more-generous benefit plans, which appeal to people with health problems, constitute a greater portion of plans sold off-exchange than those sold on-exchange. Although insur­ers that sell mostly on the exchanges incur an additional fee, they still devote a greater portion of their premium dollars to medical care. Their projected admin­istrative costs and profit margins are lower than are those of insurers selling only off the exchanges.

  14. An Evidence Roadmap for Implementation of Integrated Behavioral Health under the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Bethany M. Kwan


    Full Text Available The Affordable Care Act (ACA created incentives and opportunities to redesign health care to better address mental and behavioral health needs. The integration of behavioral health and primary care is increasingly viewed as an answer to address such needs, and it is advisable that evidence-based models and interventions be implemented whenever possible with fidelity. At the same time, there are few evidence-based models, especially beyond depression and anxiety, and thus further research and evaluation is needed. Resources being allocated to adoption of models of integrated behavioral health care (IBHC should include quality improvement, evaluation, and translational research efforts using mixed methodology to enhance the evidence base for IBHC in the context of health care reform. This paper covers six key aspects of the evidence for IBHC, consistent with mental and behavioral health elements of the ACA related to infrastructure, payments, and workforce. The evidence for major IBHC models is summarized, as well as evidence for targeted populations and conditions, education and training, information technology, implementation, and cost and sustainability.

  15. Affordable Care Act (ACA) (United States)

    Social Security Administration — The Affordable Care Act (ACA) is a federal statute enacted with a goal of increasing the quality and affordability of health insurance. Through a web service, CMS...

  16. Critical Anthropology of Global Health "takes a stand" statement: a critical medical anthropological approach to the U.S.'s Affordable Care Act. (United States)

    Horton, Sarah; Abadía, Cesar; Mulligan, Jessica; Thompson, Jennifer Jo


    The Affordable Care Act (ACA) of 2010--the U.S.'s first major health care reform in over half a century-has sparked new debates in the United States about individual responsibility, the collective good, and the social contract. Although the ACA aims to reduce the number of the uninsured through the simultaneous expansion of the private insurance industry and government-funded Medicaid, critics charge it merely expands rather than reforms the existing fragmented and costly employer-based health care system. Focusing in particular on the ACA's individual mandate and its planned Medicaid expansion, this statement charts a course for ethnographic contributions to the on-the-ground impact of the ACA while showcasing ways critical medical anthropologists can join the debate. We conclude with ways that anthropologists may use critiques of the ACA as a platform from which to denaturalize assumptions of "cost" and "profit" that underpin the global spread of market-based medicine more broadly.

  17. The Patient Protection and Affordable Care Act and Utilization of Preventive Health Care Services

    Directory of Open Access Journals (Sweden)

    Victor Eno


    Full Text Available We examined how (a health insurance coverage, and (b familiarity with the Patient Protection and Affordable Care Act (ACA’s or ObamaCare mandate of cost-free access to preventive health services, affect the use of preventive services by residents of a minority community. It was based on primary data collected from a survey conducted during March to April 2012 among a sample of self-identified African American adults in Tallahassee-Leon County area of northwest Florida. The Statistical Package for the Social Sciences (SPSS Version 22 was used for running frequency analysis on the data set and multivariable regression modeling. The results showed that of 524 respondents, 382 (73% had health insurance while 142 (27% lacked insurance. Majority of insured respondents, 332 (87%, used preventive health services. However, the remaining 13% of respondents did not use preventive services because they were unfamiliar with the ACA provision of free access to preventive services for insured people. Regression analysis showed a high (91.04% probability that, among the insured, the use of preventive health services depended on the person’s age, income, and education. For uninsured residents, the lack of health insurance was the key reason for non-use of preventive health services, while among the insured, lack of knowledge about the ACA benefit of free access contributed to non-use of preventive services. Expansion of Medicaid eligibility can increase insurance coverage rates among African Americans and other minority populations. Health promotion and awareness campaigns about the law’s benefits by local and state health departments can enhance the use of preventive services.

  18. Mobile Health for All: Public-Private Partnerships Can Create a New Mental Health Landscape. (United States)

    Ben-Zeev, Dror


    Research has already demonstrated that different mHealth approaches are feasible, acceptable, and clinically promising for people with mental health problems. With a robust evidence base just over the horizon, now is the time for policy makers, researchers, and the private sector to partner in preparation for the near future. The Lifeline Assistance Program is a useful model to draw from. Created in 1985 by the U.S. Federal Communications Commission (FCC), Lifeline is a nationwide program designed to help eligible low-income individuals obtain home phone and landline services so they can pursue employment, reach help in case of emergency, and access social services and healthcare. In 2005, recognizing the broad shift towards mobile technology and mobile-cellular infrastructure, the FCC expanded the program to include mobile phones and data plans. The FCC provides a base level of federal support, but individual states are responsible for regional implementation, including engagement of commercial mobile phone carriers. Given the high rates of disability and poverty among people with severe mental illness, many are eligible to benefit from Lifeline and research has shown that a large proportion does in fact use this program to obtain a mobile phone and data plan. In the singular area of mobile phone use, the gap between people with severe mental illness and the general population in the U.S. is vanishing. Strategic multi-partner programs will be able to grant access to mHealth for mental health programs to those who will not be able to afford them-arguably, the people who need them the most. Mobile technology manufacturing costs are dropping. Soon all mobile phones in the marketplace, including the more inexpensive devices that are made available through subsidy programs, will have "smart" capabilities (ie, internet connectivity and the capacity to host apps). Programs like Lifeline could be expanded to include mHealth resources that capitalize on "smart" functions

  19. 77 FR 31513 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans... (United States)


    ... HUMAN SERVICES 45 CFR Parts 155, 156, and 157 RIN 0938-AQ67 Patient Protection and Affordable Care Act... Federal Register on March 27, 2012, entitled ``Patient Protection and Affordable Care Act; Establishment... rule regarding the codification of section 1413(c) of the Affordable Care Act. To align the...

  20. Health Education Specialists' Knowledge, Attitudes, and Perceptions of the Patient Protection and Affordable Care Act. (United States)

    Strong, Jessica; Hanson, Carl L; Magnusson, Brianna; Neiger, Brad


    The changing landscape of health care as a result of the Patient Protection and Affordable Care Act (ACA) may provide new opportunities for health education specialists (HES). The purpose of this study was to survey HES in the United States on their knowledge and attitudes of the ACA and assess their perceptions of job growth under the law. A random sample of 220 (36% response rate) certified HES completed a 53-item cross sectional survey administered online through Qualtrics. Findings were compared to public opinion on health care reform. HES are highly favorable of the law (70%) compared to the general public (23%). A total of 85% of respondents were able to list a provision of the ACA, and most (81%) thought the ACA would be successful at increasing insured Americans. Over half (64.6%) believe job opportunities will increase. Those who viewed the law favorably were significantly more likely to score better on a knowledge scale related to the ACA. HES understand publicized provisions but are uncertain about common myths and specific provisions related to Title IV, "Prevention of Chronic Disease and Improving Public Health." Directed and continuing education to HES regarding the ACA is warranted.

  1. Buying best value health care: Evolution of purchasing among Australian private health insurers. (United States)

    Willcox, Sharon


    Since 1995 Australian health insurers have been able to purchase health services pro-actively through negotiating contracts with hospitals, but little is known about their experience of purchasing. This paper examines the current status of purchasing through interviews with senior managers representing all Australian private health insurers. Many of the traditional tools used to generate competition and enhance efficiency (such as selective contracting and co-payments) have had limited use due to public and political opposition. Adoption of bundled case payment models using diagnosis related groups (DRGs) has been slow. Insurers cite multiple reasons including poor understanding of private hospital costs, unfamiliarity with DRGs, resistance from the medical profession and concerns about premature discharge. Innovation in payment models has been limited, although some insurers are considering introduction of volume-outcome purchasing and pay for performance incentives. Private health insurers also face a complex web of regulation, some of which appears to impede moves towards more efficient purchasing.

  2. Tax incentives and the demand for private health insurance. (United States)

    Stavrunova, Olena; Yerokhin, Oleg


    We analyze the effect of an individual insurance mandate (Medicare Levy Surcharge) on the demand for private health insurance (PHI) in Australia. With administrative income tax return data, we show that the mandate has several distinct effects on taxpayers' behavior. First, despite the large tax penalty for not having PHI coverage relative to the cost of the cheapest eligible insurance policy, compliance with mandate is relatively low: the proportion of the population with PHI coverage increases by 6.5 percentage points (15.6%) at the income threshold where the tax penalty starts to apply. This effect is most pronounced for young taxpayers, while the middle aged seem to be least responsive to this specific tax incentive. Second, the discontinuous increase in the average tax rate at the income threshold created by the policy generates a strong incentive for tax avoidance which manifests itself through bunching in the taxable income distribution below the threshold. Finally, after imposing some plausible assumptions, we extrapolate the effect of the policy to other income levels and show that this policy has not had a significant impact on the overall demand for private health insurance in Australia.

  3. Assuring Access to Affordable Coverage (United States)

    U.S. Department of Health & Human Services — Under the Affordable Care Act, millions of uninsured Americans will gain access to affordable coverage through Affordable Insurance Exchanges and improvements in...

  4. Africa's health: could the private sector accelerate the progress towards health MDGs? (United States)


    Background Out of 1.484 billion disability-adjusted life years lost globally in 2008, 369.1 million (25%) were lost in the WHO African Region. Despite the heavy disease burden, the majority of countries in the Region are not on track to achieve Millennium Development Goals (MDG) 4 (reducing child mortality), 5 (improving maternal health), and 6 (combating HIV/AIDS, malaria and other diseases). This article provides an overview of the state of public health, summarizes 2010-2015 WHO priorities, and explores the role that private sector could play to accelerate efforts towards health MDGs in the African Region. Discussion Of the 752 total resolutions adopted by the WHO Regional Committee for Africa (RC) between years 1951 and 2010, 45 mention the role of the private sector. We argue that despite the rather limited role implied in RC resolutions, the private sector has a pivotal role in supporting the achievement of health MDGs, and articulating efforts with 2010-2015 priorities for WHO in the African Region: provision of normative and policy guidance as well as strengthening partnerships and harmonization; supporting the strengthening of health systems based on the Primary Health Care approach; putting the health of mothers and children first; accelerating actions on HIV/AIDS, malaria and tuberculosis; intensifying the prevention and control of communicable and noncommunicable diseases; and accelerating response to the determinants of health. Conclusion The very high maternal and children mortality, very high burden of communicable and non-communicable diseases, health systems challenges, and inter-sectoral issues related to key determinants of health are too heavy for the public sector to address alone. Therefore, there is clear need for the private sector, given its breadth, scope and size, to play a more significant role in supporting governments, communities and partners to develop and implement national health policies and strategic plans; strengthen health

  5. Public health service options for affordable and accessible noncommunicable disease and related chronic disease prevention and management

    Directory of Open Access Journals (Sweden)

    Brownie S


    Full Text Available Sharon Brownie,1,2 Andrew P Hills,3,4 Rachel Rossiter51Workforce and Health Services, Griffith Health, Griffith University, Gold Coast, QLD, Australia; 2Oxford PRAXIS Forum, Green Templeton College, Oxford University, Oxford, United Kingdom; 3Allied Health Research, Mater Research Institute – The University of Queensland and Mater Mothers' Hospital, South Brisbane, QLD, Australia; 4Griffith Health Institute, Griffith Health, Griffith University, Gold Coast, QLD, Australia; 5MMHN and Nurse Practitioner Programs, School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, AustraliaAbstract: Globally, nations are confronted with the challenge of providing affordable health services to populations with increasing levels of noncommunicable and chronic disease. Paradoxically, many nations can both celebrate increases in life expectancy and bemoan parallel increases in chronic disease prevalence. Simply put, despite living longer, not all of that time is spent in good health. Combined with factors such as rising levels of obesity and related noncommunicable disease, the demand for health services is requiring nations to consider new models of affordable health care. Given the level of disease burden, all staff, not just doctors, need to be part of the solution and encouraged to innovate and deliver better and more affordable health care, particularly preventative primary health care services. This paper draws attention to a range of exemplars to encourage and stimulate readers to think beyond traditional models of primary health service delivery. Examples include nurse-led, allied health-led, and student-led clinics; student-assisted services; and community empowerment models. These are reported for the interest of policy makers and health service managers involved in preventative and primary health service redesign initiatives.Keywords: primary health care planning, community health care, nurse-led clinics, allied health personnel

  6. Which moral hazard? Health care reform under the Affordable Care Act of 2010. (United States)

    Mendoza, Roger Lee


    Purpose - Moral hazard is a concept that is central to risk and insurance management. It refers to change in economic behavior when individuals are protected or insured against certain risks and losses whose costs are borne by another party. It asserts that the presence of an insurance contract increases the probability of a claim and the size of a claim. Through the US Affordable Care Act (ACA) of 2010, this study seeks to examine the validity and relevance of moral hazard in health care reform and determine how welfare losses or inefficiencies could be mitigated. Design/methodology/approach - This study is divided into three sections. The first contrasts conventional moral hazard from an emerging or alternative theory. The second analyzes moral hazard in terms of the evolution, organization, management, and marketing of health insurance in the USA. The third explains why and how salient reform measures under the ACA might induce health care consumption and production in ways that could either promote or restrict personal health and safety as well as social welfare maximization. Findings - Insurance generally induces health care (over) consumption. However, not every additional consumption, with or without adverse selection, can be considered wasteful or risky, even if it might cost insurers more in the short run. Moral hazard can generate welfare and equity gains. These gains might vary depending on which ACA provisions, insured population, covered illnesses, treatments, and services, as well as health outcomes are taken into account, and because of the relative ambiguities surrounding definitions of "health." Actuarial risk models can nonetheless benefit from incorporating welfare and equity gains into their basic assumptions and estimations. Originality/value - This is the first study which examines the ACA in the context of the new or alternative theory of moral hazard. It suggests that containing inefficient moral hazard, and encouraging its desirable

  7. Storing and using health data in a virtual private cloud. (United States)

    Regola, Nathan; Chawla, Nitesh V


    Electronic health records are being adopted at a rapid rate due to increased funding from the US federal government. Health data provide the opportunity to identify possible improvements in health care delivery by applying data mining and statistical methods to the data and will also enable a wide variety of new applications that will be meaningful to patients and medical professionals. Researchers are often granted access to health care data to assist in the data mining process, but HIPAA regulations mandate comprehensive safeguards to protect the data. Often universities (and presumably other research organizations) have an enterprise information technology infrastructure and a research infrastructure. Unfortunately, both of these infrastructures are generally not appropriate for sensitive research data such as HIPAA, as they require special accommodations on the part of the enterprise information technology (or increased security on the part of the research computing environment). Cloud computing, which is a concept that allows organizations to build complex infrastructures on leased resources, is rapidly evolving to the point that it is possible to build sophisticated network architectures with advanced security capabilities. We present a prototype infrastructure in Amazon's Virtual Private Cloud to allow researchers and practitioners to utilize the data in a HIPAA-compliant environment.

  8. Effects of the Affordable Care Act on Consumer Health Care Spending and Risk of Catastrophic Health Costs. (United States)

    Nowak, Sarah A; Eibner, Christine; Adamson, David M; Saltzman, Evan


    This study examines the likely effects of the Affordable Care Act (ACA) on average annual consumer health care spending and the risk of catastrophic medical costs for the United States overall and in two large states that have decided not to expand their Medicaid programs (Texas and Florida). The ACA will have varied impacts on individuals' and families' spending on health care, depending on income level and on estimated 2016 insurance status without the ACA. The authors find that average out-of-pocket spending is expected to decrease for all groups considered in the analysis, although decreases in out-of-pocket spending will be largest for those who would otherwise be uninsured. People who would otherwise be uninsured who transition to the individual market under the ACA will have higher total health care spending on average after implementation of the ACA because they will now incur the cost of health insurance premiums. The authors also find that risk of catastrophic health care spending will decrease for individuals of all income levels for the insurance transitions considered; decreases will be greatest for those at the lowest income levels. Case studies found that in Texas and Florida, Medicaid expansion would substantially reduce out-of-pocket and total health care spending for those with incomes below 100 percent of the federal poverty level, compared with a scenario in which the ACA is implemented without Medicaid expansion. Expansion would reduce the risk of high medical spending for those covered under Medicaid who would remain uninsured without expansion.

  9. Artemisinin combination therapies price disparity between government and private health sectors and its implication on antimalarial drug consumption pattern in Morogoro Urban District, Tanzania

    Directory of Open Access Journals (Sweden)

    Malisa Allen


    Full Text Available Abstract Background Universal access to effective treatments is a goal of the Roll Back Malaria Partnership. However, despite official commitments and substantial increases in financing, this objective remains elusive, as development assistance continue to be routed largely through government channels, leaving the much needed highly effective treatments inaccessible or unaffordable to those seeking services in the private sector. Methods To quantify the effect of price disparity between the government and private health systems, this study have audited 92 government and private Drug Selling Units (DSUs in Morogoro urban district in Tanzania to determine the levels, trend and consumption pattern of antimalarial drugs in the two health systems. A combination of observation, interviews and questionnaire administered to the service providers of the randomly selected DSUs were used to collect data. Results ALU was the most selling antimalarial drug in the government health system at a subsidized price of 300 TShs (0.18 US$. By contrast, ALU that was available in the private sector (coartem was being sold at a price of about 10,000 TShs (5.9 US$, the price that was by far unaffordable, prompting people to resort to cheap but failed drugs. As a result, metakelfin (the phased out drug was the most selling drug in the private health system at a price ranging from 500 to 2,000 TShs (0.29–1.18 US$. Conclusions In order for the prompt diagnosis and treatment with effective drugs intervention to have big impact on malaria in mostly low socioeconomic malaria-endemic areas of Africa, inequities in affordability and access to effective treatment must be eliminated. For this to be ensued, subsidized drugs should be made available in both government and private health sectors to promote a universal access to effective safe and affordable life saving antimalarial drugs.

  10. Innovative health service delivery models in low and middle income countries - what can we learn from the private sector?

    Directory of Open Access Journals (Sweden)

    Daar Abdallah S


    Full Text Available Abstract Background The poor in low and middle income countries have limited access to health services due to limited purchasing power, residence in underserved areas, and inadequate health literacy. This produces significant gaps in health care delivery among a population that has a disproportionately large burden of disease. They frequently use the private health sector, due to perceived or actual gaps in public services. A subset of private health organizations, some called social enterprises, have developed novel approaches to increase the availability, affordability and quality of health care services to the poor through innovative health service delivery models. This study aims to characterize these models and identify areas of innovation that have led to effective provision of care for the poor. Methods An environmental scan of peer-reviewed and grey literature was conducted to select exemplars of innovation. A case series of organizations was then purposively sampled to maximize variation. These cases were examined using content analysis and constant comparison to characterize their strategies, focusing on business processes. Results After an initial sample of 46 studies, 10 case studies of exemplars were developed spanning different geography, disease areas and health service delivery models. These ten organizations had innovations in their marketing, financing, and operating strategies. These included approaches such a social marketing, cross-subsidy, high-volume, low cost models, and process reengineering. They tended to have a narrow clinical focus, which facilitates standardizing processes of care, and experimentation with novel delivery models. Despite being well-known, information on the social impact of these organizations was variable, with more data on availability and affordability and less on quality of care. Conclusions These private sector organizations demonstrate a range of innovations in health service delivery that have

  11. Public and private health insurance in Germany: the ignored risk selection problem. (United States)

    Grunow, Martina; Nuscheler, Robert


    We investigate risk selection between public and private health insurance in Germany. With risk-rated premiums in the private system and community-rated premiums in the public system, advantageous selection in favor of private insurers is expected. Using 2000 to 2007 data from the German Socio-Economic Panel Study (SOEP), we find such selection. While private insurers are unable to select the healthy upon enrollment, they profit from an increase in the probability to switch from private to public health insurance of those individuals who have experienced a negative health shock. To avoid distorted competition between the two branches of health care financing, risk-adjusted transfers from private to public insurers should be instituted.

  12. Women's Use of Private and Government Health Facilities for Childbirth in Nairobi's Informal Settlements


    Bazant, Eva S.; Koenig, Michael A; Fotso, Jean-Christophe; Mills, Samuel


    The private sector's role in increasing the use of maternal health care for the poor in developing countries has received increasing attention, yet few data exist for urban slums. Using household-survey data from 1,926 mothers in two informal settlements in Nairobi, Kenya, collected in 2006, we describe and examine the factors associated with women's use of private and government health facilities for childbirth. More women gave birth at private facilities located in the settlements than at g...

  13. Demand for Private Health Insurance Where Public Health Services are Free: The Case of Malawi (United States)

    Makoka, Donald; Kaluwa, Ben; Kambewa, Patrick

    This study assesses the determinants of demand for private health insurance among formal sector employees in Malawi using a multinomial logit. We examine membership in the three different schemes of Medical Aid Society of Malawi`s (MASM), which was the only health insurance provider at the time of the study. The results indicate that formal sector employees prefer to receive medical treatment from private health facilities, but lack of access to information prevents many from becoming insured. Further, the probability of enrolling in any of MASM`s schemes increases with income and with age for the top and minimum schemes. More children and good health status reduce the probability of enrolling into the two lower schemes. Policies that improve access to information and income among the target group are likely to increase demand for MASM schemes.

  14. Bridging gaps in discovery and development: chemical and biological sciences for affordable health, wellness and sustainability. (United States)

    Chauhan, Prem Man Singh


    To commemorate 2011 as the International Year of Chemistry, the Indian Society of Chemists and Biologists organized its 15th International Conference on 'Bridging Gaps in Discovery and Development: Chemical and Biological Sciences for Affordable Health, Wellness and Sustainability' at Hotel Grand Bhagwati, in association with Saurashtra University, Rajkot, India. Anamik Shah, President of the Indian Society of Chemists and Biologists, was organizing secretary of the conference. Nicole Moreau, President of the International Union of Pure and Applied Chemistry and Secretary General of the Comité National de la Chimie, National Centre for Scientific Research France, was chief guest of the function. The four-day scientific program included 52 plenary lectures, 24 invited lectures by eminent scientists in the field and 12 oral presentations. A total of 317 posters were presented by young scientists and PhD students in three different poster sessions. Approximately 750 delegates from India, the USA, UK, France, Switzerland, Germany, Austria, Belgium, Sweden, Japan and other countries attended the conference. The majority of the speakers gave presentations related to their current projects and areas of interest and many of the talks covered synthesis, structure-activity relationships, current trends in medicinal chemistry and drug research.

  15. Convergent innovation for sustainable economic growth and affordable universal health care: innovating the way we innovate. (United States)

    Dubé, Laurette; Jha, Srivardhini; Faber, Aida; Struben, Jeroen; London, Ted; Mohapatra, Archisman; Drager, Nick; Lannon, Chris; Joshi, P K; McDermott, John


    This paper introduces convergent innovation (CI) as a form of meta-innovation-an innovation in the way we innovate. CI integrates human and economic development outcomes, through behavioral and ecosystem transformation at scale, for sustainable prosperity and affordable universal health care within a whole-of-society paradigm. To this end, CI combines technological and social innovation (including organizational, social process, financial, and institutional), with a special focus on the most underserved populations. CI takes a modular approach that convenes around roadmaps for real world change-a portfolio of loosely coupled complementary partners from the business community, civil society, and the public sector. Roadmaps serve as collaborative platforms for focused, achievable, and time-bound projects to provide scalable, sustainable, and resilient solutions to complex challenges, with benefits both to participating partners and to society. In this paper, we first briefly review the literature on technological innovation that sets the foundations of CI and motivates its feasibility. We then describe CI, its building blocks, and enabling conditions for deployment and scaling up, illustrating its operational forms through examples of existing CI-sensitive innovation.

  16. Health-based risk neutralization in private disability insurance (United States)

    Buitenhuis, Jan; Brouwer, Sandra; van der Klink, Jac J.L.; de Boer, Michiel R.


    Background: Exclusions are used by insurers to neutralize higher than average risks of sickness absence (SA). However, differentiating risk groups according to one’s medical situation can be seen as discrimination against people with health problems in violation of a 2006 United Nations convention. The objective of this study is to investigate whether the risk of SA of insured persons with exclusions added to their insurance contract differs from the risk of persons without exclusions. Methods: A dynamic cohort of 15 632 applicants for private disability insurance at a company insuring only college and university educated self-employed in the Netherlands. Mean follow-up was 8.94 years. Duration and number of SA periods were derived from insurance data to calculate the hazard of SA periods and of recurrence of SA periods. Results: Self-employed with an exclusion added to their insurance policy experienced a higher hazard of one or more periods of SA and on average more SA days than self-employed without an exclusion. Conclusion: Persons with an exclusion had a higher risk of SA than persons without an exclusion. The question to what extent an individual should benefit from being less vulnerable to disease and SA must be addressed in a larger societal context, taking other aspects of health inequality and solidarity into account as well. PMID:27371668

  17. Private well water in Colorado: collaboration, data use, and public health outreach. (United States)

    Brown, Eric M; Van Dyke, Mike; Kuhn, Stephanie; Mitchell, Jane; Dalton, Hope


    As a result of participating in the Centers for Disease Control and Prevention's Private Well Initiative and Environmental Public Health Tracking Network (Tracking), the Colorado Department of Public Health and Environment was able to inventory private well water quality data, prioritize potential health concerns associated with drinking water from these wells, and create a Web portal for sharing public health information regarding private well water. The Colorado Department of Public Health and Environment collaborated with a local health department to pilot the project prior to a public implementation. Approximately 18 data sets were identified and inventoried. The Colorado Department of Public Health and Environment also participated in development and pilot testing of best practices for display of well water quality data with other Tracking states. Available data sets were compiled and summarized, and the data made available on the Colorado Tracking portal using geographic information system technology to support public health outreach regarding private wells.


    Directory of Open Access Journals (Sweden)

    Lana Kordić


    Full Text Available Health care systems face pressure to increase the quality of health care at the same time with pressure to reduce public spending. The attempt to overcome the gap between needs and opportunities can be resolved through the introduction of public-private partnerships. Goals of this study are to investigate variation of the number, form and efficiency of private providers of general/family medicine services in primary health care and the contribution of socioeconomic and demographic environment on those variations, among counties. Socioeconomic and demographic factors are identified as independent variables that influence the health care need and utilization and consequently the decision of private entities to engage in the provision of health care services. This study extended previous studies because it has introduced socioeconomic and demographic variables. This may shed same new lights on the relationship between private providers of health service and efficiency of providing health service in primary health care.

  19. The Affordable Care Act's implications for a public health workforce agenda: taxonomy, enumeration, and the Standard Occupational Classification system. (United States)

    Montes, J Henry; Webb, Susan C


    The Affordable Care Act brings a renewed emphasis on the importance of public health services and those whose occupations are defined by performing the essential public health functions. The Affordable Care Act Prevention and Public Health Fund is a signal to the field that its work is important and critical to the health of the nation. Recent reports by the Institute of Medicine describe the changing dimensions of public health work in primary care integration and the need for enhanced financing of public health as investment. Gaining knowledge about the public health workforce, that is, how many workers there are and what they are doing, is of growing interest and concern for the field. Although enumeration of the public health workforce has been attempted several times by the federal government beginning as early as 1982, it was not until the year 2000 that a major effort was undertaken to obtain more complete information. Limitations that hampered Enumeration 2000 have persisted however. With implementation of the Affordable Care Act and other new ventures, key federal agencies are developing strategies to pursue a systemic and systematic enumeration and consistent taxonomy process. Included in these efforts is use of the Bureau of Labor Statistics, Standard Occupational Classification system. A clear and accurate understanding of the public health workforce and its characteristics is a major challenge. A well-constructed, systematic enumeration process can add to our understanding of the nature and functions of that workforce. In addition, discussion of enumeration must include the need for a consensus within the field that leads to a consistent taxonomy for the public health occupations. This article will provide a stage-setting brief of historical actions regarding enumeration, and it will examine selected enumeration activities taking place currently. It will discuss positive and negative implications facing public health and the potential for enhancing the

  20. Roundtable discussion: what is the future role of the private sector in health? (United States)


    Background The role for the private sector in health remains subject to much debate, especially within the context of achieving universal health coverage. This roundtable discussion offers diverse perspectives from a range of stakeholders – a health funder, a representative from an implementing organization, a national-level policy-maker, and an expert working in a large multi-national company – on what the future may hold for the private sector in health. Discussion The first perspective comes from a health funder, who argues that the discussion about the future role of the private sector has been bogged down in language. He argues for a ‘both/and’ approach rather than an ‘either/or’ when it comes to talking about health service provision in low- and middle-income countries. The second perspective is offered by an implementer of health insurance in sub-Saharan Africa. The piece examines the comparative roles of public sector actors, private sector actors and funding agencies, suggesting that they must work together to mobilize domestic resources to fund and deliver health services in the longer term. Thirdly, a special advisor working in the federal government of Nigeria considers the situation in that country. He notes that the private sector plays a significant role in funding and delivering health services there, and that the government must engage the private sector or forever be left behind. Finally, a representative from a multi-national pharmaceutical corporation gives an overview of global shifts that are creating opportunities for the private sector in health markets. Summary Overall, the roundtable discussants agree that the private sector will play an important role in future health systems. But we must agree a common language, work together, and identify key issues and gaps that might be more effectively filled by the private sector. PMID:24961806

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

    Directory of Open Access Journals (Sweden)

    Joanne Yoong

    Full Text Available BACKGROUND: 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. METHODOLOGY/PRINCIPAL FINDINGS: 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. CONCLUSIONS/SIGNIFICANCE: 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

  2. Occupational Stress and Mental Health of Employees of a Petrochemical Company before and after Privatization

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    A Mahdad


    Full Text Available Background: Many countries make many of their governmental sectors private. This transition, however, may affect their employees in numerous ways.Objective: To determine the level of occupational stress and mental health of employees of a petrochemical company in Isfahan, Central Iran, before and 3 months after privatization.Methods: Out of the 700 employees of the studied company, using a stratified random sampling technique, 140 persons were selected. We used Steinmetz occupational stress and GHQ-28 questionnaires to determine the level of stress and mental health status of participants.Results: The reliability of the questionnaires used was acceptable (Chronbach alpha coefficients: 0.85 and 0.86, respectively. Job stress level was significantly increased 3 months after privatization; the mean±SD job stress score before and after privatization were 22.9±10.43 and 28.3±12.25, respectively (p<0.001. The mean±SD mental health score after privatization (17.57±11.63 was also significantly (p<0.001 higher than that before the privatization (13.8±6.0. There was a significant (p<0.001 positive correlation between the mental health status score and job score (r=0.476.Conclusion: After privatization, the job stress of employees increased significantly. This increase was associated with a decrease in mental health. To lessen the side effects of privatization, the process should be performed cautiously.

  3. What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries. (United States)

    Mackintosh, Maureen; Channon, Amos; Karan, Anup; Selvaraj, Sakthivel; Cavagnero, Eleonora; Zhao, Hongwen


    Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners-both unlicensed and licensed-to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa.

  4. The affordances of broken affordances

    DEFF Research Database (Denmark)

    Grünbaum, Martin Gielsgaard; Simonsen, Jakob Grue


    important: how users may (i) achieve their goals in the presence of such broken affordances, and may (ii) repurpose or otherwise interact with artefacts with broken affordances. We argue that (A) thorough analyses of breakdowns of affordances and their associated signifiers and feedbacks have implication...

  5. Illegal private clinics: ideal health services choices among rural-urban migrants in China? (United States)

    Li, Yan


    The main purpose of this article is to explore the important issues and the role of illegal private clinics in health services access among rural-urban migrants in China. The function that illegal private clinics substantially play on the health among rural-urban migrants in China is rarely discussed in studies. A study on a migrant community in Beijing shows the disadvantaged status of health services choices and the constraints for access to health services among migrants. It argues that the existence of illegal private clinics provides a channel to migrants for medical services in the city and reflects the difficulties and high cost of providing medical services to migrants in urban public hospitals. Occasionally the illegal private clinics can cause danger to the health of migrants.

  6. 78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review (United States)


    ... opposite sex and same sex domestic partners; biological, adoptive, step, foster, and grandchildren (if... XXVII of the PHS Act. Section 1321(d) of the Affordable Care Act applies the same preemption principle... approach, the issuer would charge the same per- member premium for all family members of the same age...

  7. [The role of private insurance in public health care systems: conceptual framework and policies]. (United States)

    Rodríguez, M


    The structure of the health care system ans specifically the type and amount of the public and private mix is not a closed issue. This article provides and update of the arguments that justify public intervention in health, and emphasizes the failures of the private insurance market that call for mandatory universal health insurance, although that does not necessarily mean that state has to be the insurer. The relationship between both sectors and the variables determining the relative level of expenditure in both are also analyzed. Following the literature on the public provision of private goods, the level of expenditure in a democracy is seen to depend on the preferences of the median voter, where private insurance usually tops up public insurance. The key variable determining the decision to buy additional private insurance is the difference in quality, defined broadly, between both sectors. Concerning policies, the appropriateness of fiscal incentives to promote the uptake of private insurance is discussed and it is concluded that there is no clear evidence of its suitability. Also, it is argued that models in which the public and private sectors appear totally segregated or totally integrated are preferable to intermediate models, in which both sectors appear combined. Medical coverage bought by an informed agent in exchange for a capitation payment seems a better way to integrate the private sector than through a system of vouchers.

  8. Impacts of the Affordable Care Act dependent coverage provision on health-related outcomes of young adults. (United States)

    Barbaresco, Silvia; Courtemanche, Charles J; Qi, Yanling


    The first major insurance expansion of the Affordable Care Act - a provision requiring insurers to allow dependents to remain on parents' health insurance until turning 26 - took effect in September 2010. We estimate this mandate's impacts on numerous outcomes related to health care access, preventive care utilization, risky behaviors, and self-assessed health. We estimate difference-in-differences models with 23-25 year olds as the treatment group and 27-29 year olds as the control group. For the full sample, the dependent coverage provision increased the probabilities of having health insurance, a primary care doctor, and excellent self-assessed health, while reducing body mass index. However, the mandate also increased risky drinking and did not lead to any significant increases in preventive care utilization. Subsample analyses reveal particularly large gains for men and college graduates.

  9. Health outcomes and related effects of using social media in chronic disease management: a literature review and analysis of affordances. (United States)

    Merolli, Mark; Gray, Kathleen; Martin-Sanchez, Fernando


    Whilst the future for social media in chronic disease management appears to be optimistic, there is limited concrete evidence indicating whether and how social media use significantly improves patient outcomes. This review examines the health outcomes and related effects of using social media, while also exploring the unique affordances underpinning these effects. Few studies have investigated social media's potential in chronic disease, but those we found indicate impact on health status and other effects are positive, with none indicating adverse events. Benefits have been reported for psychosocial management via the ability to foster support and share information; however, there is less evidence of benefits for physical condition management. We found that studies covered a very limited range of social media platforms and that there is an ongoing propensity towards reporting investigations of earlier social platforms, such as online support groups (OSG), discussion forums and message boards. Finally, it is hypothesized that for social media to form a more meaningful part of effective chronic disease management, interventions need to be tailored to the individualized needs of sufferers. The particular affordances of social media that appear salient in this regard from analysis of the literature include: identity, flexibility, structure, narration and adaptation. This review suggests further research of high methodological quality is required to investigate the affordances of social media and how these can best serve chronic disease sufferers. Evidence-based practice (EBP) using social media may then be considered.

  10. Differences in public and private health services in a rural district of Malaysia. (United States)

    Aljunid, S M; Zwi, A B


    A cross-sectional study, comparing the nature of services in 15 private clinics and 6 public health facilities, was undertaken in a rural district of Malaysia. Semi-structured interviews and observations using check-lists were employed. Public health facilities were run by younger doctors (mean age = 31.1 years), supported mostly by trained staff. The private clinics were run by older doctors (mean age = 41.2 years) who had served the district for much longer (8.9 years vs 1.5 years) but were supported by less well trained staff. The curative services were the main strength of the private clinics but their provision of preventive care was less comprehensive and of inferior quality. Private clinics were inclined to provide more expensive diagnostic services than the public facilities. 'Short hours' private clinics had very restricted opening hours and offered limited range of services.

  11. Differences in essential newborn care at birth between private and public health facilities in eastern Uganda

    Directory of Open Access Journals (Sweden)

    Peter Waiswa


    Full Text Available Background: In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. Objective: To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Design: Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. Results: The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007. Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p<0.001. Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. Conclusions: In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was

  12. Measuring the effects of reducing subsidies for private insurance on public expenditure for health care. (United States)

    Cheng, Terence Chai


    This paper investigates the effects of reducing subsidies for private health insurance on public sector expenditure for hospital care. An econometric framework using simultaneous equation models is developed to analyse the interrelated decisions on the intensity and type of health care use and private insurance. The framework is applied to the context of the mixed public-private system in Australia. The simulation projections show that reducing premium subsidies is expected to generate net cost savings. This arises because the cost savings achieved from reducing subsidies are larger than the potential increase in public expenditure on hospital care.

  13. Private health insurance policies in Israel: a report on the 2012 Dead Sea Conference. (United States)

    Bin Nun, Gabi


    The private health insurance (commercial and supplementary health insurance) sector has undergone a revolutionary transformation in recent years, both in the number of individuals who own private plans, and in the financial scope of these plans. With these developments in the background, leaders of the Israeli healthcare system convened in December 2012 at the Dead Sea for a discussion on "Private healthcare insurance plans in Israel: Developments, concerns, and directions for a solution". This meeting report summarizes the main issues discussed at the conference.

  14. The use of data mining by private health insurance companies and customers' privacy. (United States)

    Al-Saggaf, Yeslam


    This article examines privacy threats arising from the use of data mining by private Australian health insurance companies. Qualitative interviews were conducted with key experts, and Australian governmental and nongovernmental websites relevant to private health insurance were searched. Using Rationale, a critical thinking tool, the themes and considerations elicited through this empirical approach were developed into an argument about the use of data mining by private health insurance companies. The argument is followed by an ethical analysis guided by classical philosophical theories-utilitarianism, Mill's harm principle, Kant's deontological theory, and Helen Nissenbaum's contextual integrity framework. Both the argument and the ethical analysis find the use of data mining by private health insurance companies in Australia to be unethical. Although private health insurance companies in Australia cannot use data mining for risk rating to cherry-pick customers and cannot use customers' personal information for unintended purposes, this article nonetheless concludes that the secondary use of customers' personal information and the absence of customers' consent still suggest that the use of data mining by private health insurance companies is wrong.

  15. Affordable Vehicle Avionics Overview (United States)

    Cockrell, James J.


    Public and private launch vehicle developers are reducing the cost of propulsion for small commercial launchers, but conventional high-performance, high-reliability avionics remain the disproportionately high cost driver for launch. AVA technology performs as well or better than conventional launch vehicle avionics, but with a fraction of the recurring costs. AVA enables small launch providers to offer affordable rides to LEO to nano-satellites as primary payloads meaning, small payloads can afford to specify their own launch and orbit parameters

  16. Public-Private Partnerships for Health Promotion: The Experiences of the S[superscript 5] Project (United States)

    Gold, J.; Hellard, M. E.; Lim, M. S.; Dixon, H.; Wakefield, M.; Aitken, C. K.


    There is increasing emphasis on involving the private sector in public health to harness the considerable resources and skills of the business world to address significant health issues. While such collaboration should be encouraged, the involvement of business in public health campaigns can raise unexpected challenges when the approaches and…

  17. Oral Health Status and Behaviour of Mauritians Visiting Private Dental Clinics (United States)

    Gunsam, P. Pugo; Banka, S.


    Purpose: This paper seeks to assess the oral health status and behaviour of a sample of the Mauritian population visiting private dental clinics. Design/methodology/approach: Oral health status was determined using the World Health Organization (Decayed, Missing, Filled Teeth (DMFT) index indicating the prevalence of caries, and factors associated…

  18. Healthy firms: constraints to growth among private health sector facilities in Ghana and Kenya.

    Directory of Open Access Journals (Sweden)

    Nicholas E Burger

    Full Text Available BACKGROUND: Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa, but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. METHODOLOGY/PRINCIPAL FINDINGS: We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent. Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent, accounting (Ghana: 45 percent; Kenya: 27 percent, and inventory control (Ghana: 41 percent; Kenya: 24 percent. A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. CONCLUSIONS/SIGNIFICANCE: The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to

  19. Treatment and prevention of malaria in pregnancy in the private health sector in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus;


    and prevention practices for malaria among pregnant women. The main study outcome was the proportion of private health facilities who prescribe treatment of fever among pregnant women as recommended in the guidelines. RESULTS: A total of 241 private health facilities were surveyed; 70.5 % were registered drug...... clinics and pharmacies for prevention of malaria in pregnancy. Few facilities had malaria treatment guidelines; (44.1 % of private clinics, 17.9 % of drug shops, and 41.7 % at pharmacies. Knowledge of people at risk of malaria, P = 0.02 and availability of malaria treatment guidelines, P = 0.03 were......BACKGROUND: Malaria in pregnancy is a major public health problem in Uganda; and it is the leading cause of anaemia among pregnant women and low birth weight in infants. Previous studies have noted poor quality of care in the private sector. Thus there is need to explore ways of improving quality...

  20. Why employers will continue to provide health insurance: the impact of the Affordable Care Act. (United States)

    Blumberg, Linda J; Buettgens, Matthew; Feder, Judith; Holahan, John


    The Congressional Budget Office, the Rand Corporation, and the Urban Institute have estimated that the Patient Protection and Affordable Care Act (ACA) will leave employer-sponsored coverage largely intact; in contrast, some economists and benefit consultants argue that the ACA encourages employers to drop coverage, thereby making both their workers and their firms better off (a "win-win" situation). This analysis shows that no such "win-win" situation exists and that employer-sponsored insurance will remain the primary source of coverage for most workers. Analysis of three issues-the terms of the ACA, worker characteristics, and the fundamental economics of competitive markets-supports this conclusion.

  1. Public health law: the constitutionality of the Patient Protection and Affordable Care Act. (United States)

    De Ville, Kenneth


    Congress of the Patient Protection and Affordable Care Act (PPACA) was immediately challenged by lawsuits attacking the constitutionality of the legislation. The lawsuits, joined by over 2 dozen state's attorney generals, contend that PPACA is an unconstitutional exercise of federal power. Specifically, the suits argue that the individual insurance mandate portion of the law is justified by neither the "Commerce Power" nor Congress' authority to "tax" and provide for "the general welfare." This essay outlines and analyzes the constitutional arguments for, and against, PPACA forecasting the likely resolution of the debate if the suits reach the US Supreme Court.

  2. Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program. (United States)

    Watnick, Suzanne; Weiner, Daniel E; Shaffer, Rachel; Inrig, Jula; Moe, Sharon; Mehrotra, Rajnish


    In addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

  3. Involving private health care providers in delivery of TB care: global strategy. (United States)

    Uplekar, Mukund


    Most poor countries have a large and growing private medical sector. Evidence suggests that a large proportion of tuberculosis patients in many high TB- burden countries first approach a private health care provider. Further, private providers manage a significant proportion of tuberculosis cases. Surprisingly though, there is virtually no published evidence on linking private providers to tuberculosis programmes. As a part of global efforts to control tuberculosis through effective DOTS implementation, the World Health Organization has recently begun addressing the issue of private providers in TB control through an evolving global strategy. As a first step, a global assessment of private providers' participation in tuberculosis programmes was undertaken. The findings of the assessment were discussed and debated in a consultation involving private practitioners, TB programme managers and policy makers. Their recommendations have contributed to the evolving global strategy called Public-Private Mix for DOTS implementation (PPM DOTS). This paper presents the guiding principles of PPM DOTS and major elements of the global strategy. These include: informed advocacy; setting-up "learning projects"; scaling-up successful projects and formulation of regional, national and local strategies; developing practical tools to facilitate PPM DOTS and pursuing an operational research agenda to help better design and shape PPM DOTS strategies. Encouraging results from some ongoing project sites are discussed. The paper concludes that concerted global efforts and local input are required for a sustained period to help achieve productive engagement of private practitioners in DOTS implementation. Such efforts have to be targeted as much towards national tuberculosis programmes as towards private providers and their associations. Continued apathy in this area could not only potentially delay achieving global targets for TB control but also undo, in the long run, the hard

  4. Introducing a model of cardiovascular prevention in Nairobi's slums by integrating a public health and private-sector approach: the SCALE-UP study

    Directory of Open Access Journals (Sweden)

    Steven van de Vijver


    Full Text Available Introduction: Cardiovascular disease (CVD is a leading cause of death in sub-Saharan Africa (SSA, with annual deaths expected to increase to 2 million by 2030. Currently, most national health systems in SSA are not adequately prepared for this epidemic. This is especially so in slum settlements where access to formal healthcare and resources is limited. Objective: To develop and introduce a model of cardiovascular prevention in the slums of Nairobi by integrating public health and private sector approaches. Study design: Two non-profit organizations that conduct public health research, Amsterdam Institute for Global Health and Development (AIGHD and African Population and Health Research Center (APHRC, collaborated with private-sector Boston Consulting Group (BCG to develop a service delivery package for CVD prevention in slum settings. A theoretic model was designed based on the integration of public and private sector approaches with the focus on costs and feasibility. Results: The final model includes components that aim to improve community awareness, a home-based screening service, patient and provider incentives to seek and deliver treatment specifically for hypertension, and adherence support. The expected outcomes projected by this model could prove potentially cost effective and affordable (1 USD/person/year. The model is currently being implemented in a Nairobi slum and is closely followed by key stakeholders in Kenya including the Ministry of Health, the World Health Organization (WHO, and leading non-governmental organizations (NGOs. Conclusion: Through the collaboration of public health and private sectors, a theoretically cost-effective model was developed for the prevention of CVD and is currently being implemented in the slums of Nairobi. If results are in line with the theoretical projections and first impressions on the ground, scale-up of the service delivery package could be planned in other poor urban areas in Kenya by

  5. Public vs private administration of rural health insurance schemes: a comparative study in Zhejiang of China. (United States)

    Zhou, Xiaoyuan; Mao, Zhengzhong; Rechel, Bernd; Liu, Chaojie; Jiang, Jialin; Zhang, Yinying


    Since 2003, China has experimented in some of the country's counties with the private administration of the New Cooperative Medical Scheme (NCMS), a publicly subsidized health insurance scheme for rural populations. Our study compared the effectiveness and efficiency of private vs public administration in four counties in one of China's most affluent provinces in the initial stage of the NCMS's implementation. The study was undertaken in Ningbo city of Zhejiang province. Out of 10 counties in Ningbo, two counties with private administration for the NCMS (Beilun and Ninghai) were compared with two others counties with public administration (Zhenhai and Fenghua), using the following indicators: (1) proportion of enrollees who were compensated for inpatient care; (2) average reimbursement-expense ratio per episode of inpatient care; (3) overall administration cost; (4) enrollee satisfaction. Data from 2004 to 2006 were collected from the local health authorities, hospitals and the contracted insurance companies, supplemented by a randomized household questionnaire survey covering 176 households and 479 household members. In our sample counties, private administration of the NCMS neither reduced transaction costs, nor improved the benefits of enrollees. Enrollees covered by the publicly administered NCMS were more likely to be satisfied with the insurance scheme than those covered by the privately administered NCMS. Experience in the selected counties suggests that private administration of the NCMS did not deliver the hoped-for results. We conclude that caution needs to be exercised in extending private administration of the NCMS.

  6. Preference heterogeneity and selection in private health insurance: the case of Australia. (United States)

    Buchmueller, Thomas C; Fiebig, Denzil G; Jones, Glenn; Savage, Elizabeth


    A basic prediction of theoretical models of insurance is that if consumers have private information about their risk of suffering a loss there will be a positive correlation between risk and the level of insurance coverage. We test this prediction in the context of the market for private health insurance in Australia. Despite a universal public system that provides comprehensive coverage for inpatient and outpatient care, roughly half of the adult population also carries private health insurance, the main benefit of which is more timely access to elective hospital treatment. Like several studies on different types of insurance in other countries, we find no support for the positive correlation hypothesis. Because strict underwriting regulations create strong information asymmetries, this result suggests the importance of multi-dimensional private information. Additional analyses suggest that the advantageous selection observed in this market is driven by the effect of risk aversion, the ability to make complex financial decisions and income.

  7. Prohibit, constrain, encourage, or purchase: how should we engage with the private health-care sector? (United States)

    Montagu, Dominic; Goodman, Catherine


    The private for-profit sector's prominence in health-care delivery, and concern about its failures to deliver social benefit, has driven a search for interventions to improve the sector's functioning. We review evidence for the effectiveness and limitations of such private sector interventions in low-income and middle-income countries. Few robust assessments are available, but some conclusions are possible. Prohibiting the private sector is very unlikely to succeed, and regulatory approaches face persistent challenges in many low-income and middle-income countries. Attention is therefore turning to interventions that encourage private providers to improve quality and coverage (while advancing their financial interests) such as social marketing, social franchising, vouchers, and contracting. However, evidence about the effect on clinical quality, coverage, equity, and cost-effectiveness is inadequate. Other challenges concern scalability and scope, indicating the limitations of such interventions as a basis for universal health coverage, though interventions can address focused problems on a restricted scale.

  8. Ethics in public health research: masters of marketing: bringing private sector skills to public health partnerships. (United States)

    Curtis, Valerie A; Garbrah-Aidoo, Nana; Scott, Beth


    Skill in marketing is a scarce resource in public health, especially in developing countries. The Global Public-Private Partnership for Handwashing with Soap set out to tap the consumer marketing skills of industry for national handwashing programs. Lessons learned from commercial marketers included how to (1) understand consumer motivation, (2) employ 1 single unifying idea, (3) plan for effective reach, and (4) ensure effectiveness before national launch. After the first marketing program, 71% of Ghanaian mothers knew the television ad and the reported rates of handwashing with soap increased. Conditions for the expansion of such partnerships include a wider appreciation of what consumer marketing is, what it can do for public health, and the potential benefits to industry. Although there are practical and philosophical difficulties, there are many opportunities for such partnerships.

  9. Network Affordances

    DEFF Research Database (Denmark)

    Samson, Audrey; Soon, Winnie


    This paper examines the notion of network affordance within the context of network art. Building on Gibson's theory (Gibson, 1979) we understand affordance as the perceived and actual parameters of a thing. We expand on Gaver's affordance of predictability (Gaver, 1996) to include ecological...... and computational parameters of unpredictability. We illustrate the notion of unpredictability by considering four specific works that were included in a network art exhibiton, SPEED SHOW [2.0] Hong Kong. The paper discusses how the artworks are contingent upon the parameteric relations (Parisi, 2013......), of the network. We introduce network affordance as a dynamic framework that could articulate the experienced tension arising from the (visible) symbolic representation of computational processes and its hidden occurrences. We base our proposal on the experience of both organising the SPEED SHOW and participating...

  10. Referral of children seeking care at private health facilities in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K.; Buregyeya, Esther; Rutebemberwa, Elizeus


    Background In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health...... children to higher levels of care in the two weeks prior to the survey. The main constraints to follow referral advice as perceived by caretakers were: not appreciating the importance of referral, gender-related decision-making and negotiations at household level, poor quality of care at referral...

  11. Keeping up with the Cadillacs: What Health Insurance Disparities, Moral Hazard, and the Cadillac Tax Mean to The Patient Protection and Affordable Care Act. (United States)

    Fletcher, Rebecca Adkins


    A major goal of The Patient Protection and Affordable Care Act is to broaden health care access through the extension of insurance coverage. However, little attention has been given to growing disparities in access to health care among the insured, as trends to reduce benefits and increase cost sharing (deductibles, co-pays) reduce affordability and access. Through a political economic perspective that critiques moral hazard, this article draws from ethnographic research with the United Steelworkers (USW) at a steel mill and the Retail, Wholesale and Department Store Union (RWDSU) at a food-processing plant in urban Central Appalachia. In so doing, this article describes difficulties of health care affordability on the eve of reform for differentially insured working families with employer-sponsored health insurance. Additionally, this article argues that the proposed Cadillac tax on high-cost health plans will increase problems with appropriate health care access and medical financial burden for many families.

  12. Supplemental Private Health Insurance and Depressive Symptoms in Older Married Couples (United States)

    Min, Meeyoung Oh; Townsend, Aloen L.; Miller, Baila; Rovine, Michael J.


    Stress process theory is applied to examine lack of supplemental private health insurance as a risk factor for depressive symptomatology among older married couples covered by Medicare. Dyadic data from 130 African-American couples and 1,429 White couples in the 1993 Asset and Health Dynamics Among the Oldest-Old Survey were analyzed using…

  13. Reducing Ex-offender Health Disparities through the Affordable Care Act: Fostering Improved Health Care Access and Linkages to Integrated Care

    Directory of Open Access Journals (Sweden)

    Lacreisha Ejike-King


    Full Text Available Despite steadily declining incarceration rates overall, racial and ethnic minorities, namely African Americans, Latinos, and American Indians and Alaska Natives, continue to be disproportionately represented in the justice system. Ex-offenders commonly reenter communities with pressing health conditions but encounter obstacles to accessing care and remaining in care. The lack of health insurance coverage and medical treatment emerge as the some of the most reported reentry health needs and may contribute to observed health disparities. Linking ex-offenders to care and services upon release increases the likelihood that they will remain in care and practice successful disease management. The Affordable Care Act (ACA offers opportunities to address health disparities experienced by the reentry population that places them at risk for negative health outcomes and recidivism. Coordinated efforts to link ex-offenders with these newly available opportunities may result in a trajectory for positive health and overall well-being as they reintegrate into society.

  14. 78 FR 12833 - Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits... (United States)


    ..., Medicaid consultations, and meetings with tribal leaders and representatives, health insurance issuers... election of the state. Summary of Regulatory Changes For the reasons described in the proposed rule...

  15. How the Affordable Care Act Has Improved Americans’ Ability to Buy Health Insurance on Their Own: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016. (United States)

    Collins, Sara R; Gunja, Munira Z; Doty, Michelle M; Beutel, Sophie


    Issue: Since 2001, long before the passage of the Affordable Care Act (ACA), the Commonwealth Fund Biennial Health Insurance Survey has examined health coverage and consumers’ experiences buying insurance and using health care. Goals: To examine long-term trends and to make comparisons before and after passage of health reform. Methods: Analysis of the Commonwealth Fund Biennial Health Insurance Survey, 2016. Findings and Conclusions: There have been dramatic improvements in people’s ability to buy health plans on their own following the passage of the ACA. For adults with family incomes less than $48,500, uninsured rates dropped about 17 percentage points below their 2010 peak. Lower-income whites, blacks, and Latinos have experienced drops this large, though Latinos are uninsured at higher rates. Among working-age adults who had shopped for plans in the individual market and ACA marketplaces over the prior three years, the percentage who reported it was very difficult to find affordable plans fell by nearly half from 2010, prior to the ACA reforms, to 2016. Coverage gains are helping working-age Americans get the care they need: the number of adults who reported problems getting needed health care and filling prescriptions because of costs fell from a high of 80 million in 2012 to an estimated 63 million in 2016.

  16. Public-private sector interactions and the demand for supplementary health insurance in the United Kingdom. (United States)

    Bíró, Anikó; Hellowell, Mark


    We examine the demand for private health insurance (PHI) in the United Kingdom and relate this to changes in the supply of public and private healthcare. Using a novel collection of administrative, private sector and survey data, we re-assess the relationships between the quality and availability of public and private sector inpatient care, and the demand for PHI. We find that PHI coverage in the United Kingdom is positively related to the median of the region- and year-specific public sector waiting times. We find that PHI prevalence ceteris paribus increases with being self-employed and employed, while it decreases with having financial difficulties. In addition, we highlight the complexities of inter-sectoral relations and their impact on PHI demand. Within a region, we find that an increase in private healthcare supply is associated with a decrease in public sector waiting times, implying lower PHI demand. This may be explained by the usage of private facilities by NHS commissioners. These results have important implications for policymakers interested in the role of private healthcare supply in enhancing the availability of and equitable access to acute inpatient care.

  17. Affordability Calculations on a Health Education Campaign to Promote the Use of Aspirin in Wales (United States)

    Morgan, Gareth


    Aspirin has far-reaching public health potential in reducing the risk of heart attacks, ischemic strokes and possibly cancer. Balanced against this potential are undesirable effects of the drug. It seems reasonable to allow every individual over the age of 50 years to make an informed choice about whether or not to take aspirin. A health education…

  18. Ninety-day waiting period limitation and technical amendments to certain health coverage requirements under the Affordable Care Act. Final rule. (United States)


    These final regulations implement the 90-day waiting period limitation under section 2708 of the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act), as amended, and incorporated into the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code. These regulations also finalize amendments to existing regulations to conform to Affordable Care Act provisions. Specifically, these rules amend regulations implementing existing provisions such as some of the portability provisions added by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) because those provisions of the HIPAA regulations have become superseded or require amendment as a result of the market reform protections added by the Affordable Care Act.

  19. Public-private partnership role in increasing the quality of the health insurance services

    Directory of Open Access Journals (Sweden)



    Full Text Available In a context in which the social politics tend to become an optimization instrument for adapting the social security system to the market’s forces, and the talk of some analysts about reinventing the European social model, the partnership between the public sector and the private one in the social domain presumes, besides a tight collaboration, a combination of advantages specific to the private sector, more competitive and efficient, with the ones from the public sector, more responsible toward the society regarding the public money spending. The existence of the private health insurances cannot be tied, causally, to a social politics failure, reason for which they don’t intend, usually, to replace the public insurances, but rather, to offer a complementary alternative for them. In such a context, the public-private partnership’s goal regards both increasing the insurant’s satisfaction and increasing his/her access degree to services, and increasing the investments profitability made by the insurant and insurer. We are facing thus a mixed competitive system that combines the peculiarities of the public and private sectors. Interesting is the fact that, although the different meanings for the quality term may generate some problems regarding implementing quality management in the two health insurance sectors, the experts in the area reckon that establishing a good relationship between public buyers and private providers of healthcare can reduce the costs of public health programs. An essential condition for operating efficiently the partnership model is defining correctly the basic medical services packet financed by the public budget. Which doesn’t exclude the possibility of administrating by the private insurers, the sums of money gathered from the employees and employers contributions to the health fund, as a recently initiated project of law intends to do in Romania.

  20. Affordances revisited

    DEFF Research Database (Denmark)

    Dohn, Nina Bonderup


    , it is argued, is a problem for both design and empirical research. Because HCI discussions of the concept have informed CSCL, views presented within this discourse are discussed. A Merleau-Pontian account of affordances is developed, building on his view of the human being as always already being-in-the world...... in a non-thematized, pre-reflective correspondence of body and world in the concrete activity. A dynamic, agent-centred, cultural-, experience- and skill-relative, but perception-independent, ontology is proposed for affordances. Toward the end of the article, examples are given of how the Merleau......-Pontian account of affordances may shift the focus of empirical research and of design processes within CSCL....

  1. Public and private roles in plant health management

    NARCIS (Netherlands)

    Oude Lansink, A.G.J.M.


    World-wide, government institutions play an important role in the management of plant health. This paper develops a conceptual framework in which suppliers and demanders jointly determine the optimal level of plant health in a hypothetical market. Next this paper argues that this market falls short

  2. Touch Affordances (United States)

    Slegers, Karin; de Roeck, Dries; Arnall, Timo

    The workshop “Touch Affordances” addresses a concept relevant to human computer interactions based on touch. The main topic is the challenge of applying the notion of affordances to domains related to touch interactions (e.g. (multi)touch screens, RFID & NFC, ubiquitous interfaces). The goals of this workshop are to launch a community of researchers, designers, etc. interested in this topic, to create a common understanding of the field of touch affordances and to generate ideas for new research areas for intuitive touch interactions. The workshop will be highly interactive and will have a creative, generative character.

  3. Comparisons between inner-city and private school adolescents' perceptions of health problems. (United States)

    Walker, D K; Cross, A W; Heyman, P W; Ruch-Ross, H; Benson, P; Tuthill, J W


    A youth health survey was administered to 247 students in an inner-city ghetto high school and 404 students in a private boarding school. Significant differences between the two socioeconomic groups were found for responses about health information, health concerns and problems, and health status and service utilization. Sex-related issues were of greater concern to the private school youth and they desired more help with depression-sadness and birth control. Inner-city youth had more health worries and indicated a desire for more help with physical problems such as toothaches, headaches, and stomach aches, and social problems such as racial discrimination and parent relations. From a list of 22 health problems, the inner-city youth ranked dental problems, acne, and health worries highest while the private school youth ranked depression-sadness, tiredness, and acne highest. Regardless of social class, most adolescents perceived large gaps in their health education. One implication of our data is that the specific self-reported needs and concerns of adolescents should be considered in planning health services and education programs.

  4. Factors Influencing the Choice of a Public or Private Health Institution for Childbirth in Chandigarh

    Directory of Open Access Journals (Sweden)

    Trusty Khumukcham


    Full Text Available Background: Knowledge of factors affecting the choice of place for delivery may help in developing a user friendly maternity program. Hence, this study aimed at finding out factors influencing women’s choice about the type of health institutions for delivery. Materials and methods: A cross sectional study was conducted in selected communities of Chandigarh city in India during 2010-11. A consecutive sample of 300 women (150 in public and 150 in private institutions who had delivered a baby in previous three months were interviewed using a pre-tested interview schedule. Chi square test was used to find association of socio-demographic, maternal, and institutional factors with the type of institution selected for delivery. Results: Women from lower socio-economic status delivered more frequently in public sector institutions (47.3% than in private institutions (16.7%  (p<0.01. In private institutions 30% of the women were delivered through Caesarean Section compared to 17.3% in public institutions (p<0.05. Physical infrastructure was better in private institutions. Cost was lower in public (Rs. 4,630 than in private institutions (Rs 21,676. Most women were satisfied with quality of care received in public and private institutions. However, some reported that public institution staff needs to be more polite. Quality of infrastructure in health facility, quality of care, and socio-economic status were associated with the choice of institution for delivery. Conclusions: Public sector health institutions are a major source of maternity care in Chandigarh, hence, care providers should be trained in handling clients gently. Regulations for adherence to protocols, e.g., indications for Caesarean Section and fee structure etc. need to be implemented in private institutions.

  5. 76 FR 41263 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH10-1004 (United States)


    ... health and help restrain the rate of growth in private and public sector health care costs.'' ACA and the... (ACA) Funding, EH10-1004 Notice of Intent to award Affordable Care Act (ACA) funding to National Association for Public Health Statistics and Information Systems (NAPHSIS) to continue with the...

  6. Affordable Care Act Qualified Health Plan Enrollment for AIDS Drug Assistance Program Clients: Virginia's Experience and Best Practices. (United States)

    McManus, Kathleen A; Rodney, Robert C; Rhodes, Anne; Bailey, Steven; Dillingham, Rebecca


    With the implementation of the Affordable Care Act (ACA) in 2014, many safety net resources, including state AIDS Drug Assistance Programs (ADAPs), incorporated ACA Qualified Health Plans (QHPs) into their healthcare delivery model. This article highlights the benefits of the ACA for persons living with HIV. It also describes the range of strategies employed by state ADAPs to enroll patients in QHPs. The Virginia ADAP ACA implementation experience is described to illustrate one ADAP's shift to purchasing QHPs in addition to providing direct medications. Virginia ADAP is in a Medicaid nonexpansion state and funds the full costs of the QHP premiums, deductibles, and medication copayments. Virginia's experience is applicable to other Medicaid nonexpansion states and to state ADAPs in Medicaid expansion states, who are looking for options for their Medicaid ineligible clients. This article provides practical details of Virginia ADAP's ACA implementation as well as insights and best practices at both the state and clinic level.

  7. Analysis of Developing Public Health Service Sector with Private Finance Initiative in Guangxi

    Institute of Scientific and Technical Information of China (English)



    In Guangxi Public Health Service Sector (GPHSS), because lack of budget, it has caused a number of problems, such as weakened public health service in rural areas, poor professional quality of medical personnel in public health units at village and township levels, current urban public health service could not meet the health demand for urban residents. This paper is a secondary research. Through analysis of the financial problem and both of the advantages and disadvantages of using the Private Finance Initiative (PFI), it intend to demonstrate that using the PFI could be considered as a good way for the Guangxi government.

  8. Institutional public private partnerships for core health services: evidence from Italy

    Directory of Open Access Journals (Sweden)

    Longo Francesco


    Full Text Available Abstract Background Public-private partnerships (PPPs are potential instruments to enable private collaboration in the health sector. Despite theoretical debate, empirical analyses have thus far tended to focus on the contractual or project dimension, overlooking institutional PPPs, i.e., formal legal entities run by proper corporate-governance mechanisms and jointly owned by public and private parties for the provision of public-health goods. This work aims to fill this gap by carrying out a comparative analysis of the reasons for the adoption of institutional PPPs and the governance and managerial features necessary to establish them as appropriate arrangements for public-health services provisions. Methods A qualitative analysis is carried out on experiences of institutional PPPs within the Italian National Health Service (Sistema Sanitario Nazionale, SSN. The research question is addressed through a contextual and comparative embedded case study design, assuming the entire population of PPPs (4 currently in force in one Italian region as the unit of analysis: (i a rehabilitation hospital, (ii, an orthopaedic-centre, (iii a primary care and ambulatory services facility, and (iv a health- and social-care facility. Internal validity is guaranteed by the triangulation of sources in the data collection phase, which included archival and interview data. Results Four governance and managerial issues were found to be critical in determining the positive performance of the case examined: (i a strategic market orientation to a specialised service area with sufficient potential demand, (ii the allocation of public capital assets and the consistent financial involvement of the private partner, (iii the adoption of private administrative procedures in a regulated setting while guaranteeing the respect of public administration principles, and (iv clear regulation of the workforce to align the contracts with the organisational culture. Conclusions Findings

  9. Constraining National Health Care Expenditures. Achieving Quality Care at an Affordable Cost. (United States)


    performed on an outpatient basis. Such procedures include dilatation and curettage tubal ligations , tonsillectomies, and herniarepairs.147 Medicare...example, the commission concluded that a healthy Down’s syndrome child whose life is in danger from a surgically correctable condition should receive the...for post -hospital nursing home and home health care may increase. HHS has predicted that the number of persons qualifying for the Medicare skilled

  10. Quality of Tuberculosis Care in Private Health Facilities of Addis Ababa, Ethiopia

    Directory of Open Access Journals (Sweden)

    Gezahegn Gebrekidan


    Full Text Available Ensuring provision of good quality tuberculosis (TB care, especially in private for profit health facilities, is an important component of TB control strategy to reduce poor medical practice which results in multidrug resistant TB (MDR-TB. The aim of this study was to investigate quality of TB care in private health facilities of Addis Ababa. A facility based cross-sectional study was conducted based on Donabedian’s structure-process-outcome model of health care quality. Quality of care was determined by adherence to National TB Program guidelines, treatment success rate, and client satisfaction. Exit interview was conducted on 292 patients on the intensive phase of treatment and 384 patient records were reviewed in eight private health facilities. Initial diagnostic AFB test was done for 95.4% of pulmonary TB patients. Most important components of TB care recommended by national guidelines were delivered for a significant proportion of patients. Majority (75% of the clients were found to be satisfied with each component of TB care. The treatment success rate was 90.9%. The quality of TB care was fairly good. However, only 77.7% of the patients were counseled for HIV testing. Strengthening HIV counseling and testing, tackling shortage of streptomycin and laboratory reagent at private TB clinic is crucial.

  11. Three methods of interfacing with the private sector by mental health agencies. (United States)

    McRae, J A


    This article outlines three methods of mental health marketing--formal, intermediary, and interactive. It discusses advantages and disadvantages of each method. These approaches are particularly good for public, non-profit agencies and individuals in contacting the private sector. The need for flexibility and marketing mix is emphasized.

  12. Dedicated Doctors: Public and Private Provision of Health Care with Altruistic Physicians

    NARCIS (Netherlands)

    J. Delfgaauw (Josse)


    textabstractPhysicians are supposed to serve patients' interests, but some are more inclined to do so than others. This paper studies how the system of health care provision affects the allocation of patients to physicians when physicians differ in altruism. We show that allowing for private provisi

  13. Public-private partnerships and responsibility under international law: a global health perspective

    NARCIS (Netherlands)

    L. Clarke


    Partnerships between the public and private sectors are an increasingly accepted method to deal with pressing global issues, such as those relating to health. Partnerships, comprised of states and international organizations (public sector) and companies, non-governmental organizations, research ins

  14. Comparison Quality of Health Services between Public and Private Providers: The Iranian People’s Perspective (United States)

    Alijanzadeh, Mehran; Zare, Seyed Ali Moosaniaye; Rajaee, Roya; Fard, Seyed Mohammad Ali Mousavi; Asefzadeh, Saeed; Alijanzadeh, Mahnaz; Gholami, Soheyla


    Introduction Health services quality has been the most important criteria of judging, and its improvement causes people’s satisfaction of health systems. In a health system, public and private sectors provide services and typically have been effective in promoting health services quality of community. The aim of this study was to compare the quality of health services in both public and private sectors from the perspective of residents in Qazvin (Iran). Methods This cross-sectional study was conducted in 2014. The study population included all residents of Qazvin Province, and the sample size was estimated to 1002. The research tool was a perceptions of services quality standard questionnaire. Data were collected by trained interviewers visiting homes and were analyzed by IBM-SPSS software version 22 and t-test and linear regression. Cronbach’s alpha coefficient was 0.91 and test–re-test coefficient was 83%. Results 741 people (74%) in their last visit to receive services were referred to the public sector. Between the perception of people participating in the study about medical equipment and supplies, welfare facilities, competence and experience of doctor, waiting time, rapid reception, and access to doctor in public and private sectors, significant differences were observed (p < 0.05). In the tangible realm in perception of health services, there was a significant difference in quality between the public and private sectors (p < 0.05). In addition, place of receiving services, waiting time, education, occupation, and type of received services were affecting factors in regards to perceptions of health services from the perspective of Iran’s population (p < 0.05). Conclusion The results showed the importance of a tangible realm on people’s satisfaction of health services. It seems that the public sector should pay more attention to this issue. PMID:27790347

  15. Provision of Private Care by Doctors Employed in Public Health Institutions: Ethical Considerations and Implications for Clinical Training. (United States)

    Benbassat, Jochanan


    This paper summarizes the difficulties that may emerge when the same care-provider attends to private and public patients within the same or different clinical settings. First, I argue that blurring the boundaries between public and private care may start a slippery slope leading to "black" under-the-table payments for preferential patient care. Second, I question whether public hospitals that allow their doctors to attend to private patients provide an appropriate learning environment for medical students and residents. Finally, I propose a way to both maintain the advantages of private care and avoid its negative consequences: complete separation between the public and the private health care systems.

  16. Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services (United States)

    Leal, Maria do Carmo; Esteves-Pereira, Ana Paula; Nakamura-Pereira, Marcos; Torres, Jacqueline Alves; Domingues, Rosa Maria Soares Madeira; Dias, Marcos Augusto Bastos; Moreira, Maria Elizabeth; Theme-Filha, Mariza; da Gama, Silvana Granado Nogueira


    Background A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk. Methods This is a sub-analysis of a national population-based survey of postpartum women entitled “Birth in Brazil”, performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services. Results Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s) and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8%) when compared to the ones receiving public services (rate of 2.4%), regardless of obstetric risk–adjusted OR of 2.3 (CI 1.5–3.6) for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1–2.3) for women of high obstetric risk. Conclusion The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care. PMID:27196102

  17. Provider-Initiated Late Preterm Births in Brazil: Differences between Public and Private Health Services.

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Leal

    Full Text Available A large proportion of the rise in prematurity worldwide is owing to late preterm births, which may be due to the expansion of obstetric interventions, especially pre-labour caesarean section. Late preterm births pose similar risks to overall prematurity, making this trend a concern. In this study, we describe factors associated with provider-initiated late preterm birth and verify differences in provider-initiated late preterm birth rates between public and private health services according to obstetric risk.This is a sub-analysis of a national population-based survey of postpartum women entitled "Birth in Brazil", performed between 2011 and 2012. We included 23,472 singleton live births. We performed non-conditional multiple logistic regressions assessing associated factors and analysing differences between public and private health services.Provider-initiated births accounted for 38% of late preterm births; 32% in public health services and 61% in private health services. They were associated with previous preterm birth(s and maternal pathologies for women receiving both public and private services and with maternal age ≥35 years for women receiving public services. Women receiving private health services had higher rates of provider-initiated late preterm birth (rate of 4.8% when compared to the ones receiving public services (rate of 2.4%, regardless of obstetric risk-adjusted OR of 2.3 (CI 1.5-3.6 for women of low obstetric risk and adjusted OR of 1.6 (CI 1.1-2.3 for women of high obstetric risk.The high rates of provider-initiated late preterm birth suggests a considerable potential for reduction, as such prematurity can be avoided, especially in women of low obstetric risk. To promote healthy births, we advise introducing policies with incentives for the adoption of new models of birth care.

  18. Private religious practice, spiritual coping, social support, and health status among older Korean adult immigrants. (United States)

    Lee, Kyoung Hag; Hwang, Myung Jin


    This study explored the role of spiritual factors and social support on the health status of 246 older Korean adult immigrants age 65 years or older. Ordinary least squares regression results revealed that private religious practice, spiritual coping, and social support were significantly associated with improved health status. However, stressors such as the lack of English proficiency and transportation, longer residency in the United States, and financial problems were significantly associated with lower health status. Social workers need to consider providing appropriate spiritual interventions and social support programs for older Korean adult immigrants so that they may better handle their stressors and health problems.

  19. Meeting the public health challenge of protecting private wells: Proceedings and recommendations from an expert panel workshop

    Energy Technology Data Exchange (ETDEWEB)

    Fox, Mary A., E-mail: [Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 407, Baltimore, MD 21205 (United States); Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205 (United States); Nachman, Keeve E. [Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 407, Baltimore, MD 21205 (United States); Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205 (United States); Center for a Livable Future, Johns Hopkins University, 615 North Wolfe Street, Room W7010, Baltimore, MD 21205 (United States); Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205 (United States); Anderson, Breeana [Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205 (United States); Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, 725 North Wolfe Street, Baltimore, MD 21205 (United States); Lam, Juleen [Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 407, Baltimore, MD 21205 (United States); Risk Sciences and Public Policy Institute, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Room 429, Baltimore, MD 21205 (United States); University of California at San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences, Mailstop 0132, 550 16th Street, 7th Floor, San Francisco, CA 94143 (United States); and others


    Private wells serving fewer than 25 people are federally unregulated, and their users may be exposed to naturally occurring agents of concern such as arsenic and radionuclides, as well as anthropogenic contaminants. The Centers for Disease Control and Prevention's Clean Water for Health Program works to protect private wells and prevent adverse health outcomes for the roughly 15% of Americans who rely on them. To understand current and emerging challenges to the private drinking water supply, an interdisciplinary expert panel workshop on “Future and Emerging Issues for Private Wells” was organized to inform strategic planning for the Clean Water for Health Program. The panel assessed current conditions of ground water as a source for private wells, identified emerging threats, critical gaps in knowledge, and public health needs, and recommended strategies to guide future activities to ensure the safety of private drinking water wells. These strategies addressed topics of broad interest to the environmental public health community including: development of new methods to support citizen science; addressing contaminant mixtures; expanding capacity for well testing; evaluating treatment technologies; building an evidence base on best practices on well owner outreach and stewardship; and research and data needs. - Highlights: • About 43 million Americans use federally unregulated private wells for drinking water. • Private wells may be contaminated with naturally occurring and man-made chemicals. • Protecting well water requires an “infrastructure for stewardship”. • Recommendations to advance private well protection are offered.

  20. Private Sector An Important But Not Dominant Provider Of Key Health Services In Low- And Middle-Income Countries. (United States)

    Grépin, Karen A


    There is debate about the role of the private sector in providing services in the health systems of low- and middle-income countries and about how the private sector could help achieve the goal of universal health coverage. Yet the role that the private sector plays in the delivery of health services is poorly understood. Using data for the period 1990-2013 from 205 Demographic and Health Surveys in seventy low- and middle-income countries, I analyzed the use of the private sector for the treatment of diarrhea and of fever or cough in children, for antenatal care, for institutional deliveries, and as a source of modern contraception for women. I found that private providers were the dominant source of treatment for childhood illnesses but not for the other services. I also found no evidence of increased use of the private sector over time. There is tremendous variation in use of the private sector across countries and health services. Urban and wealthier women disproportionately use the private sector, compared to rural and poorer women. The private sector plays an important role in providing coverage, but strategies to further engage the sector, if they are to be effective, will need to take into consideration the variation in its use.

  1. Initial Health Assessments and HIV Screening under the Affordable Care Act.

    Directory of Open Access Journals (Sweden)

    Arleen A Leibowitz

    Full Text Available The Centers for Disease Control and Prevention (CDC estimates that 156,300 (95% CI 144,100-165,900 Americans living with HIV in 2012 were unaware of their infection. To increase knowledge of HIV status, CDC guidelines seek to make HIV screening a routine part of medical care. This paper examines how routinely California primary care providers test for HIV and how providers' knowledge of California's streamlined testing requirements, use of sexual histories, and having an electronic medical record prompt for HIV testing, relate to test offers.We surveyed all ten California health plans offered under health reform's Insurance Exchange (response rate = 50% and 322 primary care providers to those plans (response rate = 19% to assess use of HIV screening and risk assessments.Only 31.7% of 60 responding providers reported offering HIV tests to all or most new enrollees and only 8.8% offered an HIV test of blood samples all or most of the time despite the California law requiring that providers offer HIV testing of blood samples in primary care settings. Twenty-eight of the 60 providers (46.6% were unaware that California had reduced barriers to HIV screening by eliminating the requirement for written informed consent and pre-test counseling. HIV screening of new enrollees all or most of the time was reported by 53.1% of the well-informed providers, but only 7.1% of the less informed providers, a difference of 46 percentage points (95% CI: 21.0%-66.5%. Providers who routinely obtained sexual histories were 29 percentage points (95% CI: 0.2%-54.9% more likely to screen for HIV all or most of the time than those who did not ask sexual histories.Changing HIV screening requirements is important, but not sufficient to make HIV testing a routine part of medical care. Provider education to increase knowledge about the changed HIV testing requirements could positively impact testing rates.

  2. Discourses of social movements about the privatization of Catalan health services

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    Lutiane de Lara


    Full Text Available In this paper, we discuss the discourses about the health privatization from the analysis of interviews and manifests of three Catalan movements: Centre d’Anàlisis i Programes Sanitaris (Caps, Grup de Defensa de Sanitat Pública (15MBCNSalut and Plataforma Pel Dret a la Salut (PDS. The content analysis has been adopted as methodology. The analysis has evidenced a dichotomy between public and private systems as a duality that structures discourses favoring the public model and the great efforts made by the movements to guarantee that model. This has shaped the movements as a revolutionary force that defends the public system from private threats by assuming that it essentially represents the people’s ideals. The debate between the traditional and the new in social action has been central to the analysis, as well as the problem of coexistence of different models of action.

  3. Affordable Luxuries

    Institute of Scientific and Technical Information of China (English)


    Tariff cuts and new trade measures are in the works to make luxury goods more affordable in the Chinese market Where there is luxury,there are Chinese buyers.And when they arrive,cash registers ring incess antly as sale after sale is made.It’s particularly true at luxury shopping outlets worldwide.From Galleries Lafayette in Paris to Harrods in London and premium outlets in New York City,Chinese touristsd escend on these locales,often leaving their

  4. The development of voluntary private health insurance in the Nordic countries

    DEFF Research Database (Denmark)

    Alexandersen, Nina; Anell, Anders; Kaarboe, Odvar


    The Nordic countries represent an institutional setting with tax-based health care financing and universal access to health care services. Very few health care services are excluded from what are offered within the publically financed health care system. User fees are often non-existing or low...... and capped. Nevertheless, the markets for voluntary private health insurance (VPHI) have been rapidly expanding. In this paper we describe the development of the market for VPHI in the Nordic countries. We outline similarities and differences and provide discussion of the rationale for the existence...... of different types of VPHI. Data is collected on the population covered by VPHI, type and scope of coverage, suppliers of VPHI and their relations with health providers. It seems that the main roles of VPHI are to cover out-of-pocket payments for services that are only partly financed by the public health care...

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

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    Kheya Melo Furtado


    Full Text Available 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.

  6. Health Resources in a 200,000 Urban Indian Population Argues the Need for a Policy on Private Sector Health Services (United States)

    Furtado, Kheya Melo; Kar, Anita


    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

  7. Public/private financing in the Greek health care system: implications for equity. (United States)

    Liaropoulos, L; Tragakes, E


    The 1983 health reforms in Greece were indirectly aimed at increasing equity in financing through expansion of the role of the public sector and restriction of the private sector. However, the rigid application of certain measures, the failure to change health care financing mechanisms, as well as growing dissatisfaction with publicly provided services actually increased the private share of health care financing relative to that of the public share. The greatest portion of this increase involved out-of-pocket payments, which constitute the most regressive form of financing, and hence resulted in reduced equity. The growing share of private insurance financing, though as yet quite small, has also contributed to reducing equity. Within public funding, while a small shift has occurred in favor of tax financing, it is questionable whether this has contributed to increased equity in view of widespread tax evasion. On balance, it is most unlikely that the 1983 health care reforms have led to increased equity; it is rather more likely that the system in operation today is more inequitable from the point of view of financing than the highly inequitable system that was in place in the early 1980s.


    Hoffmann, Diane; Schwartz, Jack


    This Article offers a thorough analysis of an important public health issue, namely how to confront the growing problem of deceptive claims regarding foods and dietary supplements, including increasingly prevalent but unverifiable claims. The authors call for the creation of a limited private right of action under the Federal Trade Commission (FTC) Act for deceptive health-related claims for these products. The proposal responds to the growing market for these products and the inadequacy of current laws and enforcement actions to prevent such claims. In crafting the limited private right of action, the authors attempt to enhance consumer protection without undermining federal agency primacy in enforcement. The Article ends with an appendix setting forth proposed language for a statutory amendment to the FTC Act incorporating the authors' proposal.

  9. Increase in caesarean deliveries after the Australian Private Health Insurance Incentive policy reforms.

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    Kristjana Einarsdóttir

    Full Text Available BACKGROUND: The Australian Private Health Insurance Incentive (PHII policy reforms implemented in 1997-2000 increased PHI membership in Australia by 50%. Given the higher rate of obstetric interventions in privately insured patients, the reforms may have led to an increase in surgical deliveries and deliveries with longer hospital stays. We aimed to investigate the effect of the PHII policy introduction on birth characteristics in Western Australia (WA. METHODS AND FINDINGS: All 230,276 birth admissions from January 1995 to March 2004 were identified from administrative birth and hospital data-systems held by the WA Department of Health. Average quarterly birth rates after the PHII introduction were estimated and compared with expected rates had the reforms not occurred. Rate and percentage differences (including 95% confidence intervals were estimated separately for public and private patients, by mode of delivery, and by length of stay in hospital following birth. The PHII policy introduction was associated with a 20% (-21.4 to -19.3 decrease in public birth rates, a 51% (45.1 to 56.4 increase in private birth rates, a 5% (-5.3 to -5.1 and 8% (-8.9 to -7.9 decrease in unassisted and assisted vaginal deliveries respectively, a 5% (-5.3 to -5.1 increase in caesarean sections with labour and 10% (8.0 to 11.7 increase in caesarean sections without labour. Similarly, birth rates where the infant stayed 0-3 days in hospital following birth decreased by 20% (-21.5 to -18.5, but rates of births with >3 days in hospital increased by 15% (12.2 to 17.1. CONCLUSIONS: Following the PHII policy implementation in Australia, births in privately insured patients, caesarean deliveries and births with longer infant hospital stays increased. The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals.

  10. Women at risk: why increasing numbers of women are failing to get the health care they need and how the Affordable Care Act will help. Findings from the Commonwealth Fund Biennial Health Insurance Survey of 2010. (United States)

    Robertson, Ruth; Collins, Sara R


    Women have greater health care needs than men, and generally play larger roles in the health care of family members. Rising health care costs combined with sluggish income growth has contributed to losses in health insurance among women and rising rates of problems gaining necessary health care and paying medical bills. Women who seek coverage in the individual insurance market face additional hurdles--few plans offer maternity coverage and, in most states, insurance carriers charge higher premium rates to young women than men of the same age. The Affordable Care Act is bringing change for women through required free coverage of preventive care services, small business tax credits, new affordable coverage options, and insurance market reforms, including bans on gender rating. When the law is fully implemented in 2014, nearly all the 27 million working-age women who went without health insurance in 2010 will gain affordable and comprehensive benefits.

  11. A five-year assessment of the affordable care act: market forces still trump the common good in U.S. Health care. (United States)

    Geyman, John P


    The Affordable Care Act (ACA) was enacted in 2010 as the signature domestic achievement of the Obama presidency. It was intended to contain costs and achieve near-universal access to affordable health care of improved quality. Now, five years later, it is time to assess its track record. This article compares the goals and claims of the ACA with its actual experience in the areas of access, costs, affordability, and quality of care. Based on the evidence, one has to conclude that containment of health care costs is nowhere in sight, that more than 37 million Americans will still be uninsured when the ACA is fully implemented in 2019, that many more millions will be underinsured, and that profiteering will still dominate the culture of U.S. health care. More fundamental reform will be needed. The country still needs to confront the challenge that our for-profit health insurance industry, together with enormous bureaucratic waste and widespread investor ownership throughout our market-based system, are themselves barriers to health care reform. Here we consider the lessons we can take away from the ACA's first five years and lay out the economic, social/political, and moral arguments for replacing it with single-payer national health insurance.

  12. Income, social stratification, class, and private health insurance: a study of the Baltimore metropolitan area. (United States)

    Muntaner, C; Parsons, P E


    Most studies of inequalities and access to health care have used income as the sole indicator of social stratification. Despite the significance of social theory in health insurance research, there are no empirical studies comparing the ability of different models of social stratification to predict health insurance coverage. The aim of this study is to provide a comparative analysis using a variety of theory-driven indicators of social stratification and assess the relative strength of the association between these indicators and private health insurance. Data were collected in a 1993 telephone interview of a random digit dialing sample of the white population in the Baltimore Metropolitan Statistical Area. Indicators of social stratification included employment status, full-time work, education, occupation, industry, household income, firm size, and three types of assets: ownership, organizational, and skill/credential. The association between social stratification and private health insurance was strongest for those having higher household incomes, having attained at least a bachelor's degree, and working in a firm with more than 50 employees, followed by being an owner or manager, and by being employed. The addition of education and firm size improved the prediction of the household income model. The authors conclude that studies of inequalities in health insurance coverage can benefit from the inclusion of theory-driven indicators of social stratification such as human capital, labor market segmentation, and control over productive assets.

  13. On the international stability of health care expenditure functions: are government and private functions similar? (United States)

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


    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.

  14. The role and uptake of private health insurance in different health care systems: are there lessons for developing countries?

    Directory of Open Access Journals (Sweden)

    Odeyemi IA


    Full Text Available Isaac AO Odeyemi,1 John Nixon21Senior Director and Head of Health Economics and Outcomes Research, Astellas Pharma UK Ltd, Chertsey, UK; 2Teaching Associate in Health Economics, Department of Economics and Related Studies, University of York, York, UKBackground: 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.Methods: 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.Results: 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.Conclusion: 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

  15. Healthy, wealthy and insured? The role of self-assessed health in the demand for private health insurance. (United States)

    Doiron, Denise; Jones, Glenn; Savage, Elizabeth


    Both adverse selection and moral hazard models predict a positive relationship between risk and insurance; yet the most common finding in empirical studies of insurance is that of a negative correlation. In this paper, we investigate the relationship between ex ante risk and private health insurance using Australian data. The institutional features of the Australian system make the effects of asymmetric information more readily identifiable than in most other countries. We find a strong positive association between self-assessed health and private health cover. By applying the Lokshin and Ravallion (J. Econ. Behav. Organ 2005; 56:141-172) technique we identify the factors responsible for this result and recover the conventional negative relationship predicted by adverse selection when using more objective indicators of health. Our results also provide support for the hypothesis that self-assessed health captures individual traits not necessarily related to risk of health expenditures, in particular, attitudes towards risk. Specifically, we find that those persons who engage in risk-taking behaviours are simultaneously less likely to be in good health and less likely to buy insurance.

  16. Product development public-private partnerships for public health: a systematic review using qualitative data. (United States)

    De Pinho Campos, Katia; Norman, Cameron D; Jadad, Alejandro R


    Almost a decade ago, public health initiated a number of innovative ventures to attract investments from multinational drug companies for the development of new drugs and vaccines to tackle neglected diseases (NDs). These ventures - known as product development public-private partnerships (PD PPPs) - represent the participation of the public and private actors toward the discovery and development of essential medicines to reduce the suffering of over one billion people worldwide living with NDs. This systematic review aimed to identify empirical-based descriptive articles to understand critical elements in the partnership process, and propose a framework to shed light on future guidelines to support better planning, design and management of existing and new forms of PPPs for public health. Ten articles met the inclusion criteria and were analyzed and synthesized using qualitative content analysis. The findings show that the development stage of PD PPPs requires a careful initiation and planning process including discussion on values and shared goals, agreement on mutual interests & equality of power relation, exchange of expertise & resources, stakeholder engagement, and assessment of the local health capacity. The management stage of PD PPPs entails transparency, extensive communication and participatory decision-making among partner organizations. This review illustrates the difficulties, challenges and effective responses during the partnering process. This model of collaboration may offer a way to advance population health at present, while creating streams of innovation that can yield future social and financial dividends in enhancing the public's health more widely.

  17. A practical guideline for identifying research intent with projects that collect private, identifiable health information. (United States)

    Amdur, Robert J; Speers, Marjorie A


    Radiation oncologists frequently engage in activities that involve the collection and analysis of data from medical records. Access to health information is an ethical issue because, if not done according to appropriate guidelines, it constitutes an invasion of privacy or breach in confidentiality. To protect patients for the social harm that may result from medical record review, our society has established laws and regulations that apply to projects that require medical record review. A major branch point in the guidelines for such projects is whether private information will be collected for research or nonresearch purposes. However, a problem with discussing privacy protection in terms of a research versus nonresearch model is that it is difficult to make this distinction for many kinds of projects. The purpose of this paper is to establish a practical guideline that can be used to decide if a project that involves analysis of private, identifiable medical information should be considered research from the regulatory standpoint.

  18. Utilization of dental health services by Danish adolescents attending private or public dental health care systems

    DEFF Research Database (Denmark)

    Christensen, Lisa Bøge; Petersen, Poul Erik; Bastholm, Annelise


    The objectives of the study were: 1) to describe the choice of dental care system among 16-year-olds, 2) to describe the utilization of dental services among 16-17-year-olds enrolled in either public or private dental care systems, and to compare the dental services provided by the alternative sy...

  19. Public-private partnerships with large corporations: setting the ground rules for better health. (United States)

    Galea, Gauden; McKee, Martin


    Public-private partnerships with large corporations offer potential benefits to the health sector but many concerns have been raised, highlighting the need for appropriate safeguards. In this paper we propose five tests that public policy makers may wish to apply when considering engaging in such a public-private partnership. First, are the core products and services provided by the corporation health enhancing or health damaging? In some cases, such as tobacco, the answer is obvious but others, such as food and alcohol, are contested. In such cases, the burden of proof is on the potential partners to show that their activities are health enhancing. Second, do potential partners put their policies into practice in the settings where they can do so, their own workplaces? Third, are the corporate social responsibility activities of potential partners independently audited? Fourth, do potential partners make contributions to the commons rather than to narrow programmes of their choosing? Fifth, is the role of the partner confined to policy implementation rather than policy development, which is ultimately the responsibility of government alone?

  20. Benefits of a health impact assessment in relation to fuel poverty: assessing Luton's Affordable Warmth Strategy and the need for a national mandatory strategy. (United States)

    Stewart, Jill; Habgood, Veronica


    The links between fuel poverty and poor health are well documented, yet there is no statutory requirement on local authorities to develop fuel poverty strategies, which tend to be patchy nationally and differ substantially in quality. Fuel poverty starts from the perspective of income, even though interventions can improve health. The current public health agenda calls for more partnership-based, cost-effective strategies based on sound evidence. Fuel poverty represents a key area where there is currently little local evidence quantifying and qualifying health gain arising from strategic interventions. As a result, this initial study sought to apply the principles of a health impact assessment to Luton's Affordable Warmth Strategy, exploring the potential to identify health impact arising--as a baseline for future research--in the context of the public health agenda. A national strategy would help ensure the promotion of targeted fuel poverty strategies.

  1. A study on corporate social responsibility for the health care of the elderly by private health care providers of Mangalore city: A health systems research

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    U Sudarshan Pai


    Full Text Available Introduction: Private sector is the largest provider of health care services in India. But it is expensive. Self-driven corporate social responsibility (CSR providing free or subsidised services will be useful to the elderly. There are no published data reporting the pattern or types of health care services provided to elderly by the private health care sector of India through CSR initiative. So this study was undertaken. Objectives: To know the pattern (Subsidised/free and type (Medical, Surgical etc., of Health care services received by the elderly people as a part of CSR. Materials and Methods: A questionnaire based cross-sectional study conducted among all private health care providers of Mangalore city. List of all private health care providers which included various types of hospitals (corporate hospitals, multispecialty hospitals etc... were obtained from the local chapter of Indian Medical Association. The data was collected form hospitals fulfilling the study criteria. The data was analysed using SPSS software for windows, version 16.0. Results are presented as frequencies and proportions in appropriate tables. Results: Totally 24 hospitals had participated in this study. Most (n = 16, 66.7% reported providing some free or subsidised services. Among them only 7 (29.2% were providing free services like: Health check-up camps, subsidised medical and surgical treatment. However most of them did not respond to the "criteria for selecting of the elderly for such free services." Conclusion: Most of the private hospitals in Mangalore do not provide free or subsidised health care services to the elderly through a self-driven CSR initiative

  2. Meeting the public health challenge of protecting private wells: Proceedings and recommendations from an expert panel workshop. (United States)

    Fox, Mary A; Nachman, Keeve E; Anderson, Breeana; Lam, Juleen; Resnick, Beth


    Private wells serving fewer than 25 people are federally unregulated, and their users may be exposed to naturally occurring agents of concern such as arsenic and radionuclides, as well as anthropogenic contaminants. The Centers for Disease Control and Prevention's Clean Water for Health Program works to protect private wells and prevent adverse health outcomes for the roughly 15% of Americans who rely on them. To understand current and emerging challenges to the private drinking water supply, an interdisciplinary expert panel workshop on "Future and Emerging Issues for Private Wells" was organized to inform strategic planning for the Clean Water for Health Program. The panel assessed current conditions of ground water as a source for private wells, identified emerging threats, critical gaps in knowledge, and public health needs, and recommended strategies to guide future activities to ensure the safety of private drinking water wells. These strategies addressed topics of broad interest to the environmental public health community including: development of new methods to support citizen science; addressing contaminant mixtures; expanding capacity for well testing; evaluating treatment technologies; building an evidence base on best practices on well owner outreach and stewardship; and research and data needs.

  3. Privatizing health care in times of new public management: Investigating the role of psychological empowerment using cluster analysis. (United States)

    Hansen, Niklas; Baraldi, Stephan; Berntson, Erik; Andersson, Håkan


    Although privatization within health care is usually justified using arguments based on efficiency and productivity, the empirical investigations underpinning such arguments are few and ambiguous in their results. Presenting a new theoretical and analytical approach to this research field, we argue that psychological empowerment, reflecting individuals' intrinsic change motivation state, is a crucial prerequisite for the transformation of a nonprofit health care organization to a for-profit one. The general aims of this study were to explore empowerment cognitions during a privatization, to relate these to a selection of key work-related outcome variables, and to identify the effects of privatization in terms of individual level changes in empowerment after privatization. A sample of health care workers (n = 210) provided survey longitudinal data that were analyzed using cluster analysis. Eight clusters were identified at both pre- and postprivatization with each cluster mirroring specific empowerment patterns: Empowered, In Control, Quasi-Empowered, Competent/Normed, Reference, Underused, Misfit, and Powerless. The clusters discriminated on positive work attitudes, mental health complaints, and turnover intentions. The analysis also revealed the complexity of privatization in that a homogenization as well as a differentiation tendency was observed, thereby implicating both socio-structural equality and inequality effects. The results highlighted the relevance of allocating importance to health care workers' psychological empowerment during the privatization process, and of viewing such organizational transformations not as simple shifts in the state of affairs, but as nonlinear processes involving dynamic changes in individual perceptions over time.

  4. Partisan Politics or Public-Health Need? An empirical analysis of state choice during initial implementation of the Affordable Care Act. (United States)

    Mayer, Martin; Kenter, Robert; Morris, John C


    States' policy decisions regarding the Affordable Care Act (ACA) of 2010 have often been explained as predominantly, if not solely, partisan. Might rival explanations also apply? Using a cross-sectional 50-state regression model, we studied standard political variables coupled with public-health indicators. This work differs from existing research by employing a dependent variable of five additive measures of ACA support, examining the impact of both political and socioeconomic indicators on state policy decisions. Expanding on recent empirical studies with our more nuanced additive index of support measures, we found that same-party control of a state's executive and legislative branches was indeed by far the single best predictor of policy decisions. Public-health indicators, overwhelmed by partisan effect, did not sufficiently explain state policy choice. This result does not allay the concerns that health policy has become synonymous with health politics and that health politics now has little to do with health itself.

  5. Breastfeeding: Mothers and health practitioners in the context of private medical care in Gauteng

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    Diana du Plessis


    Full Text Available Despite the well-documented health benefits of breastfeeding and recommendations by the Department of Health for women to exclusively breastfeed for approximately the first six months of life and continuation beyond one year, a large percentage of South African women do not breastfeed their infants, or only do so for a short period of time. No national South African statistics are available but figures emerging from the attendance of mothers at a baby clinic on the West Rand in Gauteng indicated the following: 64% of the mothers breastfeed up to six weeks, after which the figure rapidly declines to less than 20% at three months (Truter 2007. Several studies have assessed the attitudes of health care personnel towards breastfeeding, but little is known of the type of information given to breastfeeding mothers by private medical practitioners who are the frontline of contact with clients and who may convey information that either promotes or discourages breastfeeding. The following question was thus formulated: With regard to breastfeeding, what are the constraints to breastfeeding in private practice?

    Therefore, in order to understand the constraints to breastfeeding, the purpose of this study was to assess the breastfeeding information given to pregnant women by health professionals in private practice. The specific objectives of the study were to determine the breastfeeding recommendations made by private health professionals during pregnancy, to describe the management of breastfeeding in the consulting rooms of private medical practitioners, and to describe women’s experiences of breastfeeding in private hospitals. In Phase 1 of the study the population comprised all mothers who attended a support group for new mothers at a private post-natal clinic In Phase 2 the population comprised all mothers who attended a community baby clinic or support group. The sample consisted of all primigravidae who breastfed or attempted to breastfeed in the

  6. Health problems among migrant construction workers: A unique public-private partnership project

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    Balkrishna B Adsul


    Full Text Available Background: Construction sector is a booming industry and involves many hazardous activities. Migrant labor in the industry is susceptible to various health and occupational hazards. In a unique public-private partnership project, a medical team from a public sector teaching hospital in Mumbai provided comprehensive on-site health care services to the construction workers of a private construction company. Objective: To study socio-demographic profile and morbidity pattern of construction workers. Setting and Design: A cross-sectional study at construction site Vidyavihar (West, Mumbai, was carried out over the period of May to November 2010. Materials and Methods: A medical team provided comprehensive on-site health care services, and a Health Card was devised to maintain the record of socio-demographic, occupational details, and complete physical examination findings of the workers who participated in the study. Statistical Analysis Used: Statistical analysis was done using SPSS 15.0. Results: Of the 1337 workers (all males examined, 1289 (96.4% belonged to 15-45 years age group. The mean age of the workers was 26.25 ± 8.49 years. A third of the migrants belonged to West Bengal. The average number of health problems in the workers was 1.41. Regular consumers of tobacco and alcohol were 50.48 and 14.65%, respectively. Nearly one-fifth of the workers had febrile illness, of which 20.71% had suspected malaria; 12.6% had respiratory infections, while 3.4% were found to have hypertension. There was a statistically significant association (P < 0.05 between type of occupation and morbidity status.

  7. Exploring the Public Health Impacts of Private Security Guards on People Who Use Drugs: a Qualitative Study. (United States)

    Markwick, Nicole; McNeil, Ryan; Small, Will; Kerr, Thomas


    Private security guards occupy an increasingly prominent role in the policing of private and public spaces. There are growing concerns regarding security guards' potential to shape violence, discrimination, and adverse health outcomes among vulnerable populations, including people who use drugs (PWUD). This is relevant in Vancouver, Canada, where private security guards have increasingly been employed by private organizations to manage public and private spaces, including those within urban drug scenes. This qualitative study sought to understand interactions between PWUD and private security guards and explore their impacts on health care access, risks, and harms among PWUD. Semi-structured interviews were conducted with 30 PWUD recruited from two ongoing prospective cohort studies. Interviews were transcribed and analyzed using a coding framework comprised of a priori and emergent categories. Study data indicate that participants experience pervasive, discriminatory profiling and surveillance by security guards, which exacerbates existing social marginalization and structural vulnerability, particularly among PWUD of Aboriginal ancestry. Participants reported that security guards restrict PWUD's access to public and private spaces, including pharmacies and hospitals. PWUD also reported that their interactions with security guards often involved interpersonal violence and aggression, experiences that served to increase their vulnerability to subsequent risks and harms. Our findings highlight that private security forces contribute significantly to the everyday violence experienced by PWUD within drug scenes and elsewhere and do so in a manner very similar to that of traditional police forces. These findings point to the urgent need for greater oversight and training of private security guards in order to protect the health and safety of PWUD.

  8. Antimalarial drug prescribing practice in private and public health facilities in South-east Nigeria: a descriptive study

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    Okebe Joseph


    Full Text Available Abstract Background Nigeria's national standard has recently moved to artemisinin combination treatments for malaria. As clinicians in the private sector are responsible for attending a large proportion of the population ill with malaria, this study compared prescribing in the private and public sector in one State in Nigeria prior to promoting ACTs. Objective To assess prescribing for uncomplicated malaria in government and private health facilities in Cross River State. Method Audit of 665 patient records at six private and seven government health facilities in 2003. Results Clinicians in the private sector were less likely to record history or physical examination than those in public facilities, but otherwise practice and prescribing were similar. Overall, 45% of patients had a diagnostic blood slides; 77% were prescribed monotherapy, either chloroquine (30.2%, sulphadoxine-pyrimethamine (22.7% or artemisinin derivatives alone (15.8%. Some 20.8% were prescribed combination therapy; the commonest was chloroquine with sulphadoxine-pyrimethamine. A few patients (3.5% were prescribed sulphadoxine-pyrimethamine-mefloquine in the private sector, and only 3.0% patients were prescribed artemisinin combination treatments. Conclusion Malaria treatments were varied, but there were not large differences between the public and private sector. Very few are following current WHO guidelines. Monotherapy with artemisinin derivatives is relatively common.

  9. Community rating in the absence of risk equalisation: lessons from the Irish private health insurance market. (United States)

    Turner, Brian; Shinnick, Edward


    Ireland's private health insurance market operates on the basis of community rating, alongside open enrolment and lifetime cover. A risk equalisation scheme was introduced in 2003 to bolster community rating. However, in July 2008 the Irish Supreme Court set aside this scheme, on the basis of the interpretation of community rating in Irish legislation. This decision has significant implications for the Irish private health insurance market. This paper reviews the development of the market, focusing in particular on community rating. The breakdown of community rating in a market with multiple insurers with differing risk profiles is discussed. Applying this to the Irish market, it can be seen that the Irish Supreme Court judgment has significant implications for the application of community rating. Specifically, while community rating operates within plans, it no longer operates across the market, leading to high-risk lives paying more, on average, than low-risk lives. It has also led to greater opportunities for insurers to engage in market segmentation. This may have relevance for the design and operation of other community rated markets.

  10. Doctor-Patient Relationship Between Individuals With Fibromyalgia and Rheumatologists in Public and Private Health Care in Mexico. (United States)

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


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

  11. (Net)Working out: social capital in a private health club. (United States)

    Crossley, Nick


    In Bowling Alone Robert Putnam considers the possibility that the growth of private health clubs and the rising rates of membership to such clubs might represent a counter-trend to his thesis on the decline in social capital. In this paper I explore this idea using ethnographic data and social network analysis. I show both that and how networks form in health clubs and I discuss the ways in which these networks constitute social capital for their members. In addition, however, I explore the 'dark side' of this form of social capital. I argue that high integration amongst some members of a fitness class can generate a power differential between those members and other, less integrated members who experience this negatively. Furthermore, with an eye on Burt's (2005) important thesis on brokerage and closure, I argue that brokerage between relatively closed clusters of agents can lead to inter-group rivalry and conflict, which, in turn, is experienced negatively by those involved.

  12. Workplace stress and its influence in professional and private life of health care workers

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    Aristotelis Koinis


    Full Text Available Stress work place influences the physical and mental well-being of health professionals, reducing performance and negatively affecting health-related quality of life. Aim: The purpose of this review was to investigate the causes of occupational stress and the impact on the professional and personal lives of healthcare professionals. Methodology: It is conducted a literature review of published journals from scientific databases such as Medline, Pub Med, Google Scholar, for the period 1985-2010, using keywords: "health professionals", "stress", “anxiety”, "working environment", "working conditions "," effects of stress on mental health. " Total of 205 studies were found and 48 of them were reviewed for this study. Results: The last fifteen years there was a significant increase of anxiety disorders in workplace and specifically in health organizations (hospitals, private clinics etc. The vast majority of the sample was nurses and practitioner doctors. However it is important to note that because of these cases, (which were persistent and repetitive, there were (increasing, negative impacts in mental and physical health of professionals. These were the key factors, due to which the employees are reluctant to work, or in many cases they think to quit their profession. Conclusions: The work environment in combination with other factors of the life of health professionals helps in triggering anxiety. Although the context is still under investigation by the authorities of health facilities (hospitals, clinics, etc.Also, health care professionals are invited to acquire knowledge for recognition of anxiety in the workplace and to develop policies and intervention in order to prevent and cope with the phenomenon.

  13. Job satisfaction and motivation of health workers in public and private sectors: cross-sectional analysis from two Indian states

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    Mahapatra Prasanta


    Full Text Available Abstract Background Ensuring health worker job satisfaction and motivation are important if health workers are to be retained and effectively deliver health services in many developing countries, whether they work in the public or private sector. The objectives of the paper are to identify important aspects of health worker satisfaction and motivation in two Indian states working in public and private sectors. Methods Cross-sectional surveys of 1916 public and private sector health workers in Andhra Pradesh and Uttar Pradesh, India, were conducted using a standardized instrument to identify health workers' satisfaction with key work factors related to motivation. Ratings were compared with how important health workers consider these factors. Results There was high variability in the ratings for areas of satisfaction and motivation across the different practice settings, but there were also commonalities. Four groups of factors were identified, with those relating to job content and work environment viewed as the most important characteristics of the ideal job, and rated higher than a good income. In both states, public sector health workers rated "good employment benefits" as significantly more important than private sector workers, as well as a "superior who recognizes work". There were large differences in whether these factors were considered present on the job, particularly between public and private sector health workers in Uttar Pradesh, where the public sector fared consistently lower (P P Conclusion There are common areas of health worker motivation that should be considered by managers and policy makers, particularly the importance of non-financial motivators such as working environment and skill development opportunities. But managers also need to focus on the importance of locally assessing conditions and managing incentives to ensure health workers are motivated in their work.

  14. Power in global health agenda-setting: the role of private funding Comment on "Knowledge, moral claims and the exercise of power in global health". (United States)

    Levine, Ruth E


    The editorial by Jeremy Shiffman, "Knowledge, moral claims and the exercise of power in global health", highlights the influence on global health priority-setting of individuals and organizations that do not have a formal political mandate. This sheds light on the way key functions in global health depend on private funding, particularly from the Bill & Melinda Gates Foundation.

  15. A comparison of human elements and nonhuman elements in private health care settings: customers' perceptions and expectations. (United States)

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


    In today's highly competitive health care environment, many private health care settings are now looking into customer service indicators to learn customers' perceptions and determine whether they are meeting customers' expectations in order to ensure that their customers are satisfied with the services. This research paper aims to investigate whether the human elements were more important than the nonhuman elements in private health care settings. We used the internationally renowned SERVQUAL five-dimension model plus three additional dimensions-courtesy, communication, and understanding of customers of the human element-when evaluating health care services. A total of 191 respondents from three private health care settings in the Klang Valley region of Malaysia were investigated. Descriptive statistics were calculated by the Statistical Package for Social Sciences (SPSS) computer program, version 15. Interestingly, the results suggested that customers nowadays have very high expectations especially when it comes to the treatment they are receiving. Overall, the research indicated that the human elements were more important than the nonhuman element in private health care settings. Hospital management should look further to improve on areas that have been highlighted. Implications for management practice and directions for future research are discussed.

  16. Determinants of Quality of Family Planning Counseling among Private Health Facilities in Lagos. (United States)

    Johnson, Doug; Ugaz, Jorge


    We use a unique dataset that includes an objective measure of the quality of family planning counseling from 927 private health facilities in Lagos State, Nigeria, to determine which variables at the facility and provider levels are most closely correlated with the quality of family planning counseling. Our data on quality come from mystery client surveys in which the clients posed as women seeking family planning counseling. We find that quality is strongly associated with the cadre of provider, with doctors delivering substantially higher-quality counselling than nurses. Doctors not only outperform nurses overall, but also perform better on each category of quality and spend nearly three minutes longer on average counseling the mystery client. Location, fees charged for the service, and facility type are also strongly correlated with quality. The degree to which a facility specializes in family planning and facility size are only weakly predictive of quality.

  17. Support of public–private partnerships in health promotion and conflicts of interest (United States)

    Hernandez-Aguado, Ildefonso; Zaragoza, G A


    Objectives Public–private partnerships (PPPs) are considered key elements in the development of effective health promotion. However, there is little research to back the enthusiasm for these partnerships. Our objective was to describe the diversity of visions on PPPs and to assess the links between the authors and corporations engaged in such ventures. Methods We reviewed the scientific literature through PubMed in order to select all articles that expressed a position or recommendation on governments and industries engaging in PPPs for health promotion. We included any opinion paper that considered agreements between governments and corporations to develop health promotion. Papers that dealt with healthcare provision or clinical preventive services and those related to tobacco industries were excluded. We classified the articles according to the authors' position regarding PPPs: strongly agree, agree, neutral, disagree and strongly disagree. We related the type of recommendation to authors' features such as institution and conflicts of interest. We also recorded whether the recommendations were based on previous assessments. Results Of 46 papers analysed, 21 articles (45.6%) stated that PPPs are helpful in promoting health, 1 was neutral and 24 (52.1%) were against such collaborations. 26 papers (57%) set out conditions to assure positive outcomes of the partnerships. Evidence for or against PPPs was mentioned in 11 papers that were critical or neutral (44%) but not in any of those that advocated collaboration. Where conflicts were declared (26 papers), absence of conflicts was more frequent in critics than in supporters (86% vs 17%). Conclusions Although there is a lack of evidence to support PPPs for health promotion, many authors endorse this approach. The prevalence of ideas encouraging PPPs can affect the intellectual environment and influence policy decisions. Public health researchers and professionals must make a contribution in properly framing the PPP

  18. The problems of private health insurance in Chile: Looking for a solution to a history of inefficiency and inequity

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    Camilo Cid


    Full Text Available The concept of health insurance is of vital importance for health policy. Beneficiaries are able to share the risk arising from health expenses, and are ensured access to health care provisions whenever necessary. The need to share an individual’s risk to become ill is the direct consequence of the uncertainty that surrounds the health sector. Chilean health insurance companies are able to reach financial balance (the state-owned insurer or profits (privately-owned insurers by setting a premium rate. Information flow tends to be asymmetric and one of the shortcomings of this system is that the private health insurance companies have better information, which leads to risk selection. A form of regulation would be to set a premium rate proportional to income thus incentivizing contributions in accordance with income (independent of risk and pool efficiency if the whole population is included. A natural solution that would be functional to the current system is the creation of a single pool together with a broad community premium rate to finance the fund. The article analyses the feasibility of a single fund, its requisites, and the health plan that the Chilean government is proposing in its bill to reform the private health insurance sector.

  19. Public and Private Sector in the Health Care System of the Federation Bosnia and Herzegovina: Policy and Strategy (United States)

    Slipicevic, Osman; Malicbegovic, Adisa


    In Bosnia and Herzegovina citizens receive health care from both public and private providers. The current situation calls for a clear government policy and strategy to ensure better position and services from both parts. This article examines how health care services are delivered, particularly with respect to relationship between public and private providers. The paper notes that the public sector is plagued by a number of weaknesses in terms of inefficiency of services provision, poorly motivated staff, prevalent dual practice of public employees, poor working conditions and geographical imbalances. Private sector is not developing in ways that address the weaknesses of the public sector. Poorly regulated, it operates as an isolated entity, strongly profit-driven. The increasing burdens on public health care system calls for government to abandon its passive role and take action to direct growth and use potential of private sector. The paper proposes a number of mechanisms that can be used to influence private as well as public sector, since actions directed toward one part of the system will inevitable influence the other. PMID:23678309

  20. Utilization of public or private health care providers by febrile children after user fee removal in Uganda

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    Peterson Stefan


    Full Text Available Abstract Background Despite investments in providing free government health services in Uganda, many caretakers still seek treatment from the drug shops/private clinics. The study aimed to assess determinants for use of government facilities or drug shops/private clinics for febrile illnesses in children under five. Methods Structured questionnaires were administered to caretakers in 1078 randomly selected households in the Iganga – Mayuge Demographic Surveillance site. Those with children who had had fever in the previous two weeks and who had sought care from outside the home were interviewed on presenting symptoms and why they chose the provider they went to. Symptoms children presented with and reasons for seeking care from government facilities were compared with those of drug shops/private clinics. Results Of those who sought care outside the home, 62.7% (286/456 had first gone to drug shops/private clinics and 33.1% (151/456 first went to government facilities. Predictors of having gone to government facilities with a febrile child were child presenting with vomiting (OR 2.07; 95% CI 1.10 – 3.89 and perceiving that the health providers were qualified (OR 10.32; 95% CI 5.84 – 18.26 or experienced (OR 1.93; 95% CI 1.07 – 3.48. Those who took the febrile child to drug shops/private clinics did so because they were going there to get first aid (OR 0.20; 95% CI 0.08 – 0.52. Conclusion Private providers offer 'first aid' to caretakers with febrile children. Government financial assistance to health care providers should not stop at government facilities. Multi-faceted interventions in the private sector and implementation of community case management of febrile children through community medicine distributors could increase the proportion of children who access quality care promptly.

  1. Good governance of animal health systems and public-private partnerships: an Australian case study. (United States)

    Black, P F


    The animal health system in Australia has evolved over more than 100 years and includes innovative public-private partnership arrangements. The establishment in 1996 of Animal Health Australia (AHA), a not-for-profit company, was a crucial development which formalised arrangements for shared decision-making and funding across both government and industry stakeholders. However, Federal and State governments retain legislative authority for animal health control. Accordingly, all programmes must recognise that the public sector remains an executive arm of government, accountable for its actions. Hence, much effort has been invested in ensuring that the governance arrangements within AHA are lawful and transparent. The Emergency Animal Disease Response Agreement (EADRA) is a very good example of governance arrangements that are sustainably financed, widely available, provided efficiently, without waste or duplication, and in a manner that is transparent and free of fraud or corruption. The benefits of EADRA include certainty and greater transparency of funding; greater efficiency through increased probability of a rapid response to an occurrence of any of 65 diseases; and industry participation in the management and financing of such a response.

  2. Health care consumers’ perspectives on pharmacist integration into private general practitioner clinics in Malaysia: a qualitative study

    Directory of Open Access Journals (Sweden)

    Saw PS


    Full Text Available Pui San Saw,1 Lisa M Nissen,2,3 Christopher Freeman,2,4 Pei Se Wong,3 Vivienne Mak5 1School of Postgraduate Studies and Research, International Medical University, Kuala Lumpur, Malaysia; 2School of Clinical Sciences, Queensland University Technology, Brisbane, QLD, Australia; 3School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia; 4School of Pharmacy, University of Queensland, St Lucia, QLD, Australia; 5School of Pharmacy, Monash University Malaysia, Selangor, Malaysia Background: Pharmacists are considered medication experts but are underutilized and exist mainly at the periphery of the Malaysian primary health care team. Private general practitioners (GPs in Malaysia are granted rights under the Poison Act 1952 to prescribe and dispense medications at their primary care clinics. As most consumers obtain their medications from their GPs, community pharmacists’ involvement in ensuring safe use of medicines is limited. The integration of a pharmacist into private GP clinics has the potential to contribute to quality use of medicines. This study aims to explore health care consumers’ views on the integration of pharmacists within private GP clinics in Malaysia.Methods: A purposive sample of health care consumers in Selangor and Kuala Lumpur, Malaysia, were invited to participate in focus groups and semi-structured interviews. Sessions were audio recorded and transcribed verbatim and thematically analyzed using NVivo 10. Results: A total of 24 health care consumers participated in two focus groups and six semi-structured interviews. Four major themes were identified: 1 pharmacists’ role viewed mainly as supplying medications, 2 readiness to accept pharmacists in private GP clinics, 3 willingness to pay for pharmacy services, and 4 concerns about GPs’ resistance to pharmacist integration. Consumers felt that a pharmacist integrated into a private GP clinic could offer potential benefits such as to provide trustworthy

  3. Findings from a hepatitis B birth dose assessment in health facilities in the Philippines: opportunities to engage the private sector (United States)

    Patel, Minal K.; Capeding, Rosario Z.; Ducusin, Joyce U.; de Quiroz Castro, Maricel; Garcia, Luzviminda C.; Hennessey, Karen


    Background Hepatitis B vaccination in the Philippines was introduced in 1992 to reduce the high burden of chronic hepatitis B virus (HBV) infection in the population; in 2007, a birth dose (HepB-BD) was introduced to decrease perinatal HBV transmission. Timely HepB-BD coverage, defined as doses given within 24 hours of birth, was 40% nationally in 2011. A first step in improving timely HepB-BD coverage is to ensure that all newborns born in health facilities are vaccinated. Methods In order to assess ways of improving the Philippines’ HepB-BD program, we evaluated knowledge, attitudes, and practices surrounding HepB-BD administration in health facilities. Teams visited selected government clinics, government hospitals, and private hospitals in regions with low reported HepB-BD coverage and interviewed immunization and maternity staff. HepB-BD coverage was calculated in each facility for a 3 month period in 2011. Results Of the 142 health facilities visited, 12 (8%) did not provide HepB-BD; seven were private hospitals and five were government hospitals. Median timely HepB-BD coverage was 90% (IQR 80%–100%) among government clinics, 87% (IQR 50%–97%) among government hospitals, and 50% (IQR 0%–90%) among private hospitals (p=0.02). The private hospitals were least likely to receive supervision (53% versus 6%–31%, p=0.0005) and to report vaccination data to the national Expanded Programme on Immunization (36% vs. 96%–100%, p<0.0001). Conclusions Private sector hospitals in the Philippines, which deliver 18% of newborns, had the lowest timely HepB-BD coverage. Multiple avenues exist to engage the private sector in hepatitis B prevention including through existing laws, newborn health initiatives, hospital accreditation processes, and raising awareness of the government’s free vaccine program. PMID:24361121

  4. Medicaid Crowd-Out of Private Long-Term Care Insurance Demand : Evidence from the Health and Retirement Survey

    NARCIS (Netherlands)

    Brown, J.R.; Coe, N.B.; Finkelstein, A.


    This paper provides empirical evidence of Medicaid crowd out of demand for private long-term care insurance. Using data on the near- and young-elderly in the Health and Retirement Survey, our central estimate suggests that a $10,000 decrease in the level of assets an individual can keep while qualif

  5. Genetic counselors and health literacy: the role of genetic counselors in developing a web-based resource about the Affordable Care Act. (United States)

    Mann, Sylvia; Mui, Pauline; Boomsma, Jennifer; Hasegawa, Lianne


    The Western States Genetic Services Collaborative (WSGSC) recognized the need for clear and understandable information about the Affordable Care Act (ACA) for families throughout the life course. The genetic counselors working in the WSGSC developed, tested, and implemented a web resource ( ) to help families navigate information about the ACA tailored to their life situation. The training and experience of genetic counselors provide the skills needed to translate complicated information, like that of the ACA, into formats that the general public can comprehend. The website went public in October 2013, and it has been positively received. The development of this website is a good case study in how genetic counseling skills can be applied to public health education and improving health literacy.

  6. Sindicalismo, SUS e planos de saúde Trade unionism, Unified Health System (SUS and private health insurance

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    José Augusto Pina


    Full Text Available Este artigo discute a interlocução do sindicalismo brasileiro com o Sistema Único de Saúde (SUS e os planos e seguros privados de saúde. São ponderadas algumas teses na Saúde Coletiva à luz de estudos mais recentes nas Ciências Sociais sobre o sindicalismo e realizada análise documental para o caso da Central Única dos Trabalhadores (CUT, tomado aqui como referência. Aponta-se a necessidade de considerar os pesos relativos que a ação sindical atribuiu a cada um dos aspectos da relação, SUS e planos privados de saúde, pelas distintas conjunturas do país. O conflito entre trabalhadores e empresas somado ao desemprego e à precarização do trabalho expõe os limites das coberturas assistenciais privadas e impele a representação sindical a pleitear a intervenção estatal. O trabalho refletiu sobre as distintas modalidades de ação sindical na empresa e no Estado. A complexidade dessa dinâmica fez emergir um setor sindical interessado na gestão da previdência complementar e dos planos de saúde e, ao mesmo tempo, recria as circunstâncias e traz novas possibilidades de as organizações sindicais se colocarem na cena política e aglutinar os interesses de amplos segmentos dos trabalhadores para pressionar o Estado na defesa da melhoria do sistema público de saúde.The article intends to discuss the patterns of interlocution between the Brazilian trade unionism, the public health system (SUS and the private health insurance sector. Some thesis originated in the Public Health area about the subject are debated, in the light of more recent Social Science's studies concerned the Brazilian unionism. It presents a documentary analysis for the case of the largest National Workers Organization, named CUT. The need to discuss the problem in distinct political and economic conjunctures of the country is pointed out. The conflicts between the workers and the companies, added to the unemployment and deregulation of the labor markets

  7. Principles for building public-private partnerships to benefit food safety, nutrition, and health research. (United States)

    Rowe, Sylvia; Alexander, Nick; Kretser, Alison; Steele, Robert; Kretsch, Molly; Applebaum, Rhona; Clydesdale, Fergus; Cummins, Deborah; Hentges, Eric; Navia, Juan; Jarvis, Ashley; Falci, Ken


    The present article articulates principles for effective public-private partnerships (PPPs) in scientific research. Recognizing that PPPs represent one approach for creating research collaborations and that there are other methods outside the scope of this article, PPPs can be useful in leveraging diverse expertise among government, academic, and industry researchers to address public health needs and questions concerned with nutrition, health, food science, and food and ingredient safety. A three-step process was used to identify the principles proposed herein: step 1) review of existing PPP guidelines, both in the peer-reviewed literature and at 16 disparate non-industry organizations; step 2) analysis of relevant successful or promising PPPs; and step 3) formal background interviews of 27 experienced, senior-level individuals from academia, government, industry, foundations, and non-governmental organizations. This process resulted in the articulation of 12 potential principles for establishing and managing successful research PPPs. The review of existing guidelines showed that guidelines for research partnerships currently reside largely within institutions rather than in the peer-reviewed literature. This article aims to introduce these principles into the literature to serve as a framework for dialogue and for future PPPs.

  8. [Work regulation in the context of new public versus private relations in health]. (United States)

    Barbosa, Nelson Bezerra


    This work discusses the management of the work relations in the context of the new systems of public vs. private relation in health, having as reference the experience of the habilitation of Social Organizations (SO), responsible for the administration of a group of hospitals in the state of São Paulo. The urgency in this kind of management supported on the legal figure of the SO has implications in the management of Human Resources in Health (HRH) through the adoption of flexibilization mechanisms which include ways of selection, hiring and dismissal, payment rules and functional progression similar to the actions adopted by the market. The establishment of this sort of administration refers to the new paradigm proposed by the managerial administrative reform which suggests the exhaustion of the bureaucratic model to promote adjustment of the public administration to the transformations originated in the new stage of internationalization of the economy and its unfolding in the work world, as well as to the new standards of requirements of performance of the public field. Aspects related to the management of HHR are approached in the two ruling modalities in the Secretaria de Estado da Saúde de São Paulo: Direct Administration Hospitals (DAH) and units organized under the SO model (SOH).

  9. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies.

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    Sima Berendes


    Full Text Available BACKGROUND: In developing countries, the private sector provides a substantial proportion of primary health care to low income groups for communicable and non-communicable diseases. These providers are therefore central to improving health outcomes. We need to know how their services compare to those of the public sector to inform policy options. METHODS AND FINDINGS: We summarised reliable research comparing the quality of formal private versus public ambulatory health care in low and middle income countries. We selected studies against inclusion criteria following a comprehensive search, yielding 80 studies. We compared quality under standard categories, converted values to a linear 100% scale, calculated differences between providers within studies, and summarised median values of the differences across studies. As the results for for-profit and not-for-profit providers were similar, we combined them. Overall, median values indicated that many services, irrespective of whether public or private, scored low on infrastructure, clinical competence, and practice. Overall, the private sector performed better in relation to drug supply, responsiveness, and effort. No difference between provider groups was detected for patient satisfaction or competence. Synthesis of qualitative components indicates the private sector is more client centred. CONCLUSIONS: Although data are limited, quality in both provider groups seems poor, with the private sector performing better in drug availability and aspects of delivery of care, including responsiveness and effort, and possibly being more client orientated. Strategies seeking to influence quality in both groups are needed to improve care delivery and outcomes for the poor, including managing the increasing burden of non-communicable diseases.

  10. Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh


    Sikder, Shegufta S.; Labrique, Alain B; Ali, Hasmot; Hanif, Abu AM; Klemm, Rolf DW; Mehra, Sucheta; West, Keith P; Christian, Parul


    Background Although safe motherhood strategies recommend that women seek timely care from health facilities for obstetric complications, few studies have described facility availability of emergency obstetric care (EmOC). We sought to describe and compare availability and readiness to provide EmOC among public and private health facilities commonly visited for pregnancy-related complications in two districts of northwest Bangladesh. We also described aspects of financial and geographic access...

  11. Assessing the potential of rural and urban private facilities in implementing child health interventions in Mukono district, central Uganda

    DEFF Research Database (Denmark)

    Rutebemberwa, Elizeus; Buregyeya, Esther; Lal, Sham;


    in diagnostic capabilities, operations and human resource in the management of malaria, pneumonia and diarrhoea. METHODS: A survey was conducted in pharmacies, private clinics and drug shops in Mukono district in October 2014. An assessment was done on availability of diagnostic equipment for malaria, record...... attended to at least one sick child in the week prior to the interview. CONCLUSION: There were big gaps between rural and urban private facilities with rural ones having less trained personnel and less zinc tablets' availability. In both rural and urban areas, record keeping was low. Child health...

  12. When worlds collide: medicine, business, the Affordable Care Act and the future of health care in the U.S. (United States)

    Wicks, Andrew C; Keevil, Adrian A C


    The dialogue about the future of health care in the US has been impeded by flawed conceptions about medicine and business. The present paper re-examines some of the underlying assumptions about both medicine and business, and uses more nuanced readings of both terms to frame debates about the ACA and the emerging health care environment.

  13. From private club to professional network: an economic history of the Health Economists' Study Group, 1972-1997. (United States)

    Croxson, B


    HESG was founded in 1972 as part of a conscious effort to establish health economics as an identifiable sub-discipline. It is debatable whether the growth of health economics was demand-led or supplier-driven, but in either case the existence of a HESG played a vital role. HESG was founded as a private club, in the tradition of English gentlemen's clubs, designed to provide a forum for debate and an invisible, supportive faculty for health economists dispersed between different organisations throughout the UK. It was given impetus by public economists at the University of York, who were effectively academic entrepreneurs, motivated in part by private gain, but by their actions overcoming the free-rider problem that might otherwise have retarded the development of health economics. Over the course of its first 25 years, HESG has changed and its membership has grown and altered in composition - over this period, HESG has evolved from a private club to a professional network. It has made a vital contribution to the existence and form of health economics as a subdiscipline in the United Kingdom, and has in turn itself been influenced by the subdiscipline. As a subdiscipline, UK health economics in the 1990s generally draws on a small body of economic theory and is practised by a distinct, identifiable group of economists. This paper was commissioned by HESG, as a history of the organisation. It also analyses the foundation and evolution of HESG as an institutional arrangement designed to overcome a collective action problem.

  14. Health literacy, health information seeking behaviors and internet use among patients attending a private and public clinic in the same geographic area. (United States)

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


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

  15. Sharing risk between payer and provider by leasing health technologies: an affordable and effective reimbursement strategy for innovative technologies? (United States)

    Edlin, Richard; Hall, Peter; Wallner, Klemens; McCabe, Christopher


    The challenge of implementing high-cost innovative technologies in health care systems operating under significant budgetary pressure has led to a radical shift in the health technology reimbursement landscape. New reimbursement strategies attempt to reduce the risk of making the wrong decision, that is, paying for a technology that is not good value for the health care system, while promoting the adoption of innovative technologies into clinical practice. The remaining risk, however, is not shared between the manufacturer and the health care payer at the individual purchase level; it continues to be passed from the manufacturer to the payer at the time of purchase. In this article, we propose a health technology payment strategy-technology leasing reimbursement scheme-that allows the sharing of risk between the manufacturer and the payer: the replacing of up-front payments with a stream of payments spread over the expected duration of benefit from the technology, subject to the technology delivering the claimed health benefit. Using trastuzumab (Herceptin) in early breast cancer as an exemplar technology, we show how a technology leasing reimbursement scheme not only reduces the total budgetary impact of the innovative technology but also truly shares risk between the manufacturer and the health care system, while reducing the value of further research and thus promoting the rapid adoption of innovative technologies into clinical practice.

  16. Music-making for health and wellbeing in youth justice settings: mediated affordances and the impact of context and social relations. (United States)

    Daykin, Norma; de Viggiani, Nick; Moriarty, Yvonne; Pilkington, Paul


    Young people in the criminal justice system experience significant health and wellbeing issues that often stem from poverty and disadvantage and, in turn, are linked with offending and reoffending behaviour. There is ongoing interest in interventions such as participatory music programmes that seek to foster social reintegration, support mental wellbeing and equip young offenders with life skills, competencies and emotional resilience. However, there is a need for a situated understanding of both positive and negative experiences that shape potential outcomes of music projects. This article reports on a research study undertaken between 2010 and 2013 with 118 young people aged 13-21 years across eight youth justice settings in England and Wales. Using mixed methods we explored the experiences of young people and their responses to a participatory music programme led by a national UK arts charity. Here, we explore the impact of young people's encounters with music and musicians with reference to the notion of 'musical affordances' (DeNora , ). We examine the ways that such affordances, including unintended outcomes, are mediated by features of the youth justice environment, including its rules and regulations, as well as issues of power, identity and social relations.

  17. The effects of market structure and payment rate on the entry of private health plans into the Medicare market. (United States)

    Frakt, Austin B; Pizer, Steven D; Feldman, Roger


    Private insurance firms participating in Medicare can offer up to three principal plan types: coordinated care plans (CCPs), prescription drug plans (PDPs), and private fee-for-service (PFFS) plans. Firms can make entry and marketing decisions separately across plan types and geographic regions. In this study, we estimate firm-level models of Medicare private plan entry using data from the years 2007 to 2009. Our models include a measure of market structure and separately identify CCP, PDP, and PFFS entry. We find evidence that entry barriers associated with CCP market concentration affect all three product types. We also find evidence of cross-product competition and common cost or demand factors that make entry with certain product combinations more likely. We predict that the market presence of CCPs and PFFS plans will decrease and that of PDPs will increase in response to payment reductions included in the new health reform law.

  18. Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership?

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    Madhivanan Purnima


    Full Text Available Abstract Developing countries are currently struggling to achieve the Millennium Development Goal Five of reducing maternal mortality by three quarters between 1990 and 2015. Many health systems are facing acute shortages of health workers needed to provide improved prenatal care, skilled birth attendance and emergency obstetric services – interventions crucial to reducing maternal death. The World Health Organization estimates a current deficit of almost 2.4 million doctors, nurses and midwives. Complicating matters further, health workforces are typically concentrated in large cities, while maternal mortality is generally higher in rural areas. Additionally, health care systems are faced with shortages of specialists such as anaesthesiologists, surgeons and obstetricians; a maldistribution of health care infrastructure; and imbalances between the public and private health care sectors. Increasingly, policy-makers have been turning to human resource strategies to cope with staff shortages. These include enhancement of existing work roles; substitution of one type of worker for another; delegation of functions up or down the traditional role ladder; innovation in designing new jobs;transfer or relocation of particular roles or services from one health care sector to another. Innovations have been funded through state investment, public-private partnerships and collaborations with nongovernmental organizations and quasi-governmental organizations such as the World Bank. This paper focuses on how two large health systems in India – Gujarat and Tamil Nadu – have successfully applied human resources strategies in uniquely different contexts to the challenges of achieving Millennium Development Goal Five.

  19. Assessing Private Sector Involvement in Health Care and Universal Health Coverage in Light of the Right to Health

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    Hallo de Wolf, Antenor; Toebes, Brigit


    e goal of universal health coverage is to “ensure that all people obtain the health services they need without su ering nancial hardship when paying for them.” There are many connections between this goal and the state’s legal obligation to realize the human right to health. In the context of this g


    Directory of Open Access Journals (Sweden)

    Bruno Vendruscolo


    Full Text Available This study aimed to identify the use of management tools and the influence of stakeholders on organizational performance of companies in the private health sector in the Federal District. We used the tools of strategic management, such as budgeting, strategic planning, balanced scorecard, benchmarking, and management software. Study participants consist of individuals involved in strategic processes. We analyzed the past 5 years in organizations to understand the performance. The data collection was face-to-face, the instruments consisted of qualitative interviews in person, and semi-structured content analysis. We also performed analysis of secondary data and documents. To measure the performance between the organizations we used the method of data envelopment analysis (DEA, using the CCR standard, and the mean change index as the number of employees, physicians, costs, number of appointments, and tests. In the analysis of tools and stakeholders we adapted values for the major and minor influences and the other results found framed. The results cite the presence of management tools in five of the six organizations. The comparison of performance between them presented as a result that organizations 2 and 4 were efficient and 3 was the least efficient. The study identified the need to understand the requirements of stakeholders and the indicators set out to understand organizational performance and its evolution, mainly determined by the management tools. Although not reaching proposed levels, this work creates hypotheses about the use of these tools and analysis of stakeholders in organizational performance.

  1. Historicizing affordance theory

    DEFF Research Database (Denmark)

    Pedersen, Sofie; Bang, Jytte Susanne


    The aim of this article is to discuss how mutually enriching points from both affordance theory and cultural-historical activity theory can promote theoretical ideas which may prove useful as analytical tools for the study of human life and human development. There are two issues that need...... to be overcome in order to explore the potentials of James Gibson’s affordance theory: it does not sufficiently theorize (a) development and (b) society. We claim that Gibson’s affordance theory still needs to be brought beyond “the axiom of immediacy.” Ambivalences in Gibson’s affordance theory...... societal character of affordance theory....

  2. An affordable physician- and consumer-friendly health care system: 2008 democratic and republican presidential candidates' views. (United States)

    Herzlinger, Regina E


    Winter issues of The American Heart Hospital Journal traditionally focus on health care policy issues. As health care reform in the United States is a topic of major importance in the upcoming presidential election, we invited Dr Regina E. Herzlinger, the Nancy R. McPherson Professor of Business Administration at Harvard University and a noted expert in the field, to provide an analysis of the major proposals currently under debate by the candidates. We invite your comments in the coming months as the field of candidates narrows and the focus on reform sharpens.-Sylvan Lee Weinberg, Editor in Chief.

  3. Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis (United States)

    Buttigieg, Sandra C.; Schuetz, Marcus; Bezzina, Frank


    The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state’s health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta. PMID:27683658

  4. Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis. (United States)

    Buttigieg, Sandra C; Schuetz, Marcus; Bezzina, Frank


    The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state's health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta.

  5. Statutory caps: an involuntary contribution to the medical malpractice insurance crisis or a reasonable mechanism for obtaining affordable health care? (United States)

    Chupkovich, P J


    extremely important in light of proposed health care legislation entitled the Health Care Liability Reform and Quality of Care Improvement Act of 1992 [the "Health Care Bill"]. This Comment critically examines the constitutionality of statutory caps on damages in medical malpractice actions. It focuses on the public policy behind the caps and the constitutional issues embodied in limiting an individual's recovery. It also analyzes the impact of the Health Care Bill on statutory caps. Part I outlines the medical malpractice insurance crisis, describes the statutory reforms and discusses the public policy behind tort reform. Part II examines the constitutionality of statutory caps and summarizes the arguments of the proponents and the opponents of these caps. Part III discusses the Health Care Bill and its impact on medical malpractice legislation with respect to statutory caps. This Comment concludes that a compromise must be reached that addresses both the growing health care insurance crisis and the protection of individual rights. The Health Care Liability Reform and Quality of Care Improvement Act of 1992 attempts to achieve this compromise.

  6. Review of the President’s Fiscal Year 2009 Budget Request for the Defense Health Program’s Private Sector Care Budget Activity Group (United States)


    2009 budget request for the Defense Health Program’s Private Sector Care BAG. To do this, we reviewed (1) DOD’s justification for the request for the... Private Sector Care BAG, including the underlying estimates and the extent to which DOD considered historical information; and (2) changes between this...develop the budget requests for the Private Sector Care BAG in fiscal years 2008 and 2009. We also interviewed officials and analyzed documents from

  7. Value chains of public and private health care services in a small EU Island State: A SWOT analysis

    Directory of Open Access Journals (Sweden)

    Sandra C. Buttigieg


    Full Text Available The global financial and macro-economic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically in health care, governments started to explore ways of establishing collaborations between the public and private healthcare sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care, as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health care systems in Malta, a small EU island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains and this was followed by an analysis of strengths, weaknesses, opportunities and threats (SWOT. The latter revealed several strengths and opportunities, which can better equip health policy makers in the quest to maximize provision of health care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that unless addressed, may threaten the state’s health care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health care services in Malta.

  8. 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. (United States)

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


    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

  9. Economic Evaluation of PCSK9 Inhibitors in Reducing Cardiovascular Risk from Health System and Private Payer Perspectives (United States)

    Page, Timothy F.; Veledar, Emir; Nasir, Khurram


    The introduction of Proprotein covertase subtilisin/kexin type 9 (PCSK9) inhibitors has been heralded as a major advancement in reducing low-density lipoprotein cholesterol levels by nearly 50%. However, concerns have been raised on the added value to the health care system in terms of their costs and benefits. We assess the cost-effectiveness of PCSK9 inhibitors based on a decision-analytic model with existing clinical evidence. The model compares a lipid-lowering therapy based on statin plus PCSK9 inhibitor treatment with statin treatment only (standard therapy). From health system perspective, incremental cost per quality adjusted life years (QALYs) gained are presented. From a private payer perspective, return-on-investment and net present values over patient lifespan are presented. At the current annual cost of $14,000 to $15,000, PCSK9 inhibitors are not cost-effective at an incremental cost of about $350,000 per QALY. Moreover, for every dollar invested in PCSK9 inhibitors, the private payer loses $1.98. Our study suggests that the annual treatment price should be set at $4,250 at a societal willingness-to-pay of $100,000 per QALY. However, we estimate the breakeven price for private payer is only $600 per annual treatment. At current prices, our study suggests that PCSK9 inhibitors do not add value to the U.S. health system and their provision is not profitable for private payers. To be the breakthrough drug in the fight against cardiovascular disease, the current price of PCSK9 inhibitors must be reduced by more than 70%. PMID:28081164

  10. Patient turnover and nursing employment in Massachusetts hospitals before and after health insurance reform: implications for the Patient Protection and Affordable Care Act. (United States)

    Shindul-Rothschild, Judith; Gregas, Matt


    The Affordable Care Act is modeled after Massachusetts insurance reforms enacted in 2006. A linear mixed effect model examined trends in patient turnover and nurse employment in Massachusetts, New York, and California nonfederal hospitals from 2000 to 2011. The linear mixed effect analysis found that the rate of increase in hospital admissions was significantly higher in Massachusetts hospitals (p<.001) than that in California and New York (p=.007). The rate of change in registered nurses full-time equivalent hours per patient day was significantly less (p=.02) in Massachusetts than that in California and was not different from zero. The rate of change in admissions to registered nurses full-time equivalent hours per patient day was significantly greater in Massachusetts than California (p=.001) and New York (p<.01). Nurse staffing remained flat in Massachusetts, despite a significant increase in hospital admissions. The implications of the findings for nurse employment and hospital utilization following the implementation of national health insurance reform are discussed.

  11. Channels for change: private water and the urban poor

    Energy Technology Data Exchange (ETDEWEB)

    Lynch, Matthew; Matthews, Petter; Ryan-Collins, Lily [Engineers Against Poverty (United Kingdom)


    For the rapidly urbanising developing world, safe and affordable water is key to health and livelihoods, as well as meeting the Millennium Development Goals. But providing it demands innovative models. Where the context allows and the approach is appropriate, private sector involvement can generate win-win outcomes. Poor people can gain access to high-quality, affordable services, and companies can gain access to new and profitable business opportunities. Two examples of innovative 'private' water suppliers are the Manila Water Company's Water for the Poor Communities (TPSB) programme, and the Water & Sanitation for the Urban Poor (WSUP) partnership. Both have a multisector approach to service expansion and provision, including partnerships with local authorities; strong community involvement in selecting, designing and operating options; appropriate service levels to reduce costs; and a flexible range of services. Many elements of these models are also replicable.

  12. Global affordability of fluoride toothpaste

    Directory of Open Access Journals (Sweden)

    Holmgren Christopher J


    Full Text Available Abstract Objective Dental caries remains the most common disease worldwide and the use of fluoride toothpaste is a most effective preventive public health measure to prevent it. Changes in diets following globalization contribute to the development of dental caries in emerging economies. The aim of this paper is to compare the cost and relative affordability of fluoride toothpaste in high-, middle- and low-income countries. The hypothesis is that fluoride toothpaste is not equally affordable in high-, middle- and low-income countries. Methods Data on consumer prices of fluoride toothpastes were obtained from a self-completion questionnaire from 48 countries. The cost of fluoride toothpaste in high-, middle- and low-income countries was compared and related to annual household expenditure as well as to days of work needed to purchase the average annual usage of toothpaste per head. Results The general trend seems to be that the proportion of household expenditure required to purchase the annual dosage of toothpaste increases as the country's per capita household expenditure decreases. While in the UK for the poorest 30% of the population only 0.037 days of household expenditure is needed to purchase the annual average dosage (182.5 g of the lowest cost toothpaste, 10.75 days are needed in Kenya. The proportion of annual household expenditure ranged from 0.02% in the UK to 4% in Zambia to buy the annual average amount of lowest cost toothpaste per head. Conclusion Significant inequalities in the affordability of this essential preventive care product indicate the necessity for action to make it more affordable. Various measures to improve affordability based on experiences from essential pharmaceuticals are proposed.

  13. "Medical tourism" and the global marketplace in health services: U.S. patients, international hospitals, and the search for affordable health care. (United States)

    Turner, Leigh


    Health services are now advertised in a global marketplace. Hip and knee replacements, ophthalmologic procedures, cosmetic surgery, cardiac care, organ transplants, and stem cell injections are all available for purchase in the global health services marketplace. "Medical tourism" companies market "sun and surgery" packages and arrange care at international hospitals in Costa Rica, India, Mexico, Singapore, Thailand, and other destination nations. Just as automobile manufacturing and textile production moved outside the United States, American patients are "offshoring" themselves to facilities that use low labor costs to gain competitive advantage in the marketplace. Proponents of medical tourism argue that a global market in health services will promote consumer choice, foster competition among hospitals, and enable customers to purchase high-quality care at medical facilities around the world. Skeptics raise concerns about quality of care and patient safety, information disclosure to patients, legal redress when patients are harmed while receiving care at international hospitals, and harms to public health care systems in destination nations. The emergence of a global market in health services will have profound consequences for health insurance, delivery of health services, patient-physician relationships, publicly funded health care, and the spread of medical consumerism.

  14. Who can afford health care? Evaluating the socio-economic conditions and the ability to contribute to health care in a post-conflict area in DR Congo.

    Directory of Open Access Journals (Sweden)

    Sibylle Gerstl

    Full Text Available INTRODUCTION: The Democratic Republic of the Congo is today one of the poorest countries in the world; the health status of the population ranks among the worst in Sub-Saharan Africa. Public health services charge user fees and drug prices. Since 2008, north-eastern Congo is facing a guerrilla war. Malteser International is assisting with free health care for internally displaced persons as well as the general population. Before the incursion the health system was based on user fees. The aim of this study was to determine the socio-economic conditions of the population and to assess their ability to contribute to health care. METHODOLOGY: Heads of 552 randomly selected households in 23 clusters in two health zones were interviewed using a standardised questionnaire. FINDINGS: The demographic description and socio-economic conditions of the study population were homogenous. Major source of income was agriculture (57%; 47% of the households earned less than US$ 5.5/week. Ninety-two percent of the interviewed households estimated that they would be able to contribute to consultation fees (maximum amount of US$ 0.27 and 79% to the drug prices (maximum amount of US$ 1.10. Six percent opted for free consultations and 19% for free drugs. CONCLUSIONS: Living conditions were very basic; the estimated income of the study population was low. Almost half of the population perceived their current living situation as fairly good/good. More than 90% of the study population estimated to be able to contribute to consultation fees and 80% to drug prices. As a result Malteser International suggested introducing flat-rates for health care services. Once the project ends, the population will have to pay again for their health service. One solution would be the introduction of a health care financing system with the goal to reach universal coverage to health care.

  15. [Complaints by private health insurance policy-holders to the Consumer Protection Bureau in Argentina, 2000-2008]. (United States)

    Luzuriaga, María José; Spinelli, Hugo


    This paper analyzes problems experienced by policy-holders of voluntary private health insurance plans in Argentina when insurance companies fail to comply with the Consumer Protection Code. The sample consisted of consumer complaints filed with the Consumer Protection Bureau and rulings by the Bureau from 2000 to 2008. One striking issue was recurrent non-compliance with services included in the Mandatory Medical Program and the companies' attempts to blame policy-holders. According to the study, the lack of an information system hinders scientific studies to adequately address the problem. Thus, a comparison with studies on health insurance in other Latin American countries highlighted the importance of such research, the relationship to health systems, constraints on use and denial of citizens' rights to healthcare, and the increasing judicialization of healthcare provision.

  16. Sources of satisfaction and dissatisfaction among specialists within the public and private health sectors

    DEFF Research Database (Denmark)

    Ashton, Toni; Brown, Paul M.; Sopina, Elizaveta (Liza)


    and professional development, key sources of dissatisfaction are workload pressures, mentally demanding work and managerial interference. In the private sector specialists value the opportunity to work independently and apply their own ideas in the workplace. Conclusion Sources of job satisfaction......Aim As in many countries, medical and surgical specialists in New Zealand have the opportunity of working in the public sector, the private sector or both. This study aimed to explore the level and sources of satisfaction and dissatisfaction of specialists in New Zealand with working in the two...... of satisfaction and 9 sources of dissatisfaction according to a 5-point Likert scale. Means and standard deviations were calculated for the total sample, and for procedural and non-procedural specialties. Differences between the means of each source of satisfaction and dissatisfaction were also calculated...

  17. Independent sector mental health care: a 1-day census of private and voluntary sector placements in seven Strategic Health Authority areas in England. (United States)

    Hatfield, Barbara; Ryan, Tony; Simpson, Victoria; Sharma, Indhu


    The aims of this study were (i) to map the extent of all mental health placements in the independent sector, for adults of working age, and elderly people (excluding those with a diagnosis of dementia placed in Local Authority care homes), on a census date, across the areas in which the study was commissioned; (ii) to identify the characteristics of the population in placements; (iii) to explore some of the characteristics of the placements and the patterns of use within the private and voluntary sectors; and (iv) to identify the funding source of placements, and cost differences between the private and voluntary sector. The study took place in seven Strategic Health Authority areas, and information was sought from all Primary Care Trust and Social Services commissioners of mental health services, including regional secure commissioning teams, within those areas. A cross-sectional sample was used. Information was requested in relation to every individual meeting the inclusion criteria, placed in independent (private or voluntary) psychiatric hospitals, registered mental nursing homes and care homes on a specified study 'census date' of 28 June 2004 in six of the Strategic Health Authority areas, and 7 October 2004 in the seventh. Information was recorded on a standard questionnaire specifically designed for the study. Information was obtained on 3535 adults and 1623 elderly people in private or voluntary facilities. The largest groups of adults and elderly people had diagnoses of severe mental illnesses (42.1% and 30.5%, respectively), and placements were described as 'continuing care' or rehabilitation, with a 'niche' in specialist forensic care. Around four-fifths of units were in the private sector, which for adults was significantly more expensive than the voluntary sector. A large proportion of units (47.2% of adult placements and 59.3% of placements for elderly people) had only single placements from particular commissioning authorities, whilst others had

  18. Public – private 'partnerships' in health – a global call to action

    Directory of Open Access Journals (Sweden)

    Nishtar Sania


    Full Text Available Abstract The need for public-private partnerships arose against the backdrop of inadequacies on the part of the public sector to provide public good on their own, in an efficient and effective manner, owing to lack of resources and management issues. These considerations led to the evolution of a range of interface arrangements that brought together organizations with the mandate to offer public good on one hand, and those that could facilitate this goal though the provision of resources, technical expertise or outreach, on the other. The former category includes of governments and intergovernmental agencies and the latter, the non-profit and for-profit private sector. Though such partnerships create a powerful mechanism for addressing difficult problems by leveraging on the strengths of different partners, they also package complex ethical and process-related challenges. The complex transnational nature of some of these partnership arrangements necessitates that they be guided by a set of global principles and norms. Participation of international agencies warrants that they be set within a comprehensive policy and operational framework within the organizational mandate and involvement of countries requires legislative authorization, within the framework of which, procedural and process related guidelines need to be developed. This paper outlines key ethical and procedural issues inherent to different types of public-private arrangements and issues a Global Call to Action.

  19. FRR: fair remote retrieval of outsourced private medical records in electronic health networks. (United States)

    Wang, Huaqun; Wu, Qianhong; Qin, Bo; Domingo-Ferrer, Josep


    Cloud computing is emerging as the next-generation IT architecture. However, cloud computing also raises security and privacy concerns since the users have no physical control over the outsourced data. This paper focuses on fairly retrieving encrypted private medical records outsourced to remote untrusted cloud servers in the case of medical accidents and disputes. Our goal is to enable an independent committee to fairly recover the original private medical records so that medical investigation can be carried out in a convincing way. We achieve this goal with a fair remote retrieval (FRR) model in which either t investigation committee members cooperatively retrieve the original medical data or none of them can get any information on the medical records. We realize the first FRR scheme by exploiting fair multi-member key exchange and homomorphic privately verifiable tags. Based on the standard computational Diffie-Hellman (CDH) assumption, our scheme is provably secure in the random oracle model (ROM). A detailed performance analysis and experimental results show that our scheme is efficient in terms of communication and computation.

  20. Private Schools (United States)

    Department of Homeland Security — This Private Schools feature dataset is composed of all Private elementary and secondary education features in the United States as defined by the Private School...

  1. Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises

    Directory of Open Access Journals (Sweden)

    Schlein Karen


    Full Text Available Abstract Background Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. Methods The study included three data sources and levels of investigation: 1 Self-reported program data; 2 Scoping telephone interviews; and 3 In-depth field interviews and clinic visits. Results Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. Conclusions These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance

  2. Determinants of General Health, Work-Related Strain, and Burnout in Public Versus Private Emergency Medical Technicians in Istanbul. (United States)

    Tunaligil, Verda; Dokucu, Ali Ihsan; Erdogan, Mehmet Sarper


    This study investigated the impact of working for public versus private ambulance services in Turkey and elaborated on predictors of mental, physical, and emotional well-being in emergency medical technicians (EMT-Bs). In this observational cross-sectional study, an 81-question self-report survey was used to gather data about employee demographics, socioeconomic status, educational background, working conditions, and occupational health and workplace safety (OHS), followed by the 12-item General Health Questionnaire (GHQ-12), the Work-Related Strain Inventory (WRSI), and the Maslach Burnout Inventory (MBI) with three subscales: Emotional Exhaustion (MBI-EE), Depersonalization (MBI-DP), and Diminished Personal Accomplishment (MBI-PA). In 2011, 1,038 EMT-Bs worked for publicly operated and 483 EMT-Bs worked for privately owned ambulance services in Istanbul, Turkey, of which 606 (58.4%) and 236 (48.9%) participated in the study (overall participation rate = 55.4%), respectively. On all scales, differences between total mean scores in both sectors were statistically insignificant (p > .05). In the public sector, work locations, false accusations, occupational injuries and diseases, work-related permanent disabilities, and organizational support were found to significantly influence self-reported perceptions of well-being (p work (p work-related permanent disabilities (p working lives that need improvement; priority expectations in the public and private sectors were higher earnings (17.5%; 16.7%) and better social opportunities (17.4%; 16.8%). Working conditions, vocational training, and OHS emerged as topics that merit priority attention.

  3. Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises (United States)


    Background Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. Methods The study included three data sources and levels of investigation: 1) Self-reported program data; 2) Scoping telephone interviews; and 3) In-depth field interviews and clinic visits. Results Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. Conclusions These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance becomes a part of the

  4. Power in Global Health Agenda-Setting: The Role of Private Funding; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”

    Directory of Open Access Journals (Sweden)

    Ruth E. Levine


    Full Text Available The editorial by Jeremy Shiffman, “Knowledge, moral claims and the exercise of power in global health”, highlights the influence on global health priority-setting of individuals and organizations that do not have a formal political mandate. This sheds light on the way key functions in global health depend on private funding, particularly from the Bill & Melinda Gates Foundation.

  5. Evaluating drug prices, availability, affordability, and price components: implications for access to drugs in Malaysia.

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    Zaheer Ud Din Babar


    Full Text Available BACKGROUND: Malaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components. METHODS AND FINDINGS: The methodology developed by the World Health Organization (WHO and Health Action International (HAI was used. Price and availability data for 48 medicines was collected from 20 public sector facilities, 32 private sector retail pharmacies and 20 dispensing doctors in four geographical regions of West Malaysia. Medicine prices were compared with international reference prices (IRPs to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of medicines. Price component data were collected throughout the supply chain, and markups, taxes, and other distribution costs were identified. In private pharmacies, innovator brand (IB prices were 16 times higher than the IRPs, while generics were 6.6 times higher. In dispensing doctor clinics, the figures were 15 times higher for innovator brands and 7.5 for generics. Dispensing doctors applied high markups of 50%-76% for IBs, and up to 316% for generics. Retail pharmacy markups were also high-25%-38% and 100%-140% for IBs and generics, respectively. In the public sector, where medicines are free, availability was low even for medicines on the National Essential Drugs List. For a month's treatment for peptic ulcer disease and hypertension people have to pay about a week's wages in the private sector. CONCLUSIONS: The free market by definition does not control medicine prices, necessitating price monitoring and control mechanisms. Markups for generic products are greater than for IBs. Reducing the base price without controlling markups may increase profits for retailers and dispensing doctors without reducing the price paid by end users. To increase access and

  6. The effects of closure and workload privatization on health risks estimated for air toxic emissions from McClellan AFB

    Energy Technology Data Exchange (ETDEWEB)

    Vanderbilt, P.; Castleberry, J. [CH2M Hill, Sacramento, CA (United States); Carroz, J. [SM-ALC/EMPW, McClellan AFB, CA (United States)


    In July 1995, McClellan AFB, one of five Air Force Logistics Centers, was included on the Base Realignment and Closure Commission list approved by President Clinton. The base will close by August 2001. Significant manufacturing and repair facilities are scheduled for privatization and/or reuse. The State of California requires major industrial facilities to inventory their air toxic emissions and estimate health risks using California-approved methods. This paper explores and discusses the changes in estimated health risks if McClellan AFB was split up into several parts, reducing or eliminating buffer zones, and moving fence lines closer to major air toxic emissions sources. The health risks for the entire base estimated in prior study are compared to the individual risks associated with separate operation of emission sources in various buildings on the base. For several of the buildings and operations studied, predicted health risks at the sites of maximum exposure are greater than limits proposed by the local air district as acceptable levels. Mitigation measures may be required, such as public notification, risk reduction audits, and implementation and tracking of risk reduction measures. For other buildings and operations, results demonstrate that separate ownership would result in predicted health risks within acceptable levels.

  7. Affordable Care Act Provision Had Similar, Positive Impacts For Young Adults With And Without Disabilities. (United States)

    Porterfield, Shirley L; Huang, Jin


    Beginning in 2010 the Affordable Care Act (ACA) allowed young adults (ages 19-25) to remain on their parents' private health insurance plans, even if they were not full-time students. This study investigated the impact of the ACA on health insurance coverage for young adults with disabilities, comparing their experience with that of young adults without disabilities and that of a group of older adults (ages 26-34) with disabilities. We analyzed the periods 2006-09 and 2011-14, which were before and after implementation of the dependent coverage provision in the ACA, respectively. Coverage gains for older adults with disabilities were entirely attributable to changes in public insurance. Gains for young adults overall were driven by changes in private insurance. Both young adults with and without disabilities experienced a 4-percentage-point increase in private health insurance coverage between the two time periods, so the gap in private coverage between the two groups did not change significantly over time. Gains in coverage affected perhaps 2.9 million young adults overall and nearly 300,000 young adults with disabilities.

  8. [Labor market structure and access to private health insurance in Brazil]. (United States)

    Machado, Ana Flavia; Andrade, Mônica Viegas; Maia, Ana Carolina


    This paper aims to describe health insurance coverage among different types of workers in Brazil. Health insurance coverage and labor market insertion are used to define homogeneous groups of workers. The Grade of Membership method is used to build a typology of workers. The database was the Brazilian National Household Survey (PNAD) for 1998 and 2003, including a health survey. Five worker profiles were defined. The key variables were: health insurance coverage, schooling, and work status. The main findings show a positive association between health insurance coverage, income from work, and trade union membership.

  9. Accelerated reforms in healthcare financing: the need to scale up private sector participation in Nigeria (United States)

    Ejughemre, Ufuoma John


    The health sector, a foremost service sector in Nigeria, faces a number of challenges; primarily, the persistent under-funding of the health sector by the Nigerian government as evidence reveals low allocations to the health sector and poor health system performance which are reflected in key health indices of the country.Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing. This underscores the need to optimize the role of private sector in complementing the government’s commitment to financing healthcare delivery and strengthening the health system in Nigeria. There are also concerns about uneven quality and affordability of private-driven health systems, which necessitates reforms aimed at regulation. Accordingly, the argument is that the benefits of leveraging the private sector in complementing the national government in healthcare financing outweigh the challenges, particularly in light of lean public resources and finite donor supports. This article, therefore, highlights the potential for the Nigerian government to scale up healthcare financing by leveraging private resources, innovations and expertise, while working to achieve the universal health coverage. PMID:24596895

  10. Accelerated Reforms in Healthcare Financing: The Need to Scale up Private Sector Participation in Nigeria

    Directory of Open Access Journals (Sweden)

    Ufuoma John Ejughemre


    Full Text Available The health sector, a foremost service sector in Nigeria, faces a number of challenges; primarily, the persistent under-funding of the health sector by the Nigerian government as evidence reveals low allocations to the health sector and poor health system performance which are reflected in key health indices of the country.Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing. This underscores the need to optimize the role of private sector in complementing the government’s commitment to financing healthcare delivery and strengthening the health system in Nigeria. There are also concerns about uneven quality and affordability of private-driven health systems, which necessitates reforms aimed at regulation. Accordingly, the argument is that the benefits of leveraging the private sector in complementing the national government in healthcare financing outweigh the challenges, particularly in light of lean public resources and finite donor supports. This article, therefore, highlights the potential for the Nigerian government to scale up healthcare financing by leveraging private resources, innovations and expertise, while working to achieve the universal health coverage.

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

    Directory of Open Access Journals (Sweden)

    Patrik Tabatabai


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

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

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


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

  13. Rethinking Affordable Housing Delivery: An Analytical Insight

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    Olanrewaju Abdullateef


    Full Text Available Malaysia currently has a housing shortage of 12 million units. Towards the year 2020, this would require an annual supply of a minimum of 2 million homes. With the current production rate, the deficits will remain over the next 100 years. The crisis will lead to poor standards of living, un-affordable rental price, high mortgage payment, abandonment, and dilapidation of the existing housing stock. Lack of affordable housing is already a source of concern among many Malaysians. The middle and lower income earners spend more than 30% of their income on rent or for mortgage payment. Housing rent or mortgage is a basic need like foods, education, clothing and health. The government has introduced various measures to address the housing deficit. Despite these measures, the housing supply and distribution gaps continue to grow. To better understand the issues, there is a need to examine how the procurement planning in the affordable housing delivery supply chain and market is formulated, explore how cost of affordable housing would be reduced, identify the user value systems in affordable housing, and identify the criteria in the current regulatory framework? For these purposes, this paper reviews the relevant literature to reach preliminary findings on the stated issues. Among the factors found accounting for housing shortages, the overwhelming factors were that of poor policies, strategies, practice, management, and finance. The findings are meaningful in framing an affordable housing delivery model. It could also be useful to stakeholders involved in affordable housing delivery in Malaysia and elsewhere.

  14. Affordances: Ten Years On (United States)

    Brown, Jill P.; Stillman, Gloria


    Ten years ago the construct, affordance, was rising in prominence in scholarly literature. A proliferation of different uses and meanings was evident. Beginning with its origin in the work of Gibson, we traced its development and use in various scholarly fields. This paper revisits our original question with respect to its utility in mathematics…

  15. District decision-making for health in low-income settings: a case study of the potential of public and private sector data in India and Ethiopia. (United States)

    Bhattacharyya, Sanghita; Berhanu, Della; Taddesse, Nolawi; Srivastava, Aradhana; Wickremasinghe, Deepthi; Schellenberg, Joanna; Iqbal Avan, Bilal


    Many low- and middle-income countries have pluralistic health systems where private for-profit and not-for-profit sectors complement the public sector: data shared across sectors can provide information for local decision-making. The third article in a series of four on district decision-making for health in low-income settings, this study shows the untapped potential of existing data through documenting the nature and type of data collected by the public and private health systems, data flow and sharing, use and inter-sectoral linkages in India and Ethiopia. In two districts in each country, semi-structured interviews were conducted with administrators and data managers to understand the type of data maintained and linkages with other sectors in terms of data sharing, flow and use. We created a database of all data elements maintained at district level, categorized by form and according to the six World Health Organization health system blocks. We used content analysis to capture the type of data available for different health system levels. Data flow in the public health sectors of both counties is sequential, formal and systematic. Although multiple sources of data exist outside the public health system, there is little formal sharing of data between sectors. Though not fully operational, Ethiopia has better developed formal structures for data sharing than India. In the private and public sectors, health data in both countries are collected in all six health system categories, with greatest focus on service delivery data and limited focus on supplies, health workforce, governance and contextual information. In the Indian private sector, there is a better balance than in the public sector of data across the six categories. In both India and Ethiopia the majority of data collected relate to maternal and child health. Both countries have huge potential for increased use of health data to guide district decision-making.

  16. Radon-contaminated drinking water from private wells: an environmental health assessment examining a rural Colorado mountain community's exposure. (United States)

    Cappello, Michael Anthony; Ferraro, Aimee; Mendelsohn, Aaron B; Prehn, Angela Witt


    In the study discussed in this article, 27 private drinking water wells located in a rural Colorado mountain community were sampled for radon contamination and compared against (a) the U.S. Environmental Protection Agency's (U.S. EPA's) proposed maximum contaminant level (MCL), (b) the U.S. EPA proposed alternate maximum contaminate level (AMCL), and (c) the average radon level measured in the local municipal drinking water system. The data from the authors' study found that 100% of the wells within the study population had radon levels in excess of the U.S. EPA MCL, 37% were in excess of the U.S. EPA AMCL, and 100% of wells had radon levels greater than that found in the local municipal drinking water system. Radon contamination in one well was found to be 715 times greater than the U.S. EPA MCL, 54 times greater than the U.S. EPA AMLC, and 36,983 times greater than that found in the local municipal drinking water system. According to the research data and the reviewed literature, the results indicate that this population has a unique and elevated contamination profile and suggest that radon-contaminated drinking water from private wells can present a significant public health concern.

  17. Drug coverage insurance as a novel element of private health insurance in Poland. (United States)

    Czerw, Aleksandra; Religioni, Urszula


    In recent years, there have been observed increased costs of health care in Poland. The patient's out of pocket expenses on drug have grown too. To the above, the insurance companies have offered patients drug coverage insurance policies since recently. Drug insurance policy covers the cost of purchasing pharmaceutical products not reimbursed by the National Health Fund is a modern product on the Polish health insurance market. The aim of the article is to characterize drug coverage insurance policies on the health insurance market in Poland. The Polish insurance market and entities offered these types of insurance are also presented.

  18. Measuring client satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana

    Directory of Open Access Journals (Sweden)

    Agha Sohail


    Full Text Available Abstract Background Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana, to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates. Methods Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs conducted in Tanzania (2006, Kenya (2004 and Ghana (2002 using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction. Results Private health facilities appear to be of higher (interpersonal process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies. Conclusions Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public

  19. Setting health insurance remuneration rates of private providers in Kenya: the role of costing, challenges and implications. (United States)

    Mathauer, Inke


    Successful health financing depends on prudent design of resource collection, pooling and purchasing. One of the critical purchasing design issues is the provider payment mechanism and the remuneration rates, which need to set appropriate incentives to health providers. In order to set remuneration rates, cost information is required, but this is not known in many developing countries. This paper illuminates the role of costing and the challenges of resetting health insurance remuneration rates for private hospitals in Kenya and discusses the implications and lessons. The results and proceedings of costing studies from Kenya are reviewed, which reveals methodological and practical challenges as to revising remuneration rates. The costing results are characterized by high variability, which is, among other factors, due to suboptimal resource use at some hospitals and provider payment mechanisms that incentivise over-provision. In such a context, hospital-specific remuneration rates are advisable. In conclusion, remuneration rate setting is not just about translating costing results into a price tag, but other factors have to be considered in a low-income country context in order to balance out health sector objectives and provider interests. Inclusion of providers in developing the costing methodology proves important to increase acceptability of results.

  20. Cost-Effectiveness Analysis of Hepatitis B Immunization in Vietnam: Application of Cost-Effectiveness Affordability Curves in Health Care Decision Making

    NARCIS (Netherlands)

    Tu, Hong Anh T.; de Vries, Robin; Woerdenbag, Herman J.; Li, Shu Chuen; Le, Hoa H.; van Hulst, Marinus; Postma, Maarten J.


    Objectives: To perform acost-effectiveness analysis and to identify the coseffectiveness affordability levels for a newborn universal vaccination program against hepatitis B virus (HBV) in Vietnam. Methods: By using a Markov model, we simulated a Vietnamese birth cohort using 1,639,000 newborns in 2

  1. A Vigorous Private Health Care System in Australia%充满活力的澳大利亚私人医疗服务体系

    Institute of Scientific and Technical Information of China (English)



    Private health care services is a powerful part of the public health system and other health security system in Australia. Private hospitals and clinics account for very high proportion of health services. It has very high proportion of commercially insured individuals. Private retail pharmacies are the main source of drug suppliers. The government offers many preferential policies or subsidies to encourage the development of private health care service. Such experiences can be referred by our health care reform.%私人医疗服务是澳大利亚公共卫生与其医疗保障体系的重要组成部分,不仅私立医院、私人诊所占比高,个人参加商业保险的比例也高,私人零售药房成为患者药品的主供渠道,政府则通过各种优惠政策对私人医疗服务系统提供相应的补偿与支持,澳大利亚的经验值得我国医改借鉴。

  2. Blurring the boundaries between public and private health care services as an alternative explanation for the emergence of black medicine: the Israeli case. (United States)

    Filc, Dani; Cohen, Nissim


    Black medicine represents the most problematic configuration of informal payments for health care. According to the accepted economic explanations, we would not expect to find black medicine in a system with a developed private service. Using Israel as a case study, we suggest an alternative yet a complimentary explanation for the emergence of black medicine in public health care systems - even though citizens do have the formal option to use private channels. We claim that when regulation is weak and political culture is based on 'do it yourself' strategies, which meant to solve immediate problems, blurring the boundaries between public and private health care services may only reduce public trust and in turn, contribute to the emergence of black medicine. We used a combined quantitative and qualitative methodology to support our claim. Statistical analysis of the results suggested that the only variable significantly associated with the use of black medicine was trust in the health care system. The higher the respondents' level of trust in the health care system, the lower the rate of the use of black medicine. Qualitatively, interviewee emphasized the relation between the blurred boundaries between public and private health care and the use of black medicine.

  3. Health profile of government aided private school children in urban slum of Solapur, Southern Maharashtra, India

    Directory of Open Access Journals (Sweden)

    Rupali R. Rajput


    Conclusions: The present study shows pattern of morbidities and malnutrition among school children. Comprehensive periodic health check-up should be carried out for early diagnosis and treatment of the common morbidities. Further studies should be carried out to assess the impact of health education. [Int J Res Med Sci 2016; 4(7.000: 2728-2733

  4. European health research and globalisation: is the public-private balance right?

    Directory of Open Access Journals (Sweden)

    McCarthy Mark


    Full Text Available Abstract Background The creation and exchange of knowledge between cultures has benefited world development for many years. The European Union now puts research and innovation at the front of its economic strategy. In the health field, biomedical research, which benefits the pharmaceutical and biotechnology industries, has been well supported, but much less emphasis has been given to public health and health systems research. A similar picture is emerging in European support for globalisation and health Case studies Two case-studies illustrate the links of European support in global health research with industry and biomedicine. The European Commission's directorates for (respectively Health, Development and Research held an international conference in Brussels in June 2010. Two of six thematic sessions related to research: one was solely concerned with drug development and the protection of intellectual property. Two European Union-supported health research projects in India show a similar trend. The Euro-India Research Centre was created to support India's participation in EU research programmes, but almost all of the health research projects have been in biotechnology. New INDIGO, a network led by the French national research agency CNRS, has chosen 'Biotechnology and Health' and funded projects only within three laboratory sciences. Discussion Research for commerce supports only one side of economic development. Innovative technologies can be social as well as physical, and be as likely to benefit society and the economy. Global health research agendas to meet the Millenium goals need to prioritise prevention and service delivery. Public interest can be voiced through civil society organisations, able to support social research and public-health interventions. Money for health research comes from public budgets, or indirectly through healthcare costs. European 'Science in Society' programme contrasts research for 'economy', using technical

  5. Medicaid expansion under the Affordable Care Act. Implications for insurance-related disparities in pulmonary, critical care, and sleep. (United States)

    Lyon, Sarah M; Douglas, Ivor S; Cooke, Colin R


    The Affordable Care Act was intended to address systematic health inequalities for millions of Americans who lacked health insurance. Expansion of Medicaid was a key component of the legislation, as it was expected to provide coverage to low-income individuals, a population at greater risk for disparities in access to the health care system and in health outcomes. Several studies suggest that expansion of Medicaid can reduce insurance-related disparities, creating optimism surrounding the potential impact of the Affordable Care Act on the health of the poor. However, several impediments to the implementation of Medicaid's expansion and inadequacies within the Medicaid program itself will lessen its initial impact. In particular, the Supreme Court's decision to void the Affordable Care Act's mandate requiring all states to accept the Medicaid expansion allowed half of the states to forego coverage expansion, leaving millions of low-income individuals without insurance. Moreover, relative to many private plans, Medicaid is an imperfect program suffering from lower reimbursement rates, fewer covered services, and incomplete acceptance by preventive and specialty care providers. These constraints will reduce the potential impact of the expansion for patients with respiratory and sleep conditions or critical illness. Despite its imperfections, the more than 10 million low-income individuals who gain insurance as a result of Medicaid expansion will likely have increased access to health care, reduced out-of-pocket health care spending, and ultimately improvements in their overall health.

  6. [Labor and health conditions of private school teachers in Vitória da Conquista, Bahia, Brazil]. (United States)

    Delcor, Núria Serre; Araújo, Tania M; Reis, Eduardo J F B; Porto, Lauro A; Carvalho, Fernando M; Oliveira e Silva, Manuela; Barbalho, Leonardo; de Andrade, Jonathan Moura


    The scientific literature on teachers' health is scarce, recent, and focuses predominantly on stress and burnout. This study describes the labor conditions of private school teachers in Vitória da Conquista, Bahia State, Brazil. Information on 250 teachers from the ten largest schools in the municipality was collected through a self-applied questionnaire. The most relevant characteristics of teachers' work, evaluated by the Job Content Questionnaire were: speed of work, creativity at work, and relations with colleagues. The most frequent complaints related to posture, mental strain, and voice problems. Prevalence of minor psychological disorders according to the Self Reporting Questionnaire-20 was 41.5%, strongly associated with long periods of intense concentration on the same job and excessive work. Results suggest an association between the prevalence of minor psychological disorders and certain characteristics of teaching work, emphasizing teachers' exposure to stress.

  7. Assessing the potential of rural and urban private facilities in implementing child health interventions in Mukono district, central Uganda

    DEFF Research Database (Denmark)

    Rutebemberwa, Elizeus; Buregyeya, Esther; Lal, Sham;


    clinicians, less likely to have people with tertiary education (OR 0.34; 95 % CI 0.17-0.66) and less likely to have zinc tablets (OR 0.38; 95 % CI 0.19-0.78). In both urban and rural areas, there was low usage of stock cards and patient registers. About half of the facilities in both rural and urban areas...... keeping, essential drugs for the treatment of malaria, pneumonia and diarrhoea; the sex, level of education, professional and in-service training of the persons found attending to patients in these facilities. A comparison was made between urban and rural facilities. Univariate and bivariate analysis...... attended to at least one sick child in the week prior to the interview. CONCLUSION: There were big gaps between rural and urban private facilities with rural ones having less trained personnel and less zinc tablets' availability. In both rural and urban areas, record keeping was low. Child health...

  8. Health impact and cost-effectiveness of a private sector bed net distribution: experimental evidence from Zambia (United States)


    Background Relatively few programmes have attempted to actively engage the private sector in national malaria control efforts. This paper evaluates the health impact of a large-scale distribution of insecticide-treated nets (ITNs) conducted in partnership with a Zambian agribusiness, and its cost-effectiveness from the perspective of the National Malaria Control Programme (NMCP). Methods The study was designed as a cluster-randomized controlled trial. A list of 81,597 cotton farmers was obtained from Dunavant, a contract farming company in Zambia’s cotton sector, in December 2010. 39,963 (49%) were randomly selected to obtain one ITN each. Follow-up interviews were conducted with 438 farmers in the treatment and 458 farmers in the control group in June and July 2011. Treatment and control households were compared with respect to bed net ownership, bed net usage, self-reported fever, and self-reported confirmed malaria. Cost data was collected throughout the programme. Results The distribution effectively reached target beneficiaries, with approximately 95% of households in the treatment group reporting that they had received an ITN through the programme. The average increase in the fraction of household members sleeping under an ITN the night prior to the interview was 14.6 percentage points (p-value <0.001). Treatment was associated with a 42 percent reduction in the odds of self-reported fever (p-value <0.001) and with a 49 percent reduction in the odds of self-reported malaria (p-value 0.002). This was accomplished at a cost of approximately five US$ per ITN to Zambia’s NMCP. Conclusions The results illustrate that existing private sector networks can efficiently control malaria in remote rural regions. The intra-household allocation of ITNs distributed through this channel was comparable to that of ITNs received from other sources, and the health impact remained substantial. PMID:23506170

  9. Managing the work-life roller-coaster: private stress or public health issue? (United States)

    Bryson, Lois; Warner-Smith, Penny; Brown, Peter; Fray, Leanne


    Although research has established the importance for health of a sense of personal control at work, the implications of this for women have not been adequately studied. Using quantitative data from the Australian Longitudinal Study on Women's Health and qualitative data from an associated study, here we examine women's health and sense of control in relation to family and employment commitments. In line with other research, 'demand over-load' is found to be important for sense of control, but both 'over-load' and 'control' prove complex, as illustrated by the finding that good mental health is associated with satisfaction with, rather than actual, hours of employment. In the contemporary western context of longer working hours, increasing time strain, and gender relations shaped within a neo-liberal, individualised social environment, the findings suggest that as life speeds up, 'control' and the health effects of 'busyness', need to be understood not merely as personal matters, but rather as potentially important public health issues.

  10. Is Canada odd? A comparison of European and Canadian approaches to choice and regulation of the public/private divide in health care. (United States)

    Flood, Colleen M; Haugan, Amanda


    Choice is often touted as a means for change within health care systems. Yet 'choice', in this context, takes at least three distinct forms: choice between providers within a publicly funded health care system; choice between competing insurers within a universal plan; and, lastly, choice as between privately financed health care and universal public coverage. In Canada, it is this last form of choice that is under active debate; particularly in light of the Supreme Court of Canada's decision in Chaoulli, which found a regulation banning private health insurance for medically necessary care was unconstitutional. The argument is frequently made that Canada is an outlier from other countries in having regulation that effectively precludes this kind of choice. This issue is likely to become of concern again in upcoming constitutional challenges where applicants are looking to overturn through judicial challenges Canada's medicare system. This article tests that argument of whether Canada truly is 'odd' from a comparative policy perspective by exploring regulation of choice of privately financed health care in several European countries - the Netherlands, Germany, Sweden, England and France. We highlight commonalities as well as differences, showing the extent to which these countries employ regulation to fetter growth of a large privately financed sector. The article's thesis is that Canada, in employing more intrusive forms of regulation, is not an outlier per se but at one point in a regulatory spectrum.

  11. Learning Grasp Affordance Densities

    DEFF Research Database (Denmark)

    Detry, Renaud; Kraft, Dirk; Kroemer, Oliver;


    We address the issue of learning and representing object grasp affordance models. We model grasp affordances with continuous probability density functions (grasp densities) which link object-relative grasp poses to their success probability. The underlying function representation is nonparametric...... these and records their outcomes. When a satisfactory number of grasp data is available, an importance-sampling algorithm turns these into a grasp density. We evaluate our method in a largely autonomous learning experiment run on three objects of distinct shapes. The experiment shows how learning increases success...... and relies on kernel density estimation to provide a continuous model. Grasp densities are learned and refined from exploration, by letting a robot “play” with an object in a sequence of graspand-drop actions: The robot uses visual cues to generate a set of grasp hypotheses; it then executes...

  12. How Doula Care Can Advance the Goals of the Affordable Care Act: A Snapshot From New York City. (United States)

    Strauss, Nan; Giessler, Katie; McAllister, Elan


    Doula care meets each of the triple aims of the Affordable Care Act: improving health outcomes for all, improving the experience of care, and lowering costs by reducing non-beneficial and unwanted medical interventions. Cost is the greatest barrier to use of doula support. Reimbursement for doula services by private insurance, Medicaid, and Medicaid managed care organizations would significantly increase access to doulas. Widespread availability of doula care could significantly reduce cesarean rates, and increased access to community-based doula programs could reduce entrenched health disparities.

  13. Public or private? The role of the state and civil society in health and health inequalities across nations. (United States)

    Olafsdottir, Sigrun; Bakhtiari, Elyas; Barman, Emily


    Social scientists have long recognized that macro-level factors have the potential to shape the health of populations and individuals. Along these lines, they have theorized about the role of the welfare state in creating more equal opportunities and outcomes and how this intervention may benefit health. More recently, scholars and policymakers alike have pointed out how the involvement of civil society actors may replace or complement any state effort. Using data from the World Values Surveys and the European Values Study, combined with national-level indicators for welfare state and civil society involvement, we test the impact of each sector on health and health inequalities in 25 countries around the world. We find that both have a statistically significant effect on overall health, but the civil society sector may have a greater independent influence in societies with weaker welfare states. The health inequalities results are less conclusive, but suggest a strong civil society may be particularly beneficial to vulnerable populations, such as the low income and unemployed. Our paper represents an early step in providing empirical evidence for the impact of the welfare state and civil society on health and health inequalities.

  14. Public and private responsibility for health: a comparative analysis of attitudes towards financing and the right for health care.

    NARCIS (Netherlands)

    Abel, T.; Zee, J. van der


    The present study focuses on values that directly relate to issues of health care. It will observe specific patterns of health values and compare their distribution across selected social groups within and across four European nations. Studying these issues, new insights are expected into Eurpean we

  15. Tuberculosis Elimination Efforts in the United States in the Era of Insurance Expansion and the Affordable Care Act. (United States)

    Balaban, Victor; Marks, Suzanne M; Etkind, Sue C; Katz, Dolly J; Higashi, Julie; Flood, Jennifer; Cronin, Ann; Ho, Christine S; Khan, Awal; Chorba, Terence


    The Patient Protection and Affordable Care Act can enhance ongoing efforts to control tuberculosis (TB) in the United States by bringing millions of currently uninsured Americans into the health-care system. However, much of the legislative and financial framework that provides essential public health services necessary for effective TB control is outside the scope of the law. We identified three key issues that will still need to be addressed after full implementation of the Affordable Care Act: (1) essential TB-related public health functions will still be needed and will remain the responsibility of federal, state, and local health departments; (2) testing and treatment for latent TB infection (LTBI) is not covered explicitly as a recommended preventive service without cost sharing or copayment; and (3) remaining uninsured populations will disproportionately include groups at high risk for TB. To improve and continue TB control efforts, it is important that all populations at risk be tested and treated for LTBI and TB; that testing and treatment services be accessible and affordable; that essential federal, state, and local public health functions be maintained; that private-sector medical/public health linkages for diagnosis and treatment be developed; and that health-care providers be trained in conducting appropriate LTBI and TB clinical care.

  16. Never Going Back: An Examination of Financial Health at Selected Private South Carolina Universities (United States)

    Armstrong, David C., Sr.


    This case study examined the leadership styles and overall financial health of the three South Carolina Baptist Convention universities. Each university share a similar story of financial exigency prior to the current president's arrival. Each institution has increased enrollment, endowment, and facilities over the last decade. This case study…

  17. Privatizing Libraries (United States)

    Jerrard, Jane; Bolt, Nancy; Strege, Karen


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

  18. [Privatization of health care management through Social Organizations in the city of São Paulo, Brazil: description and analysis of regulation]. (United States)

    Contreiras, Henrique; Matta, Gustavo Corrêa


    The article describes and discusses privatization of the municipal health system in São Paulo, Brazil, from an administrative and political perspective. The methodology consisted of a literature review and analysis of legislation and public documents. The study showed that although legislation governing the so-called "Social Organizations" (OS) in Brazil dates to the year 2006, half of the administrative privatization is still regulated by a previous provisional instrument in the form of an "agreement" ("convênio" in Portuguese). In 2011, 61% of services were administered by private organizations, which received 44% of the health budget in 2012. The twenty participating organizations include five of the ten largest health care companies in Brazil. Inspection agencies have detected flaws in the management contracts, but the "agreements" (convênios) are subject to less rigorous control and have proven invisible to inspection. Finally, the legal framework is unstable. The study uses the experience in São Paulo as the basis for discussing the political versus technical nature of private management in the Brazilian Unified National Health System (SUS).

  19. Privatización de los servicios de salud: las experiencias de Chile y Costa Rica Health services privatization: the experiences of Chile and Costa Rica

    Directory of Open Access Journals (Sweden)

    N. Homedes


    Full Text Available El trabajo cuestiona los argumentos que justifican la privatización neoliberal de la financiación, gestión y prestación de servicios de salud, y analiza el significado y estrategias de privatización. Comparamos la privatización en Costa Rica y Chile, y en la discusión se sugiere que el modelo costarricense de privatización selectiva, limitada y concebida autóctonamente de Costa Rica lleva a un sistema de salud más solidario, equitativo, eficiente y satisfactorio para los usuarios que el modelo importado de privatización chileno.This study questions the premises that justify the neoliberal privatization of financing, managing and delivering health services. It also analyses the meaning of privatization and its strategies. We compare privatization in Chile and Costa Rica and suggest that the more limited, selective and locally designed privatization process in Costa Rica has resulted in a more equitable, and efficient health system than the imported privatization model introduced in Chile. The Costa Rican system also produces greater patient satisfaction and at the same time preserves the solidarity principle.

  20. Evaluation of publicly financed and privately delivered model of emergency referral services for maternal and child health care in India.

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    Full Text Available BACKGROUND: Emergency referral services (ERS are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost. METHODS: Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective. RESULTS: On an average, an ambulance transported 3-4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7 per patient transported or INR 21 (USD 0.35 per km travelled. CONCLUSION: Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system.

  1. Private sector, for-profit health providers in low and middle income countries: can they reach the poor at scale? (United States)


    Background The bottom of the pyramid concept suggests that profit can be made in providing goods and services to poor people, when high volume is combined with low margins. To-date there has been very limited empirical evidence from the health sector concerning the scope and potential for such bottom of the pyramid models. This paper analyzes private for-profit (PFP) providers currently offering services to the poor on a large scale, and assesses the future prospects of bottom of the pyramid models in health. Methods We searched published and grey literature and databases to identify PFP companies that provided more than 40,000 outpatient visits per year, or who covered 15% or more of a particular type of service in their country. For each included provider, we searched for additional information on location, target market, business model and performance, including quality of care. Results Only 10 large scale PFP providers were identified. The majority of these were in South Asia and most provided specialized services such as eye care. The characteristics of the business models of these firms were found to be similar to non-profit providers studied by other analysts (such as Bhattacharya 2010). They pursued social rather than traditional marketing, partnerships with government, low cost/high volume services and cross-subsidization between different market segments. There was a lack of reliable data concerning these providers. Conclusions There is very limited evidence to support the notion that large scale bottom of the pyramid models in health offer good prospects for extending services to the poor in the future. In order to be successful PFP providers often require partnerships with government or support from social health insurance schemes. Nonetheless, more reliable and independent data on such schemes is needed. PMID:24961496

  2. Affordable Care Act and Women (United States)

    ... Outcomes Research Trust Fund (PCORTF) Poverty Poverty Guidelines Poverty Analysis Teen Pregnancy Prevention Homelessness MACRA Publications Data and Tools Evaluation Database The Affordable Care Act and Women 03/20/2012 Home The Affordable Care Act ...

  3. A study of occupational health and safety measures in the Laundry Department of a private tertiary care teaching hospital, Bengaluru

    Directory of Open Access Journals (Sweden)

    M. Shashi Kumar


    Full Text Available Introduction: The Laundry Department plays an important role in preventing the spread of infection and continuously supplying clean linen to various departments in any hospital. Objectives of the Study: To identify existing practices and occupational safety and health (OSH measures in the Laundry Department and to assess the use of personal protective equipments (PPEs among health care workers. Materials and Methods: A cross-sectional study was carried out in a private tertiary care teaching hospital. An observation checklist was developed, which was partially based on occupational hazard checklist of OSHA for Laundry Department. This was field tested and validated for applicability for this study. Results: The potential biological hazards are infections through exposure to aerosols, spills and splashes during various activities, fungal infection due to wet clothes and environment and infections through fomites. The potential physical hazards are injuries due to slips and falls, exposure to heat, humidity, dust, noise, and vibration. The potential chemical hazards are contact dermatitis and allergic asthma due to exposure to detergents, phenyl solution, bleaching powder, and soap oil solution. The potential ergonomic hazards are musculoskeletal diseases and repetitive stress injuries at the shoulder, elbow, and small joints of the hands. PPEs were not used consistently in most areas of the department.

  4. Essays in Health and Labor Economics


    Butler, Matthew James


    In the United States, health insurance is often necessary for access to regular, affordable health care. With only eight of every hundred Americans buying private insurance plans on the individual market, the main sources for health insurance traditionally have been employers and the government. As new laws are being debated and introduced to reform an expensive health care industry in which nearly one-sixth of the population is uninsured, research is needed in order to evaluate the costs and...

  5. 78 FR 7348 - Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions... (United States)


    ... HUMAN SERVICES 45 CFR Parts 155 and 156 RIN 0938-AR68 Patient Protection and Affordable Care Act... title I of the Patient Protection and Affordable Care Act of 2010, as amended by the Health Care and... Abbreviations Affordable Care Act--the Affordable Care Act of 2010 (which is the collective term for the...

  6. [Prevalence of risk health behavior among members of private health insurance plans: results from the 2008 national telephone survey Vigitel, Brazil]. (United States)

    Malta, Deborah Carvalho; Oliveira, Martha Regina de; Moura, Erly Catarina de; Silva, Sara Araújo; Zouain, Cláudia Soares; Santos, Fausto Pereira Dos; Morais Neto, Otaliba Libanio de; Penna, Gerson de Oliveira


    This article aims at estimating the prevalence of adults engaging in protective and risk health behaviors among members of private health insurance plans. It was used a random sample of individuals over the age of 18 living in the Brazilian state capitals collected on 28,640 telephone interviews in 2008. The results showed that among males there was a high prevalence of the following risk factors: tobacco, overweight, low fruit and vegetable consumption, high meat with fat consumption and alcohol drinking. Among females we found a high prevalence of high blood pressure, diabetes, dyslipidemia and osteoporosis. Men were generally more physically active and women consumed more fruit and vegetables. As more educated males were lower was the prevalence of tobacco, high blood pressure, but also a higher prevalence of overweight, consumption of meat with fat, dyslipidemia and lower number of yearly check-ups done. For females, tobacco smoking, overweight, obesity, decreasing with schooling, and consumption of fruit and vegetables, physical activity, mammography and PAP test, increased with schooling. The health insurance user population constitutes about 26% of Brazilian people and the current study aims to accumulate evidence for health promotion actions by this public.

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

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    Hanson Kara G


    Full Text Available Abstract 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

  8. Public–private partnerships improve health outcomes in individuals with early stage Alzheimer’s disease

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    Galvin JE


    Full Text Available James E Galvin,1 Magdalena I Tolea,1 Nika George,2 Cheryl Wingbermuehle31Alzheimer Disease Center, Departments of Neurology, Psychiatry and Population Health, New York University Langone Medical Center, New York, NY, USA; 2Clinical Psychology Program, University of Missouri – St Louis, 3Alzheimer’s Association, St Louis Chapter, St Louis, MO, USAPurpose: In a collaborative effort between the Missouri Department of Health, Area Agencies on Aging (AAA, Alzheimer Association, and academic researchers, we tested whether early dementia detection and comprehensive care consultations would improve health outcomes in care receivers (CRs and their family caregivers (FCGs, therefore addressing an important public health concern.Participants and methods: A total of 244 community-dwelling older adults screened for early-stage dementia by the AAA field staff were referred to the Alzheimer Association and participated in Project Learn MORE (Missouri Outreach and Referral Expanded (PLM – a 2-year, nonrandomized multisite intervention consisting of comprehensive care consultations to improve coping skills. PLM participants were compared against 96 controls receiving the Alzheimer Association’s “usual services” between January 2011 and December 2012. We examined CR and FCG outcomes, including burden, care confidence, and mood, as effects of PLM, on delaying transitions in level of care.Results: CRs showed improved knowledge (P=0.002 and reduced depression (P=0.007, while FCGs demonstrated improved knowledge (P=0.003 and ability to identify sources of support for the CR (P=0.032 and for themselves (P=0.043. However, FCGs were more burdened after PLM (P=0.02, due to increased awareness of Alzheimer’s disease. PLM delayed transitions in care (odds ratio [OR] 3.32, 95% confidence level [CI]: 1.25–8.83 with the number needed to treat =6.82.Conclusion: PLM was successful in improving detection of incident cases of dementia in the community

  9. Insights of private general practitioners in group practice on the introduction of National Health Insurance in South Africa

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    Shabir Moosa


    Full Text Available Background: The South African government intends to contract with ‘accredited provider groups’ for capitated primary care under National Health Insurance (NHI. South African solo general practitioners (GPs are unhappy with group practice. There is no clarity on the views of GPs in group practice on contracting to the NHI.Objectives: To describe the demographic and practice profile of GPs in group practice in South Africa, and evaluate their views on NHI, compared to solo GPs.Methods: This was a descriptive survey. The population of 8721 private GPs in South Africa with emails available were emailed an online questionnaire. Descriptive statistical analyses and thematic content analysis were conducted.Results: In all, 819 GPs responded (568 solo GPs and 251 GPs in groups. The results are focused on group GPs. GPs in groups have a different demographic practice profile compared to solo GPs. GPs in groups expected R4.86 million ($0.41 million for a hypothetical NHI proposal of comprehensive primary healthcare (excluding medicines and investigations to a practice population of 10 000 people. GPs planned a clinical team of 8 to 12 (including nurses and 4 to 6 administrative staff. GPs in group practices saw three major risks: patient, organisational and government, with three related risk management strategies.Conclusions: GPs can competitively contract with NHI, although there are concerns. NHI contracting should not be limited to groups. All GPs embraced strong teamwork, including using nurses more effectively. This aligns well with the emergence of family medicine in Africa.Keywords: Capitation, human resource, primary health care,  family medicine, South Africa, health systems

  10. Enhancing client welfare through better communication of private mental health data between rural service providers

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    Oliver Kisalay Burmeister


    Full Text Available Client welfare is detrimentally affected by poor communication of data between rural service providers, which in part is complicated by privacy legislation. A study of service provision involving interviews with mental health professionals, found challenges in communicative processes between agencies were exacerbated by the heavy workloads. Dependence on individual interpretations of legislation, and on manual handling, led to delays that detrimentally affected client welfare. The main recommendation arising from this article is the creation of an ehealth system that is able to negotiate differing levels of access to client data through centralised controls, where the administration of that system ensures that it stays current with changing legislative requirements. The main contribution of the proposed model is to combine two well-known concepts: data integration and generalisation. People with mental illness are amongst the most vulnerable members of society, and current ehealth systems that provide access to medical records inadequately cater to their needs.

  11. The private health insurance choices of medicare beneficiaries: how much does price matter? (United States)

    Rice, Thomas; Jacobson, Gretchen; Cubanski, Juliette; Neuman, Tricia


    This article presents, critiques, and analyzes the influence of prices on insurance choices made by Medicare beneficiaries in the Medicare Advantage, Part D, and Medigap markets. We define price as health insurance premiums for the Medicare Advantage and Medigap markets, and total out-of-pocket costs (including premiums and cost sharing) for the Part D market. In Medicare Advantage and Part D, prices only partly explain insurance choices. Enrollment decisions also may be influenced by other factors such as the perceived quality of the higher-premium plans, better provider networks, lower cost-sharing for services, more generous benefits, and a preference for certain brand-name products. In contrast, the one study available on the Medigap market concludes that price appears to be associated with plan selection. This may be because Medigap benefits are fully standardized, making it easier for beneficiaries to compare alternative policies. The article concludes by discussing policy options available to Medicare.

  12. Contracting private sector providers for public sector health services in Jalisco, Mexico: perspectives of system actors

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    González Luz


    Full Text Available Abstract Introduction Contracting out health services is a strategy that many health systems in the developing world are following, despite the lack of decisive evidence that this is the best way to improve quality, increase efficiency and expand coverage. A large body of literature has appeared in recent years focusing on the results of several contracting strategies, but very few papers have addressed aspects of the managerial process and how this can affect results. Case description This paper describes and analyses the perceptions and opinions of managers and workers about the benefits and challenges of the contracting model that has been in place for almost 10 years in the State of Jalisco, Mexico. Both qualitative and quantitative information was collected. An open-ended questionnaire was used to obtain information from a group of managers, while information provided by a self-selected group of workers was collected via a closed-ended questionnaire. The analysis contrasted the information obtained from each source. Discussion and Evaluation Findings show that perceptions of managers and workers vary for most of the items studied. For managers the model has been a success, as it has allowed for expansion of coverage based on a cost-effective strategy, while for workers the model also possesses positive elements but fails to provide fair labour relationships, which negatively affects their performance. Conclusion Perspectives of the two main groups of actors in Jalisco's contracting model are important in the design and adjustment of an adequate contracting model that includes managerial elements to give incentives to worker performance, a key element necessary to achieve the model's ultimate objectives. Lessons learnt from this study could be relevant for the experience of contracting models in other developing countries.

  13. How the Trans Pacific Partnership Agreement could undermine PHARMAC and threaten access to affordable medicines and health equity in New Zealand. (United States)

    Gleeson, Deborah; Lopert, Ruth; Reid, Papaarangi


    New Zealand's Pharmaceutical Management Agency (PHARMAC) has been highly successful in facilitating affordable access to medicines through a combination of aggressive price negotiations, innovative procurement mechanisms, and careful evaluation of value for money. Recently the US government, through the establishment of a series of bilateral and plurilateral "free" trade agreements, has attempted to constrain the pharmaceutical access programs of other countries in order to promote the interests of the pharmaceutical industry. The Trans Pacific Partnership Agreement (TPPA) represents the latest example; through the TPPA the US is seeking to eliminate therapeutic reference pricing, introduce appeals processes for pharmaceutical companies to challenge formulary listing and pricing decisions, and introduce onerous disclosure and "transparency" provisions that facilitate industry involvement in decision-making around coverage and pricing of medicines (and medical devices). This paper argues that the US agenda, if successfully prosecuted, would be likely to increase costs and reduce access to affordable medicines for New Zealanders. This would in turn be likely to exacerbate known inequities in access to medicines and thus disproportionately affect disadvantaged population groups, including Māori and Pacific peoples.

  14. Rural Affordable Care Act outreach and enrollment: what we learned during the first marketplace open enrollment period. (United States)

    Kwon, Linda


    As part of the Patient Protection and Affordable Care Act (Affordable Care Act) of 2010, 2 new opportunities for health care coverage were established for many uninsured individuals beginning on January 1, 2014. The first opportunity was through Medicaid expansion where states had the opportunity to expand Medicaid coverage to individuals with household incomes up to 133% of the federal poverty level. The second opportunity was through the establishment of Health Insurance Marketplaces where individuals could purchase private health plans and potentially qualify for financial assistance in paying for their plans. The Office of Rural Health Policy (ORHP) provided supplemental grant awards to help stimulate Affordable Care Act outreach and education efforts in rural communities that were being served by the Rural Health Care Services Outreach (Outreach) Grant Program. As a result, Outreach grantees enrolled 9,300 rural Americans during the initial Open Enrollment period. Valuable outreach and enrollment lessons were learned from rural communities based on discussions with the Outreach grantees who received the supplemental funding. These lessons will help rural communities prepare for the next Open Enrollment period.

  15. Impact of supplementary private health insurance on stomach cancer care in Korea: a cross-sectional study

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    Noh Jae-Hyung


    Full Text Available Abstract Background Korea achieved universal health insurance coverage in only 12 years; however, insufficient government funding has resulted in high out-of-pocket payments and, in turn, a demand for supplementary private health insurance (PHI. Supplementary PHI provides a fixed amount of benefits in the event of critical illness (e.g., cancer or stroke, surgery, or hospitalization. In this study, we tried to identify factors that influence the decision to purchase supplementary PHI and investigate the impacts of PHI on various aspects of cancer care. Methods In a cross-sectional study of 391 patients with gastric cancer, we collected data on demographic and clinical variables, coverage by PHI at the time of diagnosis, and patients' cancer care experiences from surgery databases and patient questionnaires. Two separate multivariate logistic regression models were used 1 to determine whether various sociodemographic and clinical variables influence the purchase of supplementary PHI, and 2 to determine if there is a difference in various outcome measures between individuals with and without PHI. Results We studied 187 subjects (49.6% who were covered under PHI at the time of diagnosis. Subjects who purchased PHI tended to be younger (aOR = 5.01, 95% C.I. = 2.05 – 12.24, and more educated (aOR = 2.67, 95% C.I. = 1.04 – 6.86. Supplementary PHI coverage was significantly associated with financial independence (aOR = 2.07, 95% CI = 1.19 – 3.61, but not with other aspects of cancer care, such as access to healthcare, quality of care, communication and patient autonomy. Conclusion Our findings demonstrate that supplementary PHI neither serves as a safety net for vulnerable patients nor improves cancer care experience, except for maintaining the financial independence of beneficiaries.

  16. Motivation and values of hospital consultants in south-east England who work in the national health service and do private practice. (United States)

    Humphrey, Charlotte; Russell, Jill


    In the UK, a small private health care sector has always existed alongside the national health service (NHS). The conventional assumption is that doctors who work as salaried employees of the NHS are guided in their clinical practice by professional values which encourage them to put their patients' interests first. A common suspicion is that doctors undertaking fee-for-service practice in the private sector are motivated by self-interest, with commitment to their patients compromised by consideration for their purse. The great majority of hospital consultants are salaried employees of the NHS, but most also undertake some private practice. This paper uses findings from an interview study of 60 surgeons and physicians engaged in dual practice of this kind to investigate their reasons for working in this way and look at how they reconcile their personal, professional and public sector values and responsibilities with the temptations of the market. The existence of the private sector and their own engagement in it was regarded by almost all respondents as a net benefit, not only to themselves and their private patients, but also to the NHS, so long as they handled it properly. The interviews revealed a complex range of beliefs and assumptions through which these doctors justify their activities and a variety of informal principles for dealing with such conflicts of interest as they acknowledge. Neither their values nor their actions can be adequately explained using generic concepts of professional self-interest or public service values without consideration of what such concepts represented in the specific social, economic, professional and policy context of health care in south-east England at the time of the study.

  17. Health care financing in Malaysia: A way forward

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    Ashutosh Kumar Verma


    Full Text Available Malaysia has a two-tier health care system consisting of the public and private sectors. The Ministry of Health is the main provider of health care services in the country. The private health care sector provides services on a nonsubsidized, fee-for-service basis, and mainly serves for those who can afford to pay. For financing health care two types of health insurances are available currently: Private and employee based (aka SOCSO. SOCSO and Employee Provident Fund provide some coverage to private-sector employees. There are several challenges in pure Bismarckian model (private insurance etc. like smaller portion of total population will be "economically active," international competition to attract firms, and maintain/increase employment will put downward pressure on labor taxes. How to sustain universal coverage in this context? In a population setting where unemployment is high informal sector, payroll taxes will not be a major source of funds. However, it is possible to create a universal health financing system by transforming the role of budget funding from directly subsidizing provision to subsidizing the purchase of services on behalf of the entire population. The integration of services between the public and private sector is very much needed, at a cost the people can afford. At present, there is no national health insurance scheme in place. Although there are many models proposed, the main question that the policymakers need to be aware of is that of the equity of access to holistic health services for all Malaysians.

  18. The Affordable Care Act and integrated care. (United States)

    Kuramoto, Ford


    The Patient Protection and Affordable Care Act (ACA) of 2010 offers a comprehensive, integrated health insurance reform program for those who are eligible to enroll. A core feature of the ACA is the integration of primary health, behavioral health, and related services in a new national program for the first time. This article traces the history of past federal services integration efforts and identify varying approaches for implementing them to improve care, especially for underserved populations. The business case for integrated care, reducing escalating health care costs and overcoming barriers to implementation, is also discussed.

  19. The Forum for Defence of the Brazilian Unified Health System (Sistema Único de Saúde) and its role in building community participation in the fight against the privatization of health. (United States)

    de Lara, Lutiane; Guareschi, Neuza Maria de Fátima


    Based on a Foucauldian framework, this article discusses the involvement of the Forum for Defence of the Sistema Único de Saúde in the fight against health care privatization. Community participation is a locus of experience that produces subjects implicated in the production of public health care. The locus of experience in this instance derives from the rejection of private elements that historically have been part of Brazilian public policies. It is an experience that produces workers and service users as agents able to defend the public system and endowed with instituting power.

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

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


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

  1. Positive and negative emotional responses to workrelated trauma of intensive care nurses in private health care facilities

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    Lizelle Van der Vyver


    Full Text Available Intensive care nursing is a stressful occupation and nurses are continually subjected to both primary and secondary trauma. Responses may be positive in the form of compassion satisfaction, or negative in the form of compassion fatigue. However, nurses tend to deny the negative impact of secondary trauma which leads to the silencing response and subsequent burnout. This article explores and describes the presence of these emotions and the relationships between them. A quantitative approach with a non-probability sampling method was used. The sample consisted of 30 registered nurses working in private health care intensive care units in East London, Eastern Cape. Data were gathered via the Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Subscales – Revision IV (ProQOL – R-IV and the Silencing Response Scale and were analysed according to descriptive statistics and correlation coefficients. Findings suggest a high risk for compassion fatigue, a moderate risk for burnout and the silencing response and moderate potential for compassion satisfaction. A marked negative relationship was found between compassion satisfaction and burnout and a substantial positive relationship between compassion fatigue and burnout, as well as compassion fatigue and the silencing response.


    Intensiewesorgverpleging is ‘n stresvolle beroep en verpleegsters word gedurig aan beide primêre en sekondêre trauma blootgestel. Reaksie hierop kan óf positief wees, in die vorm van empatie-tevredenheid, óf negatief, in die vorm van empatie-uitputting. Verpleegsters is egter geneig om die negatiewe impak van sekondêre trauma te ontken,wat gevolglik tot stilswye en uitbranding kan lei. Hierdie artikel ondersoek en beskryf die teenwoordigheid en verwantskap tussen hierdie emosies. ‘n Kwantitatiewe benadering met ‘n nie-waarskynlikheidsteekproefmetode is gebruik. Die steekproef het bestaan uit 30 geregistreerde

  2. Factors influencing HAART adherence among private health care sector patients in a suburb of the Ethekwini Metro

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    Panjasaram Naidoo


    Full Text Available Background: The advent of highly active antiretroviral therapy (HAART ushered in a new era in the management of the AIDS pandemic with new drugs, new strategies, new vigour from treating clinicians and enthusiasm on the part of their patients. What soon became evident, however, was the vital importance of patient adherence to prescribed medication in order to obtain full therapeutic benefits. Several factors can influence adherence to HIV drug regimens. Many treatment regimes are complex, requiring patients to take a number of drugs at set times during the day, some on a full stomach and others on an empty one. Other factors that could contribute to non-adherence include: forgetting to take medications, cost factor, side effects, incorrect use of drug, social reasons, denial or poor knowledge of drug regime. If the correct regimen is not prescribed and if patients do not adhere to therapy, then the possibility of resistant strains is high. Improving adherence is therefore arguably the single most important means of optimising overall therapeutic outcomes. Although several studies regarding patient adherence have been performed in the public health care sector, data on adherence in patients from the private health care sector of South Africa remain limited. Many factors influence compliance and identifying these factors may assist in the design of strategies to enhance adherence to such demanding regimens. This study aimed to identify these factors among private sector patients.Method: Descriptive cross-sectional study was conducted among all consenting patients with HIV who visited the rooms of participating private sector doctors from May to July 2005. A questionnaire was administered to consenting participants. Participants who reported missing any medication on any day were considered non-adherent. The data obtained was analysed using SPSS 11.5. A probability value of 5% or less was regarded as being statistically significant. Categorical

  3. 75 FR 37187 - Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual... (United States)


    ... Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions, Lifetime... CFR Parts 144, 146, and 147 RIN 0991-AB69 Patient Protection and Affordable Care Act:...

  4. Protecting the delivery of heart failure: Regenerative Medicine/Stem Cell Therapeutics: Potential protections afforded by the Department of Health and Human Services and Health Resources Service Administration's Bureau of Special Programs

    Institute of Scientific and Technical Information of China (English)

    Gary S Friedman; John S. Tomicki; Neil Cohen; Robert Marshall; Philip Lowry; Jeffrey Warsh


    malpractice liability have not impeded the development and growth of organ/cell/tissue transplantation despite increased risks of infection, malignancy and cardiovascular disease in transplant recipients. Currently, human transplantation is only performed using FDA/CBER-approved, non-embryonic stem cells from peripheral blood, bone marrow or umbilical cord blood. Federal legislation passed in 2005 (HR2520 and S1317: The Bone Marrow and Cord Blood Cell Transplantation Program) authorizes the Secretary of Health and Human Services acting through the Director of HRSA to ensure uniform stem cell units distribution and outcomes monitoring via the federally-designated C.W. Bill Young Cell Transplant Program.Historically in the U.S., human biological therapies (vaccines, organ transplant and stem cell transplant) have required federal protections to ensure continued distribution, fair access and avoidance of inhibitory product liability via protections afforded under the "stewardship" of the Secretary of Health and Human Services. The National Childhood Vaccine Injury Act of 1986 established the NVICP to equitably and expeditiously compensate individuals, or families of individuals, who have been declared injured by vaccines, thereby stabilizing a once imperiled vaccine supply by substantially reducing the threat of liability for vaccine companies, physicians, and other health care professionals who administer vaccines. Vaccines were the first biologics administered to U.S. citizens en masse and presage stem cell therapeutics(which may similarly be administered to millions) will similarly necessitate that a Stem Cell Injury Compensation Program(SCICP) will also need to be in place to demonstrate an intention to do good, an understanding that industry may do well,but that the health care consumer has a right of protection-all recognized from the outset. The Federal Tort Claims Act(FTCA) addresses liability claims via the Executive, Judicial and Legislative branches of Government

  5. [Disease monitoring and surveillance systems and the role of public and private animal health agents: the experience of Africa]. (United States)

    Roger, F; Thonnat, J; Hendrikx, P; Domenech, J


    The current importance of animal diseases, and their emergence or re-emergence, show that surveillance is crucial for defining suitable control measures. Surveillance systems rely on networks of different people, whose activities include collecting, transmitting, analysing and disseminating disease information. These activities can be distributed among both the public and private sectors. However, nowadays it is essential to clearly define the different roles of the public and private sectors. In Africa, where budget cuts for state Veterinary Services over a number of years have promoted the growth of private veterinary medicine, the tasks of public officials (veterinarians, technicians, etc.) and private sector workers (veterinarians, livestock farmers) must be clearly determined and harmonised. This article presents and comments upon a number of different experiments that various sub-Saharan African countries have conducted in this field.

  6. Barriers to Enrollment in Health Coverage in Colorado


    Martin, Laurie T.; Bharmal, Nazleen; Blanchard, Janice C.; Harvey, Melody; Williams, Malcolm


    As part of the implementation of the Affordable Care Act, Colorado has expanded Medicaid and also now operates its own health insurance exchange for individuals (called Connect for Health Colorado). As of early 2014, more than 300,000 Coloradans have newly enrolled in Medicaid or health insurance through Connect for Health Colorado, but there also continues to be a diverse mix of individuals in Colorado who remain eligible for but not enrolled in either private insurance or Medicaid. The Colo...

  7. Patterns of case management and chemoprevention for malaria-in-pregnancy by public and private sector health providers in Enugu state, Nigeria

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    Onwujekwe Ogochukwu C


    Full Text Available Abstract Background Malaria in pregnancy (MIP is a major disease burden in Nigeria and has adverse consequences on the health of the mother, the foetus and the newborn. Information is required on how to improve its prevention and treatment from both the providers’ and consumers’ perspectives. Methods The study sites were two public and two private hospitals in Enugu, southeast Nigeria. Data was collected using a pre-tested structured questionnaire. The respondents were healthcare providers (doctors, pharmacists and nurses providing ante-natal care (ANC services. They consisted of 32 respondents from the public facilities and 20 from the private facilities. The questionnaire elicited information on their: knowledge about malaria, attitude, chemotherapy and chemoprophylaxis using pyrimethamine, chloroquine proguanil as well as IPTp with sulphadoxine-pyrimethamine (SP. The data was collected from May to June 2010. Results Not many providers recognized maternal and neonatal deaths as potential consequences of MIP. The public sector providers provided more appropriate treatment for the pregnant women, but the private sector providers found IPTp more acceptable and provided it more rationally than public sector providers (p  Conclusions There is sub-optimal level of knowledge about current best practices for treatment and chemoprophylaxis for MIP especially in the private sector. Also, IPTp was hardly used in the public sector. Interventions are required to improve providers’ knowledge and practices with regards to management of MIP.

  8. Extending transaction cost economics: towards a synthesised approach for analysing contracting in health care markets with experience from the Australian private sector. (United States)

    Donato, Ronald


    Transaction cost economics (TCE) has been the dominant economic paradigm for analysing contracting, and the framework has been applied in a number of health care contexts. However, TCE has particular limitations when applied to complex industry settings and there have been calls to extend the framework to incorporate dynamic theories of industrial organisation, specifically the resource-based view (RBV). This paper analyses how such calls for theoretical pluralism are particularly germane to health care markets and examines whether a combined TCE-RBV provides a more comprehensive approach for understanding the nature of contractual arrangements that have developed within the Australian private health care sector and its implications for informing policy. This Australian case study involved a series of interviews with 14 senior contracting executives from the seven major health funds (i.e. 97% of the insured population) and seven major private hospital groups (i.e. 73% of the private hospital beds). Study findings reveal that both the TCE perspective with its focus on exchange hazards, and the RBV approach with its emphasis on the dynamic nature of capabilities, each provide a partial explanation of the developments associated with contracting between health funds and hospital groups. For a select few organisations, close inter-firm relational ties involving trust and mutual commitment attenuate complex exchange hazards through greater information sharing and reduced propensity to behave opportunistically. Further, such close relational ties also provide denser communication channels for creating and transmitting more complex information enabling organisations to tap into each other's complementary resources and capabilities. For policymakers, having regard to both TCE and RBV considerations provides the opportunity to apply competition policy beyond the current static notions of efficiency and welfare gains, and cautions policymakers against specifying ex ante the

  9. Oral health status and treatment needs among 12- and 15-year-old government and private school children in Shimla city, Himachal Pradesh, India (United States)

    Shailee, Fotedar; Girish, M. Sogi; Kapil, R. Sharma; Nidhi, Pruthi


    Objectives: To assess the dental caries, periodontal health, and malocclusion of school children aged 12 and 15 years in Shimla city and to compare them in government and private schools. Materials and Methods: A cross-sectional study of 12- and 15-year-old children in government and private schools was conducted in Shimla city, Himachal Pradesh, India. A sample of 1011 school children (both males and females) was selected by a two-stage cluster sampling method. Clinical recordings of dental caries and malocclusion were done according to World Health Organization diagnostic criteria 1997. Periodontal health was assessed by Community Periodontal Index of Treatment Needs index. The data collected was analyzed by SPSS package 13. The statistical tests used were t-test and Chi-square tests. Results: The prevalence of dental caries was 32.6% and 42.2% at 12 and 15 years, respectively. At the12 years of age, the mean decayed, missing, filled teeth was 0.62 ± 1.42 and it was 1.06 ± 2.93 at 15 years of age. Females had higher level of caries than males at both the ages. At both ages, mean of decayed teeth was statistically higher in government schools as compared with private schools. Children in government schools had significantly less number of mean filled teeth at both ages as compared with private schools. The healthy component of gingiva was present in higher percentage of children in private schools as compared with government schools at both the age groups. The prevalence of malocclusion among the 12- year-old (58.1%) was more as compared with that among the 15-year-old (53.5%). Conclusion: The caries experience of 12- and 15-year-old children was low but the prevalence of gingivitis and malocclusion was quite high. Effective oral health promotion strategies need to be implemented to improve the oral health of school children further in Shimla city. PMID:24478980

  10. Housing Affordability And Children's Cognitive Achievement. (United States)

    Newman, Sandra; Holupka, C Scott


    Housing cost burden-the fraction of income spent on housing-is the most prevalent housing problem affecting the healthy development of millions of low- and moderate-income children. By affecting disposable income, a high burden affects parents' expenditures on both necessities for and enrichment of their children, as well as investments in their children. Reducing those expenditures and investments, in turn, can affect children's development, including their cognitive skills and physical, social, and emotional health. This article summarizes the first empirical evidence of the effects of housing affordability on children's cognitive achievement and on one factor that appears to contribute to these effects: the larger expenditures on child enrichment by families in affordable housing. We found that housing cost burden has the same relationship to both children's cognitive achievement and enrichment spending on children, exhibiting an inverted U shape in both cases. The maximum benefit occurs when housing cost burden is near 30 percent of income-the long-standing rule-of-thumb definition of affordable housing. The effect of the burden is stronger on children's math ability than on their reading comprehension and is more pronounced with burdens above the 30 percent standard. For enrichment spending, the curve is "shallower" (meaning the effect of optimal affordability is less pronounced) but still significant.

  11. Improving health in the Arctic region through safe and affordable access to household running water and sewer services: an Arctic Council initiative

    Directory of Open Access Journals (Sweden)

    Thomas W. Hennessy


    Full Text Available Important health disparities have been documented among the peoples of the Arctic and subarctic, including those related to limited access to in-home improved drinking water and sanitation services. Although improving water, sanitation and hygiene (WASH has been a focus of the United Nations for decades, the Arctic region has received little attention in this regard. A growing body of evidence highlights inequalities across the region for the availability of in-home drinking WASH services and for health indicators associated with these services. In this review, we highlight relevant data and describe an initiative through the Arctic Council's Sustainable Development Working Group to characterize the extent of WASH services in Arctic nations, the related health indicators and climate-related vulnerabilities to WASH services. With this as a baseline, efforts to build collaborations across the Arctic will be undertaken to promote innovations that can extend the benefits of water and sanitation services to all residents.

  12. Affordances theory in multilingualism studies

    Directory of Open Access Journals (Sweden)

    Larissa Aronin


    Full Text Available The concept of affordances originating in Gibson’s work (Gibson, 1977 is gaining ground in multilingualism studies (cf. Aronin and Singleton, 2010; Singleton and Aronin, 2007; Dewaele, 2010. Nevertheless, studies investigating affordances in respect of teaching, learning or using languages are still somewhat rare and tend to treat isolated aspects of multilingualism. This is despite the fact that the theory of affordances can actually provide a valuable, supplementary, up-to-date framework within which a clearer, sharper description and explication of the intriguing range of attributes of multilingual communities, educational institutions and individuals, as well as teaching practices, become feasible. It is important that not only researchers and practitioners (teachers, educators, parents, community and political actors but also language users and learners themselves should be aware of how to identify or, if necessary, design new affordances for language acquisition and learning. The aim of this article is to adapt the concept of affordances to multilingualism studies and additional language teaching, and in so doing advance theoretical understanding in this context. To this end the article contains a brief summary of the findings so far available. The article also goes further into defining the ways of how affordances work in relation to multilingualism and second language teaching and puts forward an integrated model of affordances.

  13. Private costs almost equal health care costs when intervening in mild Alzheimer's: a cohort study alongside the DAISY trial

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Sørensen, Jan; Waldorff, Frans B;


    of counselling sessions, courses and informational packages. The typical duration of the intervention was 7 months. A micro-costing approach was applied using prospectively collected data on resource utilisation that included estimates of participant time and transportation. Precision estimates were calculated...... using a bootstrapping technique and structural uncertainty was assessed with sensitivity analysis. RESULTS: The direct intervention cost was estimated at EUR 1,070 (95% CI 1,029;1,109). The total cost (including private costs) was estimated at EUR 2,020 (95% CI 1,929;2,106) i.e. the ratio of private...

  14. Affordable Access to Space (AAS): Affordable Vehicle Avionics Project (United States)

    National Aeronautics and Space Administration — Affordable Vehicle Avionics (AVA) is being developed at NASA Ames Research Center and is sponsored by Space Technology Mission Directorate (STMD) Game Changing...

  15. Obamacare: what the Affordable Care Act means for patients and physicians. (United States)

    Hall, Mark A; Lord, Richard


    The Affordable Care Act's core achievement is to make all Americans insurable, by requiring insurers to accept all applicants at rates based on population averages regardless of health status. The act also increases coverage by allowing states to expand Medicaid (the social healthcare program for families and people with low income and resources) to cover everyone near the poverty line, and by subsidizing private insurance for people who are not poor but who do not have workplace coverage. The act allows most people to keep the same kind of insurance that they currently have, and it does not change how private insurance pays physicians and hospitals. Although the act falls short of achieving truly universal coverage, nine million uninsured people have received coverage so far. Market reforms have not hurt the insurance industry's profitability, prices for individual insurance have been lower than expected, and government costs so far have been less than initially projected. The act expands several ongoing pilot programs in Medicare that reform how doctors and hospitals are paid, but it does not directly change how private insurers pay healthcare providers. Nevertheless, it has set into motion market dynamics that are affecting medical practice, such as limiting insurance networks to fewer providers and requiring patients to pay for more treatment costs out of pocket. In response, many hospitals and physicians are forming closer and larger affiliations. Further time and study are needed to learn whether these evolutionary changes will achieve their goals without harming the doctor-patient relationship.

  16. [For a coordination of the supportive care for people affected by severe illnesses: proposition of organization in the public and private health care centres]. (United States)

    Krakowski, Ivan; Boureau, François; Bugat, Roland; Chassignol, Laurent; Colombat, Philippe; Copel, Laure; d'Hérouville, Daniel; Filbet, Marylène; Laurent, Bernard; Memran, Nadine; Meynadier, Jacques; Parmentier, Gérard; Poulain, Philippe; Saltel, Pierre; Serin, Daniel; Wagner, Jean-Philippe


    The concept of continuous and global care is acknowledged today by all as inherent to modern medicine. A working group gathered to propose models for the coordination of supportive care for all severe illnesses in the various private and public health care centres. The supportive care are defined as: "all care and supports necessary for ill people, at the same time as specific treatments, along all severe illnesses". This definition is inspired by that of "supportive care" given in 1990 by the MASCC (Multinational Association for Supportive Care in Cancer): "The total medical, nursing and psychosocial help which the patients need besides the specific treatment". It integrates as much the field of cure with possible after-effects as that of palliative care, the definition of which is clarified (initial and terminal palliative phases). Such a coordination is justified by the pluridisciplinarity and hyperspecialisation of the professionals, by a poor communication between the teams, by the administrative difficulties encountered by the teams participating in the supportive care. The working group insists on the fact that the supportive care is not a new speciality. He proposes the creation of units. departments or pole of responsibility of supportive care with a "basic coordination" involving the activities of chronic pain, palliative care, psycho-oncology, and social care. This coordination can be extended, according to the "history" and missions of health care centres. Service done with the implementation of a "unique counter" for the patients and the teams is an important point. The structure has to comply with the terms and conditions of contract (Consultation, Unit or Centre of chronic pain, structures of palliative care, of psycho-oncology, of nutrition, of social care). A common technical organization is one of the interests. The structure has to set up strong links with the private practitioners, the networks, the home medical care (HAD) and the nurses

  17. Medicaid program; eligibility changes under the Affordable Care Act of 2010. Final rule, Interim final rule. (United States)


    This final rule implements several provisions of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). The Affordable Care Act expands access to health insurance coverage through improvements to the Medicaid and Children's Health Insurance (CHIP) programs, the establishment of Affordable Insurance Exchanges ("Exchanges"), and the assurance of coordination between Medicaid, CHIP, and Exchanges. This final rule codifies policy and procedural changes to the Medicaid and CHIP programs related to eligibility, enrollment, renewals, public availability of program information and coordination across insurance affordability programs.

  18. Towards health impact assessment of drinking-water privatization--the example of waterborne carcinogens in North Rhine-Westphalia (Germany). (United States)

    Fehr, Rainer; Mekel, Odile; Lacombe, Martin; Wolf, Ulrike


    Worldwide there is a tendency towards deregulation in many policy sectors - this, for example, includes liberalization and privatization of drinking-water management. However, concerns about the negative impacts this might have on human health call for prospective health impact assessment (HIA) on the management of drinking-water. On the basis of an established generic 10-step HIA procedure and on risk assessment methodology, this paper aims to produce quantitative estimates concerning health effects from increased exposure to carcinogens in drinking-water. Using data from North Rhine-Westphalia in Germany, probabilistic estimates of excess lifetime cancer risk, as well as estimates of additional cases of cancer from increased carcinogen exposure levels are presented. The results show how exposure to contaminants that are strictly within current limits could increase cancer risks and case-loads substantially. On the basis of the current analysis, we suggest that with uniform increases in pollutant levels, a single chemical (arsenic) is responsible for a large fraction of expected additional risk. The study also illustrates the uncertainty involved in predicting the health impacts of changes in water quality. Future analysis should include additional carcinogens, non-cancer risks including those due to microbial contamination, and the impacts of system failures and of illegal action, which may be increasingly likely to occur under changed management arrangements. If, in spite of concerns, water is privatized, it is particularly important to provide adequate surveillance of water quality.

  19. An easy to use and affordable home-based personal eHealth system for chronic disease management based on free open source software. (United States)

    Burkow, Tatjana M; Vognild, Lars K; Krogstad, Trine; Borch, Njål; Ostengen, Geir; Bratvold, Astrid; Risberg, Marijke Jongsma


    This paper describes an easy to use home-based eHealth system for chronic disease management. We present the design and implementation of a prototype for home based education, exercises, treatment and following-up, with the TV and a remote control as user interface. We also briefly describe field trials of the system for patients with COPD and diabetes, and their experience with the technology.

  20. Housing Affordability Data System (HADS) (United States)

    Department of Housing and Urban Development — The Housing Affordability Data System (HADS) is a set of files derived from the 1985 and later national American Housing Survey (AHS) and the 2002 and later Metro...

  1. Affordable Care Act and Diabetes Mellitus. (United States)

    Shi, Qian; Nellans, Frank P; Shi, Lizheng


    The Affordable Care Act (ACA) has the potential for great impact on U.S. health care, especially for chronic disease patients requiring long-term care and management. The act was designed to improve insurance coverage, health care access, and quality of care for all Americans, which will assist patients with diabetes mellitus in acquiring routine monitoring and diabetes-related complication screening for better health management and outcomes. There is great potential for patients with diabetes to benefit from the new policy mandating health insurance coverage and plan improvement, Medicaid expansion, minimum coverage guarantees, and free preventative care. However, policy variability among states and ACA implementation present challenges to people with diabetes in understanding and optimizing ACA impact. This paper aims to select the most influential components of the ACA as relates to people with diabetes and discuss how the ACA may improve health care for this vulnerable population.

  2. The impact of population-based disease management services for selected chronic conditions: the Costs to Australian Private Insurance - Coaching Health (CAPICHe study protocol

    Directory of Open Access Journals (Sweden)

    Byrnes Joshua M


    Full Text Available Abstract Background Recent evidence from a large scale trial conducted in the United States indicates that enhancing shared decision-making and improving knowledge, self-management, and provider communication skills to at-risk patients can reduce health costs and utilisation of healthcare resources. Although this trial has provided a significant advancement in the evidence base for disease management programs it is still left for such results to be replicated and/or generalised for populations in other countries and other healthcare environments. This trial responds to the limited analyses on the effectiveness of providing chronic disease management services through telephone health coaching in Australia. The size of this trial and it's assessment of cost utility with respect to potentially preventable hospitalisations adds significantly to the body of knowledge to support policy and investment decisions in Australia as well as to the international debate regarding the effect of disease management programs on financial outcomes. Methods Intention to treat study applying a prospective randomised design comparing usual care with extensive outreach to encourage use of telephone health coaching for those people identified from a risk scoring algorithm as having a higher likelihood of future health costs. The trial population has been limited to people with one or more of the following selected chronic conditions: namely, low back pain, diabetes, coronary artery disease, heart failure, and chronic obstructive pulmonary disease. This trial will enrol at least 64,835 sourced from the approximately 3 million Bupa Australia private health insured members located across Australia. The primary outcome will be the total (non-maternity cost per member as reported to the private health insurer (i.e. charged to the insurer 12 months following entry into the trial for each person. Study recruitment will be completed in early 2012 and the results will be

  3. Studies on Private Health Insurance in German and its Implications for China%德国商业健康保险及经验借鉴

    Institute of Scientific and Technical Information of China (English)



    德国是世界上商业健康保险较为发达的国家,本文分别从市场概况、市场主体、监管和行业自治等方面对该国的商业健康保险市场进行梳理,以此为基础挖掘其对我国健康保险的借鉴意义。%Private health insurance is well developed in German. This paper respectively analyzed its private health insurance market from the aspects of market situation, the main body of the market, regulatory and industry autonomy, and found out its impact on the health insurance of our country.

  4. The need for absolute truth and self-rumination as basic suppressors in the relationship between private self-consciousness and mental health. (United States)

    Şimşek, Ömer Faruk; Ceylandağ, Aylin Ecem; Akcan, Gizem


    Self-reflection has not so far been shown to have any specific benefits for mental health except for self-knowledge. Recent research showed that the controversy concerning the relationship between self-reflection and mental health could completely be eliminated if self-rumination and the need for absolute truth, especially the need for absolute truth, were considered as suppressor variables. This research replicated these findings in a different sample and expanded these findings by showing that the same is true for private self-consciousness. The need for absolute truth as a new variable was shown to be highly important in understanding the effects of self-consciousness on mental health.

  5. 76 FR 41929 - Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and... (United States)


    ... Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment; Proposed Rule #0... OF HEALTH AND HUMAN SERVICES 45 CFR Part 153 RIN 0938-AR07 Patient Protection and Affordable Care Act... corridors, and risk adjustment consistent with title I of the Patient Protection and Affordable Care Act...

  6. Why epidemiologists cannot afford to ignore poverty. (United States)

    Krieger, Nancy


    Epidemiologists cannot afford to ignore poverty. To do so would, first, wrongly obscure the devastating impact of poverty on population health, and, second, undercut our commitment to scientific rigor. At issue is doing correct science, not "politically correct" science. Blot poverty and inequity from view, and not only will we contribute to making suffering invisible but our understanding of disease etiology and distribution will be marred. To make this case, I address current debates about the causal relationships between poverty and health, and provide examples of how failing to consider the impact of socioeconomic position has biased epidemiologic knowledge and harmed the public's health. By definition, the people we study are simultaneously social beings and biologic organisms-and we cannot study the latter without taking into account the former. It is the responsibility of all epidemiologists, and not only social epidemiologists, to keep in mind the connections between poverty and health.

  7. In health care spending, Americans who make the least contribute the greatest share of income. (United States)

    Collado, Megan


    Key findings. (1) Health care spending, both public and private, accounted for more than 20 percent of family income for families in the lowest-income quintile, but no more than 16 percent for families in any other income quintile. (2) The Affordable Care Act should reduce, but is unlikely to completely eliminate, some of this inequity through its heavy reliance on federal funding for the Medicaid expansion and income-related subsidies for private insurance.

  8. Incentivising flood risk adaptation through risk based insurance premiums : Trade-offs between affordability and risk reduction

    NARCIS (Netherlands)

    Hudson, Paul F.; Botzen, W.J.W.; Feyen, L.; Aerts, Jeroen C.J.H.


    The financial incentives offered by the risk-based pricing of insurance can stimulate policyholder adaptation to flood risk while potentially conflicting with affordability. We examine the trade-off between risk reduction and affordability in a model of public-private flood insurance in France and G

  9. Affordability of medicines in the European Union (United States)

    Zaprutko, Tomasz; Kopciuch, Dorota; Kus, Krzysztof; Merks, Piotr; Nowicka, Monika; Augustyniak, Izabela; Nowakowska, Elżbieta


    Background Medications and their prices are key issues for healthcare. Although access to medicines at affordable prices had been specified as a key objective of the European Health Policy, it seems that these goals have not been achieved. Therefore, we attempted an evaluation of affordability of selected medicines at full prices. Methods The analysis concerned 2012 and was conducted between 2013 and 2015 in all the European Union (EU) countries divided into 3 groups depending on the date of their accession to the EU. Finally, we considered 9 originators used in the treatment of schizophrenia and multiple sclerosis. Information on drug prices were collected from pharmacies. Participation in the study was voluntary and anonymous in order to avoid accusations of advertising. To evaluate affordability, several factors were used (e.g. minimum earnings and Gini coefficient). Due to unavailability in some countries, the exact number of analyzed medicines varies. Results Drug prices vary significantly between EU Member States. Almost eleven fold difference was observed between Germany (EUR 1451.17) and Croatia (EUR 132.77) in relation to Interferone beta-1a 22 μg. Generally, prices were the highest in Germany. The cheapest drugs were found in various countries but never in the poorest ones like Bulgaria or Romania. Discrepancies in wages were observed too (the smallest minimum wage was EUR 138.00 in Bulgaria and the highest EUR 1801.00 in Luxembourg). Full price of olanzapine 5mg, however, was higher in Bulgaria (EUR 64.53) than, for instance, in Belgium (EUR 37.26). Conclusions Analyzed medications are still unaffordable for many citizens of the EU. Besides, access to medicines is also impaired e.g. due to parallel trade. Unaffordability of medications may lead to the patients’ non-compliance and therefore to increased direct and indirect costs of treatment. Common European solutions are needed to achieve a real affordability and accessibility of medications. PMID

  10. The affordable care act: the value of systemic disruption. (United States)

    Shaffer, Ellen R


    It is important to recognize the political and policy accomplishments of the Patient Protection and Affordable Care Act (ACA), anticipate its limitations, and use the levers it provides strategically to address the problems it does not resolve. Passage of the ACA broke the political logjam that long stymied national progress toward equitable, quality, universal, affordable health care. It extends coverage for the uninsured who are disproportionately low income and people of color, curbs health insurance abuses, and initiates improvements in the quality of care. However, challenges to affordability and cost control persist. Public health advocates should mobilize for coverage for abortion care and for immigrants, encourage public-sector involvement in negotiating health care prices, and counter disinformation by opponents on the right.

  11. Determinantes na escolha entre atendimento de saúde privada e pública por idosos Determinants of elders' choice between private and public health care providers

    Directory of Open Access Journals (Sweden)

    Antônio M G Bós


    Full Text Available OBJETIVO: Idosos usam a rede pública ou privada de atendimento de saúde de acordo com a sua situação econômica, social, demográfica e epidemiológica. Analisar como esses fatores influenciam a escolha do local de atendimento e comparar o impacto das rendas individual e familiar do idoso nessa decisão são os objetivos do estudo. MÉTODOS: Foram utilizados dados de um estudo realizado pelo Conselho Estadual do Idoso do Rio Grande do Sul, em 1995, com 7.920 idosos, com idade acima de 60 anos. A coleta de dados foi feito mediante questionário que incluía questões sobre influência do gênero, idade, escolaridade, renda individual e familiar, tamanho da família, participação na renda familiar e auto-avaliação da saúde do idoso. As chances de uso da rede privada de atendimento de saúde foi medida pela regressão logística. RESULTADOS: No acesso à rede privada de atendimento a renda familiar do idoso teve um impacto muito mais expressivo do que a individual. Com um aumento na renda familiar em um salário mínimo, as chances do idoso utilizar a rede privada aumentam 20% contra um acréscimo de apenas 7% no mesmo aumento na renda individual. Também influenciaram positivamente: gênero feminino, idade, escolaridade e tamanho menor da família. CONCLUSÕES: As decisões sobre onde o idoso recebe cuidados de saúde dependem das necessidades e recursos da família e não somente da situação individual do idoso. Conseqüentemente, a saúde do idoso de família de renda baixa recebe prioridade menor e é desproporcionalmente prejudicada pelo pouco recurso familiar e deficiências do sistema público de atendimento.OBJECTIVE: Elderly choose between utilizing private or public health care providers based on their socioeconomic, demographic, and epidemiological condition. The purposes of this study was to evaluate how these factors affect the choice of health care provider and to compare the impact of their choice on individual and family

  12. Malaysian Affordability Housing Policies Revisited

    Directory of Open Access Journals (Sweden)

    Samad Diwa


    Full Text Available Housing has always been a significant aspiration of family expression and distinctly priciest investment by household. It plays a momentous role in the country’s economy and so central to the societal well-being that is emplaced in the United Nation Universal declaration of Human rights. Yet in developed and developing world alike, cities struggle to provide decent housing for lower and middle income population. The provision of affordable housing is a major policy concern around the world with Malaysia being no exception; rising income hardly keep pace with price hike of housing unit and housing interventions has majorly concentrated on demand side leading to a non-responsive supply sector. Therefore, this paper highlights affordable housing issues pertaining Malaysia. It formulates Malaysian Map of affordability and conducts an evaluation of global housing schemes to better identify policy priorities for Malaysia. It’s significant to harmonize supply and demand side factors in the housing market to ensure that housing supply fits the needs of citizens based on the location, price and target group. In case of Malaysia supply oriented initiative are of urgency in short and medium run. This must be supported by long term demand side schemes in parallel. Convergence of these two factors is essential for a balanced equilibrium and obtaining affordability.

  13. The National Institutes of Health Affordable Cancer Technologies Program: Improving Access to Resource-Appropriate Technologies for Cancer Detection, Diagnosis, Monitoring, and Treatment in Low- and Middle-Income Countries (United States)

    Divi, Rao; Gwede, Michael; Tandon, Pushpa; Sorg, Brian S.; Ossandon, Miguel R.; Agrawal, Lokesh; Pai, Vinay; Baker, Houston; Lash, Tiffani Bailey


    Point-of-care (POC) technologies have proved valuable in cancer detection, diagnosis, monitoring, and treatment in the developed world, and have shown promise in low-and-middle-income countries (LMIC) as well. Despite this promise, the unique design constraints presented in low-resource settings, coupled with the variety of country-specific regulatory and institutional dynamics, have made it difficult for investigators to translate successful POC cancer interventions to the LMIC markets. In response to this need, the National Cancer Institute has partnered with the National Institute of Biomedical Imaging and Bioengineering to create the National Institutes of Health Affordable Cancer Technologies (ACTs) program. This program seeks to simplify the pathway to market by funding multidisciplinary investigative teams to adapt and validate the existing technologies for cancer detection, diagnosis, and treatment in LMIC settings. The various projects under ACTs range from microfluidic cancer diagnostic tools to novel treatment devices, each geared for successful clinical adaptation to LMIC settings. Via progression through this program, each POC innovation will be uniquely leveraged for successful clinical translation to LMICs in a way not before seen in this arena. PMID:27730015

  14. Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia. (United States)

    Brown, Laurie; Barnett, J Ross


    A common feature of health reforms in western nations has been the transformation or (re)construction of health and health care as both a commodity and product. In the hospital sector, this transformation has become increasingly evident in the growth of for-profit involvement in service delivery. Investor-owned hospitals are now prominent providers of hospital care in Australia. This paper examines the changing nature of health care space through the changing portrayal and meaning of hospitals as represented by and encoded in the built environment. Public hospitals once occupied 'pride of place'. In contrast, up to the early 1980s, the private sector was seen as a cottage industry. However, increased levels of state subsidisation and government incentives and pro-market policies, combined with market-based opportunities for profit generation, have seen the emergence of large private hospital chains with a new corporate image to hospital care and the blurring of 'public' and 'private'. A significant factor in the reconstruction of hospital space in Australia has been the co-location of private and public hospitals. Co-location is a popular strategy proffered by State governments and one that has been quickly acted on by corporate providers. Using Mayne Health Ltd, Australia's largest for-profit hospital chain, and four specific case studies, this paper explores four variants of co-location. Each of these examples represent a different public and private hospital space. The growth of for-profit hospital chains signifies a new phase in the delivery of health care in Australia but also importantly the creation of a new hybridised 'health care' space. This space is neither private nor public but a reflection of the economic, political and social processes underlying this transformation.

  15. Health-care-seeking patterns in the emerging private sector in Burkina Faso: a population-based study of urban adult residents in Ouagadougou.

    Directory of Open Access Journals (Sweden)

    Idrissa Beogo

    Full Text Available BACKGROUND: The private medical care sector is expanding in urban cities in Sub-Saharan Africa (SSA. However, people's health-care-seeking behaviors in this new landscape remain poorly understood; furthermore, distinguishing between public and private providers and among various types of private providers is critical in this investigation. This study assessed, by type, the healthcare providers urban residents in Burkina Faso visit, and their choice determinants. METHOD: We conducted a population-based survey of a representative sample of 1,600 households in Ouagadougou from July to November 2011, consisting of 5,820 adults. We assessed the types of providers people typically sought for severe and non-severe conditions. We applied generalized estimating equations in this study. RESULTS: Among those surveyed, 97.7% and 53.1% indicated that they seek a formal provider for treating severe and non-severe conditions, respectively. Among the formal provider seekers, 20.5% and 17.0% chose for-profit (FP providers for treating severe and non-severe conditions, respectively. Insurance coverage was held by 2.0% of those surveyed. Possessing insurance was the strongest predictor for seeking FP, for both severe (odds ratio [OR]  = 1.15, 95% confidence interval [CI] = 1.04-1.28, and non-severe conditions (OR = 1.22, 95% CI = 1.07-1.39. Other predictors included being a formal jobholder and holding a higher level education. By contrast, we observed no significant difference in predisposing, enabling, or need characteristics between not-for-profit (NFP provider seekers and public provider seekers. Proximity was the primary reason for choosing a provider. CONCLUSION: The results suggested that FP providers play a crucial role in the urban healthcare market in SSA. Socioeconomic status and insurance status are significant predictors of provider choice. The findings can serve as a crucial reference for policymakers in response to the emergence of FP providers

  16. The Affordable Care Act: a primer for plastic surgeons. (United States)

    Chen, Jenny T; Israel, Jacqueline S; Poore, Samuel O; Rao, Venkat K


    The Patient Protection and Affordable Care Act, sometimes referred to as Obamacare, was signed into law on March 23, 2010. It represents the most extensive overhaul of the country's health care system since the passage of Medicare and Medicaid in 1965. The Affordable Care Act has two goals. The first goal is to reduce the uninsured population in the United States. Key elements to covering the uninsured include the following: (1) expanding Medicaid coverage for low-income individuals and (2) establishing health insurance marketplaces for moderate-income individuals with subsidies and tax cuts in an effort to make health insurance more affordable. The second goal of the Affordable Care Act is to address concerns about quality and the overall cost of U.S. health care. It is imperative that plastic surgeons thoroughly understand the impact that the Affordable Care Act will undoubtedly have on the country, on our patients, and on our clinical practices. Plastic surgery will see many changes in the future. This will include an overall increase in the number of insured patients, a push toward joining accountable care organizations, and a shift in payment systems to bundled reimbursement for episodes of care. In this article, the authors describe how these changes are likely to occur and what plastic surgeons must do to be part of the change.

  17. [Treatment of depressive patients in private practice--empirical results, health political and social conditions and recommendations]. (United States)

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


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

  18. Neoliberal Justice and the Transformation of the Moral: The Privatization of the Right to Health Care in Colombia. (United States)

    Abadía-Barrero, César Ernesto


    Neoliberal reforms have transformed the legislative scope and everyday dynamics around the right to health care from welfare state social contracts to insurance markets administered by transnational financial capital. This article presents experiences of health care-seeking treatment, judicial rulings about the right to health care, and market-based health care legislation in Colombia. When insurance companies deny services, citizens petition the judiciary to issue a writ affirming their right to health care. The judiciary evaluates the finances of all relevant parties to rule whether a service should be provided and who should be responsible for the costs. A 2011 law claimed that citizens who demand, physicians who prescribe, and judges who grant uncovered services use the system's limited economic resources and undermine the state's capacity to expand coverage to the poor. This article shows how the consolidation of neoliberal ideology in health care requires the transformation of moral values around life.

  19. Mercury exposure in the work place and human health: dental amalgam use in dentistry at dental teaching institutions and private dental clinics in selected cities of Pakistan. (United States)

    Khwaja, Mahmood A; Nawaz, Sadaf; Ali, Saeed Waqar


    During the past two decades, mercury has come under increasing scrutiny with regard to its safety both in the general population and in occupationally exposed groups. It's a growing issue of global concern because of its adverse environmental and health impacts. Very few investigations on mercury amalgam use in the dentistry sector have been carried out in South Asia and there is little data reported on mercury contamination of indoor/outdoor air at dental sites. According to an earlier SDPI study, reported in 2013, alarmingly high mercury levels were observed in air (indoor as well as outdoor) at 11 of the 34 visited dental sites (17 dental teaching institutions, 7 general hospitals & 10 dental clinics) in five main cities of Pakistan. 88% of the sites indicated indoor mercury levels in air above the USA EPA reference level of 300 ng/m3. According to our study, carried out at 38 dental teaching institutions in 12 main cities (in Khyber Pakhtunkhwa, Punjab and Sindh provinces) of Pakistan, respondents were of the opinion that the currently offered BDS curriculum does not effectively guide outgoing dental professionals and does not provide them adequate knowledge and training about mercury/mercury amalgam and other mercury related human health and mercury waste issues. 90% of respondents supported the review and revision of the present dental curriculum offered at dental teaching institutions in the country, at the earliest. A study has also been conducted to assess the status of mercury amalgam use in private dental clinics in Gilgit, Hunza, Peshawar, Rawalpindi and Islamabad. More than 90 private dental clinics were visited and dental professionals/private clinics in-charge were interviewed during June-July, 2015. The focus areas of the study were Hg amalgam toxicity, its waste management practices and safety measures practiced among the dental practitioners. In the light of the findings described and discussed in this brief report, to safeguard public health and

  20. Does a property-specific environmental health risk create a “neighborhood” housing price stigma? Arsenic in private well water (United States)

    Boyle, Kevin J.; Kuminoff, Nicolai V.; Zhang, Congwen; Devanney, Michael; Bell, Kathleen P.


    This paper examines the impact of arsenic contamination of groundwater on sale prices of residential properties and bare land transactions in two Maine towns, Buxton and Hollis, that rely on private wells to supply their drinking water. Prompted by tests of well water by the state of Maine, media attention focused on the communities in 1993 and 1994 when 14% of private wells were found to have arsenic concentrations exceeding the U.S. Environmental Protection Agency standard of 0.05 mg/L. Households could mitigate the serious health risks associated with arsenic ingestion by purchasing bottled water or by installing a reverse osmosis home treatment system. Our results indicate that the initial arsenic finding in 1993 led to significant, but temporary, 2 year decreases in property prices. This is a much shorter effect on prices than has been observed for Superfund sites, where prices can be depressed for a decade. These results suggest that a property-specific contamination incident that is treatable may not have a long-lasting effect on sale prices, but further research is needed to confirm if the dissipation of the price effect was actually due to the installation of in-home water treatment systems or due to the dissipation of perceived risk once the media coverage stopped.

  1. Cluster Randomized-Controlled Trial of Interventions to Improve Health for Adults with Intellectual Disability Who Live in Private Dwellings (United States)

    Lennox, Nicholas; Bain, Chris; Rey-Conde, Therese; Taylor, Miriam; Boyle, Frances M.; Purdie, David M.; Ware, Robert S.


    Background: People with intellectual disability who live in the community often have poor health and healthcare, partly as a consequence of poor communication, recall difficulties and incomplete patient health information. Materials and Methods: A cluster randomized-controlled trial with 2 x 2 factorial design was conducted with adults with…

  2. Developing Countries Vaccine Manufacturers Network: doing good by making high-quality vaccines affordable for all. (United States)

    Pagliusi, Sonia; Leite, Luciana C C; Datla, Mahima; Makhoana, Morena; Gao, Yongzhong; Suhardono, Mahendra; Jadhav, Suresh; Harshavardhan, Gutla V J A; Homma, Akira


    The Developing Countries Vaccine Manufacturers Network (DCVMN) is a unique model of a public and private international alliance. It assembles governmental and private organizations to work toward a common goal of manufacturing and supplying high-quality vaccines at affordable prices to protect people around the world from known and emerging infectious diseases. Together, this group of manufacturers has decades of experience in manufacturing vaccines, with technologies, know-how, and capacity to produce more than 40 vaccines types. These manufacturers have already contributed more than 30 vaccines in various presentations that have been prequalified by the World Health Organization for use by global immunization programmes. Furthermore, more than 45 vaccines are in the pipeline. Recent areas of focus include vaccines to protect against rotavirus, human papillomavirus (HPV), Japanese encephalitis, meningitis, hepatitis E, poliovirus, influenza, and pertussis, as well as combined pentavalent vaccines for children. The network has a growing number of manufacturers that produce a growing number of products to supply the growing demand for vaccines in developing countries.

  3. The Patient Protection and Affordable Care Act: the victory of unorthodox lawmaking. (United States)

    Beaussier, Anne-Laure


    The 2010 Patient Protection and Affordable Care Act was a major legislative achievement of the 111th Congress. This law structurally reforms the US health care system by encouraging universal health care coverage through regulated competition among private insurance companies. When looking at the process for reform, what strikes an observer of US health care policy in the first place is that the Democratic majority was able to enact something in a political field characterized by strong resistance to change. This article builds on that observation. Arguments concentrate on the legislative process of the reform and support the idea that it may be partly explained by considering an evolution of US legislative institutions, mostly in the sense of a more centralized legislative process. Based on approximately one hundred semidirected interviews, I argue that the Democratic majority, building on lessons from both President Bill Clinton's health care reform attempt and the Republicans' strategy of using strong congressional leadership to pass social reforms, was able to overcome institutional constraints that have long prevented comprehensive change. A more centralized legislative process, which has been described as "unorthodox lawmaking," enabled the Democratic leadership to overcome multiple institutional and political veto players.

  4. Primary health care and public health: foundations of universal health systems. (United States)

    White, Franklin


    The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable.

  5. Promoting Prevention Through the Affordable Care Act: Workplace Wellness


    Anderko, Laura; Roffenbender, Jason S.; Goetzel, Ron Z.; Millard, Francois; Wildenhaus, Kevin; DeSantis, Charles; Novelli, William


    Public health in the United States can be improved by building workplace “cultures of health” that support healthy lifestyles. The Affordable Care Act (ACA), which includes the Prevention and Public Health Fund, will support a new focus on prevention and wellness, offering opportunities to strengthen the public’s health through workplace wellness initiatives. This article describes the opportunity the ACA provides to improve worker wellness.

  6. [Health care waste management of potentially infectious medical waste by healthcare professionals in a private medical practice: a study of practices]. (United States)

    Brunot, Alain; Thompson, Céline


    A cross-sectional study was conducted with a sample of 278 health professionals (GPs and specialists, dentists, physical therapists and nurses) in a private medical practice in Paris to study the medical waste management practices related to the production and disposal of potentially hazardous health care waste. With the exception of physical therapists, most professionals produced medical waste (72% to 96,2% according to occupation), with a monthly median of 3 liters (inter-quartile range 1-15 liters). All sharp objects and needles were separated and 91% of them eliminated via a specific process for that sector. These percentages were respectively 84% and 69% concerning contaminated waste that was neither needles or used for cutting. 48% of the professionals reported the existence of documents that could track the disposal of their medical waste. To improve practice, professionals cited collection on-site at the office (74%) and reliability of the contracted service provider to collect the waste (59%). The study showed that health professionals need information on the regulations regarding potentially infectious medical waste, in particular on the traceability of its elimination. They also noted the lack of clarity and precision with regard to the definition of risk of infection: 31,7% of professionals only declare the production of sharp or cutting waste without having specified criteria for risk of infection.

  7. Affordability of alcohol and alcohol-related mortality in Belarus. (United States)

    Razvodovsky, Yury E


    Alcohol abuse has numerous adverse health and social consequences. The consumer response to changes in alcohol affordability is an important issue on alcohol policy debates. Studies from many countries have shown an inverse relationship between alcohol prices and alcohol consumption in the population. There are, however, suggestions that increasing the price of alcohol by rising taxes may have limited effect on alcohol-related problems, associated with long-term heavy drinking. The aim of the present study was to evaluate the relationship between alcohol affordability and alcohol-related mortality rates in post-Soviet Belarus. For this purpose trends in alcohol-related mortality rates (mortality from liver cirrhosis, pancreatitis, alcoholism and alcohol psychoses) and affordability of vodka between 1990 and 2010 were compared. The time series analysis revealed that 1% increase in vodka affordability is associated with an increase in liver cirrhosis mortality of 0,77%, an increase in pancreatitis mortality of 0.53%, an increase in mortality from alcoholism and alcohol psychoses of 0,70%. The major conclusion emerging from this study is that affordability of alcohol is one of the most important predictor of alcohol-related problems in a population. These findings provide additional evidence that decreasing in affordability of alcohol is an effective strategy for reducing alcohol consumption and alcohol-related harm.

  8. What's public? What's private? Policy trade-offs and the debate over mandatory annual influenza vaccination for health care workers. (United States)

    Mah, Catherine L


    Policy decisions about public health services differ from those for personal health services. Both require trade-offs between such policy goals as liberty, security, efficiency, and equity. In public health, however, decisions about who will approve, pay for, and deliver services are often accompanied by decisions on when and how to compel individual behaviour. Policy becomes complex because different stakeholders interpret evidence differently: stakeholders may assign different weights to policy goals and may even define the same goals differently. In the debate over mandatory annual influenza vaccination for health care workers, for example, proponents as well as opponents of mandatory vaccination may convey arguments in security terms. Those in favour of mandatory vaccination emphasize subclinical infections and duty of care (public security) while those opposed emphasize risk of adverse events (personal security). Proponents assert less worker absenteeism (efficiency) while opponents stress coercion and alternate personal infection control measures (liberty and individual rights/responsibilities). Consequently, stakeholders talk past each other. Determining the place of mandatory influenza vaccination for health care workers thus demands reconciling policy trade-offs and clarifying the underlying disputes hidden in the language of the policy debate.

  9. Factors influencing implementation of the Ministry of Health-led private medicine retailer programmes on malaria in Kenya (United States)


    Background Kenya has experienced a number of retail sector initiatives aimed at improving access to antimalarial medicines. This study explored stakeholders' perceptions of the role of private medicine retailers (PMRs), the value and feasibility of programme goals, perceived programme impact, factors influencing implementation and recommendations in three districts of Kenya. Methods This study was part of a larger evaluation of PMR programmes, including quantitative and qualitative components. The qualitative research was conducted to assess implementation processes and actors' experiences in the programmes, through focus group discussions with trained PMRs and mothers of children under five years, and in-depth interviews with programme managers, trainers and co-trainers. Results PMRs were perceived to provide rapid cheap treatment for non-serious conditions and used as a deliberate and continuously evaluated choice between different treatment sources. All stakeholders supported programme goals and most PMRs described increased customer satisfaction, more rational purchasing of medicine stock and increased medicine sales after participation. Factors undermining programme implementation included a lack of MoH resources to train and monitor large numbers of PMRs, the relative instability of outlets, medicines stocked and retail personnel, the large number of proprietary brands and financial challenges to retailers in stocking antimalarial medicines, and their customers in buying them. Unambiguous national support and a broad range of strategies are important to strengthen the feasibility of change in OTC antimalarial use. Conclusions Understanding the context and implementation processes of PMR programmes and the perspectives of key actors are critical to identifying measures to support their effective implementation. Financial barriers underlie many described challenges, with important implications for policies on subsidies in this sector. In spite of barriers to

  10. 印度私营医疗卫生服务体系的公平与效率%The Fairness and Efficiency of India's Private Medical and Health Service System

    Institute of Scientific and Technical Information of China (English)



    India's health care system is composed of public sectors and private sectors. The fairness of universal free public medical institutions attracts much worldwide attention. This paper analyzes the size of the private health sectors, the main health status in India, stressing the level of funding, service delivery, cost, and supervision and management aspects of the operation of private medical and health institutions and non-profit private medical insurance scheme, and studies the fairness and efficiency of private medical and health sectors. Furthermore, the paper draws a conclusion that the fairness and the efficiency can run parallel in this kind of the healthcare system. It provides valuable reference to China's health care system reform currently.%印度的全民免费公共医疗服务体系的公平性备受世界关注。本文分析了处于印度医疗卫生主体地位的私营医疗卫生服务体系的规模,着重从筹资水平、服务提供、费用支出以及监督管理等方面探讨了私营医疗卫生服务体系的运营和非营利私营医疗保险计划,重点研究了私营医疗卫生服务体系的公平与效率所在。旨在得出私营医疗卫生服务体系的公平与效率可以并行不悖的结论,为中国目前医疗卫生体制的改革提供有价值的借鉴。

  11. Fisiognomica emozionale. Affordances, estasi, atmosfere

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    Tonino Griffero


    Full Text Available Through an atmospherological approach, primarily inspired by the so-called Aisthetik or New Aesthetics (Gernot Böhme and the New Phenomenology (Hermann Schmitz, the paper defines the atmospheric perception as a first pathemic impression and investigates the relationship between this kind of perception and the expressive qualities of the surrounding spaces. The aim is to understand atmospheres as (amodal, transmodal, sinaesthetic affordances that permeate the lived space, namely as ‘ecological’ and affective invites or meanings which are ontologically rooted in things and quasi-things.


    Directory of Open Access Journals (Sweden)



    Full Text Available The present paper approaches the notion of public and private pension in Romania. Pension can be seen in terms of a replacement income to individuals whose age no longer affords to operate in the labour market. Pension reform in Romania has allowed besides the public pension system, called Pillar I, which is a distributive system based on solidarity between generations also a private pension system that records the contributions of participants in individual accounts, based on capitalization, investment and accumulation of these contributions.

  13. Health-Care-Seeking Patterns in the Emerging Private Sector in Burkina Faso: A Population-Based Study of Urban Adult Residents in Ouagadougou (United States)

    Beogo, Idrissa; Liu, Chieh-Yu; Chou, Yiing-Jenq; Chen, Chuan-Yu; Huang, Nicole


    Background The private medical care sector is expanding in urban cities in Sub-Saharan Africa (SSA). However, people’s health-care-seeking behaviors in this new landscape remain poorly understood; furthermore, distinguishing between public and private providers and among various types of private providers is critical in this investigation. This study assessed, by type, the healthcare providers urban residents in Burkina Faso visit, and their choice determinants. Method We conducted a population-based survey of a representative sample of 1,600 households in Ouagadougou from July to November 2011, consisting of 5,820 adults. We assessed the types of providers people typically sought for severe and non-severe conditions. We applied generalized estimating equations in this study. Results Among those surveyed, 97.7% and 53.1% indicated that they seek a formal provider for treating severe and non-severe conditions, respectively. Among the formal provider seekers, 20.5% and 17.0% chose for-profit (FP) providers for treating severe and non-severe conditions, respectively. Insurance coverage was held by 2.0% of those surveyed. Possessing insurance was the strongest predictor for seeking FP, for both severe (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.04–1.28), and non-severe conditions (OR = 1.22, 95% CI = 1.07–1.39). Other predictors included being a formal jobholder and holding a higher level education. By contrast, we observed no significant difference in predisposing, enabling, or need characteristics between not-for-profit (NFP) provider seekers and public provider seekers. Proximity was the primary reason for choosing a provider. Conclusion The results suggested that FP providers play a crucial role in the urban healthcare market in SSA. Socioeconomic status and insurance status are significant predictors of provider choice. The findings can serve as a crucial reference for policymakers in response to the emergence of FP providers in


    Directory of Open Access Journals (Sweden)

    Arun Kumar Panda


    Full Text Available Customer relationship management (CRM which has overriding significance for any business isno less significant for hospital services. Hospitals are most important elements in any health caredelivery system. A hospital plays a major role in maintaining and restoring the health of the people.Care of the sick and injured, preventive health care, health research, and training of medical andparamedical staff are general broad functions of a hospital. It involves to the outpatient and inpatienthospital services and on many occasions emergency medical services. An important resource in ahospital is a human resource. This should be particularly emphasized. This should be particularlyemphasized in the content of a hospital since relationship of medical staff plays important role intreating patients - the hospital customers. In health care, CRM practices are essentially patient -focused strategies that involve effective management of hospital interface and interaction withpatients. Effective CRM practices in a hospital may mean providing services related information toa patient very quickly. Responding to the patent appointment and an admission requests promptly,dealing with patient queries and complaints expeditiously, exercising all kinds of flexibilities inserving patients to the patients. This research paper made an attempt to analyze the factorsinfluencing the customers to select the hospital and to suggest better ways and means to retain thecustomers. For the study, the researcher has collected data from 200 respondents of 10 privatehospitals located in Greater Noida city. For this purpose stratified random sampling method was usedto select the samples. The present study highlights the extent of utilization of the hospital services bythe selected sample respondents. It also shed light on the common problems faced by therespondents. The major features of the service sectors especially on hospital performance is projectedin order to utilize the

  15. International migration of health professionals and the marketization and privatization of health education in India: from push-pull to global political economy. (United States)

    Walton-Roberts, Margaret


    Health worker migration theories have tended to focus on labour market conditions as principal push or pull factors. The role of education systems in producing internationally oriented health workers has been less explored. In place of the traditional conceptual approaches to understanding health worker, especially nurse, migration, I advocate global political economy (GPE) as a perspective that can highlight how educational investment and global migration tendencies are increasing interlinked. The Indian case illustrates the globally oriented nature of health care training, and informs a broader understanding of both the process of health worker migration, and how it reflects wider marketization tendencies evident in India's education and health systems. The Indian case also demonstrates how the global orientation of education systems in source regions is increasingly central to comprehending the place of health workers in the global and Asian rise in migration. The paper concludes that Indian corporate health care training systems are increasingly aligned with the production of professionals orientated to globally integrated health human resource labour markets, and our conceptual analysis of such processes must effectively reflect these tendencies.

  16. Strengthening referral of sick children from the private health sector and its impact on referral uptake in Uganda: a cluster randomized controlled trial protocol


    Buregyeya, Esther; Rutebemberwa, Elizeus; LaRussa, Philip; Mbonye, Anthony


    Background Uganda’s under-five mortality is high, currently estimated at 66/1000 live births. Poor referral of sick children that seek care from the private sector is one of the contributory factors. The proposed intervention aims to improve referral and uptake of referral advice for children that seek care from private facilities (registered drug shops/private clinics). Methods/Design A cluster randomized design will be applied to test the intervention in Mukono District, central Uganda. A s...

  17. Oferta pública y privada de servicios sanitarios por comunidades autónomas Public and private supply of health services by autonomous communities in Spain

    Directory of Open Access Journals (Sweden)

    Beatriz González


    Full Text Available El presente artículo resume las desigualdades territoriales en la oferta de servicios sanitarios, y discute sus implicaciones sobre las desigualdades en el acceso y la utilización. En el ámbito de la atención primaria, destacan las diferencias regionales en el proceso de implantación de la reforma y en la dotación de servicios complementarios a los tradicionales, que conviven con desigualdades territoriales significativas en la cobertura y el acceso a algunos programas asistenciales. Por su parte, la oferta de camas sigue siendo desigual entre las comunidades autónomas (CCAA, particularmente en las dotaciones geriátricas, y más aún en las psiquiátricas. Es notable la desigualdad que conlleva la oferta privada no benéfica en las distintas CCAA. Asimismo, las dotaciones de aparatos de alta tecnología médica (ATM son todavía muy desiguales entre las CCAA, particularmente las más recientes, pero se distribuyen de forma más homogénea que hace 10 años. Las desigualdades territoriales en la oferta de servicios sanitarios, aunque tangibles, son menores que las de los servicios sociosanitarios. Todavía mayor, aunque menos visible, es la desigualdad de utilización y acceso a los servicios sanitarios y sociales que el dispositivo asistencial ofertado. Además, en este ámbito la desigualdad de género se superpone a la de ámbito territorial.This chapter summarizes the main territorial inequalities in health care supply, and the related effects on access and use of health care facilities. Firstly, in the field of primary health care, the most notable inequalities refer to the process of introduction of the reform and to complementary services supply, together with the coverage of and access to some health care programs. Secondly, the distribution of hospital beds across regions is far from being uniform, specially with respect to geriatric and psychiatric beds. In addition, profit oriented private care is unequally distributed across

  18. Commercial Platforms Allow Affordable Space Research (United States)


    At an altitude of about 240 miles, its orbital path carries it over 90 percent of the Earth s population. It circles the Earth in continuous free fall; its crew of six and one Robonaut pass the days, experiencing 16 sunrises and 16 sunsets every 24 hours, in microgravity, an environment in which everything from bodily functions to the physical behavior of materials changes drastically from what is common on the ground. Outside its shielded confines, temperatures cycle from one extreme to the other, radiation is rampant, and atomic oxygen corrodes everything it touches. A unique feat of engineering, the International Space Station (ISS) also represents the most remarkable platform for scientific research ever devised. In 2005, anticipating the space station s potential for NASA and non-NASA scientists alike, the NASA Authorization Act designated the US segment of the ISS as a national laboratory, instructing the Agency to "increase the utilization of the ISS by other Federal entities and the private sector." With the ISS set to maintain operations through at least 2020, the station offers an unprecedented long-term access to space conditions, enabling research not previously possible. "There will be new drug discoveries, new pharmaceuticals, a better understanding of how we affect the planet and how we can maintain it," says Marybeth Edeen, the ISS National Laboratory manager, based at Johnson Space Center. The ISS, she says, represents a major example of the government s role in making such advancements possible. "The government is key in that researchers cannot afford to build the kind of infrastructure that the government can provide. But we then have to make that infrastructure available at a reasonable cost." Enter Jeff Manber, who saw in the ISS National Lab an extraordinary opportunity to advance science, education, and business in ways never before seen.

  19. Access to paediatric essential medicines: a survey of prices, availability, affordability and price components in Shaanxi Province, China.

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    Xiao Wang

    Full Text Available OBJECTIVE: To evaluate the prices and availability of paediatric essential medicines in Shaanxi Province, China. METHODS: Price and availability data for 28 paediatric essential medicines were collected from 60 public hospitals and 60 retail pharmacies in six areas of Shaanxi Province using a standardised methodology developed by the World Health Organization and Health Action International, during November to December 2012. Affordability was measured as the number of days' wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions. Data on medicine price components were collected from hospitals, wholesalers and distributors to obtain price mark-ups. FINDINGS: The mean availabilities of originator brands (OBs and lowest-priced generics (LPGs were 10.8% and 27.3% in the public hospitals and 11.9% and 20.6% in the private pharmacies. The public procurement and retail prices were 2.25 and 2.59 times the international reference prices (IRPs for three OBs, and 0.52 and 0.93 times for 20 LPGs. In the private sector, the final prices for OBs and LPGs were 3.89 and 1.25 times their IRPs. The final price in the private sector was 2.7% lower than in the public sector for OBs, and 14.1% higher for LPGs. Generally, standard treatments cost less than 1 day's wages in both sectors. Distribution mark-ups applied to brand salbutamol in Xi'an was 65.5%, and up to 185.3% for generic. Cumulative mark-ups for LPGs in Ankang were also high, from 33% to 50%. The manufacturer's selling price is the largest contributor to the final price in both areas. CONCLUSIONS: The government should approve a list of national paediatric essential medicines. The availability, price and affordability of these should be improved in both public hospitals and private pharmacies to enable children to obtain effective treatment. Measures should be taken to improve the efficiency of the centralised medicine purchasing system.

  20. Practicing physiotherapy in Danish private practice: an ethical perspective

    DEFF Research Database (Denmark)

    Præstegaard, Jeanette; Gard, Gunvor; Glasdam, Stinne


    Despite an increasingly growth of professional guidelines, textbooks and research about ethics in Health care, awareness about ethics in Danish physiotherapy private practice seen vague. This article explores how physiotherapists in Danish private practice, from an ethical perspective, perceive...

  1. The Affordable Care Act's plan for consumer assistance with insurance moves states forward but remains a work in progress. (United States)

    Grob, Rachel; Schlesinger, Mark; Davis, Sarah; Cohen, Deborah; Lapps, Joshua


    The Affordable Care Act provides support for state-run consumer assistance programs to help privately insured consumers who experience problems with their coverage. Its provisions signify the first national commitment to such assistance and to using cases aggregated by these state programs to inform policy. We interviewed state-level administrators and analyzed program documents to assess whether federal support for state-run consumer assistance programs achieved certain goals. We found that some federally supported programs made substantial progress in supporting and empowering patients by reorienting state agencies to become active advocates for their citizens. Yet progress across the country was inconsistent, and there was little evidence that programs addressed systemic problems experienced by consumers. On balance, the consumer assistance provisions of health care reform do not yet ensure protection for all privately insured Americans because of uneven implementation-a problem likely to be of further concern as coverage is expanded and health insurance exchanges come on line in 2014. At the same time, the demonstrated impact of consumer assistance programs in the most innovative states is arguably a useful "proof of concept" for this young federal program.

  2. Children, Families, and Disparities: Pediatric Provisions in the Affordable Care Act. (United States)

    Grace, Aimee M; Horn, Ivor; Hall, Robert; Cheng, Tina L


    The Affordable Care Act has caused and continues to cause sweeping changes throughout the health system in the United States. Poorly explained, complex, controversial, confusing, and subject to continuous legal and regulatory definition, the law stands as a hallmark piece of legislation that will change the health sector in America forever. This article summarizes the Affordable Care Act with a focus on children, families, and disparities. Also provided is the context of the current system of health care coverage in the United States.

  3. 78 FR 20581 - Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non... (United States)


    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Part 155 RIN 0938-AR75 Patient Protection and Affordable Care Act; Exchange.... Introduction The Patient Protection and Affordable Care Act (Pub. L. 111-148) was enacted on March 23,...

  4. 78 FR 13575 - Coverage of Certain Preventive Services Under the Affordable Care Act; Correction (United States)


    ... Affordable Care Act; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Correction to... Health Service Act, as added by the Patient Protection and Affordable Care Act, as amended, and incorporated into the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code....

  5. 29 CFR 1977.12 - Exercise of any right afforded by the Act. (United States)


    ... 29 Labor 9 2010-07-01 2010-07-01 false Exercise of any right afforded by the Act. 1977.12 Section..., DEPARTMENT OF LABOR (CONTINUED) DISCRIMINATION AGAINST EMPLOYEES EXERCISING RIGHTS UNDER THE WILLIAMS-STEIGER OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Specific Protections § 1977.12 Exercise of any right afforded by...

  6. Grau de cobertura dos planos de saúde e distribuição regional do gasto público em saúde Level of private health insurance coverage and regional distribution of public health expenditure

    Directory of Open Access Journals (Sweden)

    Samuel Kilsztajn


    Full Text Available O artigo analisa o grau de cobertura dos planos de saúde segundo as classes de rendimento mensal familiar e por unidade da federação e a distribuição dos recursos da Rede-SUS e do gasto público total em saúde por usuário dos serviços públicos de saúde nas regiões Norte-Nordeste e Centro-Sul do país. São apresentados e discutidos também os indicadores do gasto público total em saúde como percentual do PIB gerado nas regiões.This paper analyses the level of private health insurance coverage by classes of income and by states in Brazil and the distribution of the total public health expenditure by public health users in the North-Northeast and Central-South regions of the country. The paper also presents and discusses the total public health expenditure as a percentage of regional GDP.

  7. Can consumers make affordable care affordable? The value of choice architecture.

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    Eric J Johnson

    Full Text Available Tens of millions of people are currently choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly. However, performance can be improved quite markedly by providing calculation aids, and by choosing a "smart" default. Implementing these psychologically based principles could save purchasers of policies and taxpayers approximately 10 billion dollars every year.

  8. Estudo dos modelos assistenciais praticados por operadoras de planos privados de saúde Study of care models practiced by private operators of health plans

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    Rosiene Maria de Freitas


    Full Text Available Este estudo objetivou identificar a adoção, pelas operadoras, de modelos assistenciais que busquem a integralidade do cuidado, a partir da indução pela Agência Nacional de Saúde Suplementar (ANS. O universo foi composto por operadoras de planos de saúde atuantes no estado de Minas Gerais, nas modalidades autogestão, filantropia, medicina de grupo e cooperativa médica. As empresas foram descritas a partir dos cadastros da ANS. Foi realizada entrevista telefônica assistida por computador - ETAC - para obtenção de dados sobre o acesso dos beneficiários aos serviços, estruturação da rede e implantação de modelos segundo linhas materno-infantil, adulto/idoso, cardiovascular e neoplasias. Foram constatadas 182 empresas em atividade no estado; 108 foram elegíveis para o estudo; 27,1% das operadoras informaram ter implantado programas de cuidado na linha materno-infantil; 22,2%, na linha de cuidado ao adulto/idoso e 9,2% em neoplasias. Inadequadas estruturas internas e o pequeno porte da maioria das operadoras podem explicar, em parte, a dificuldade de implantação e modelos de atenção mais cuidadores. Ressalta-se a ampla margem de inovações ainda existente para a introdução dessas práticas por parte das operadoras.This study aimed to identify the adoption by private health insurance companies, from the induction by the Agência Nacional de Saúde Suplementar (ANS of models that foments integrality. The universe were companies in Minas Gerais, in the modalities self-management, philanthropy, group medicine and medical cooperative. The companies were described from ANS official registers. Also, was made a computer-assisted telephone interview - ETAC- which approached: the beneficiaries' access to services, the structuring of the network, and the introducion of care models on maternal and child health, adult/elderly, cardiovascular and cancer. There were found 182 companies in Minas Gerais; 108 were elegible; 27,1% reported the

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

    Directory of Open Access Journals (Sweden)

    Exley Catherine


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

  10. The share of people with high medical costs increased prior to implementation of the Affordable Care Act. (United States)

    Cunningham, Peter J


    The percentage of Americans with high medical cost burdens--those who spend more than 10 percent of their family income on out-of-pocket expenses for health care--increased to 19.2 percent in 2011, after having stabilized at 18.2 percent during the Great Recession of 2007-09. The increase was driven primarily by growth in premium expenses in 2009-11 for people with employer-sponsored coverage. Out-of-pocket spending on health services, especially for prescription drugs, continued to decrease between 2007-09 and 2011. Medical cost burdens were highest for income groups most likely to benefit from the Affordable Care Act's coverage expansions, including people with private insurance coverage. Those who purchased nongroup coverage before the implementation of the health insurance Marketplaces in 2014 spent an especially high proportion of their income on health care, and over half of these people will qualify for premium subsidies in the Marketplaces. Federal subsidies will substantially reduce medical cost burdens for many people who do not obtain health insurance through their employers.

  11. Dopamine, affordance and active inference.

    Directory of Open Access Journals (Sweden)

    Karl J Friston


    Full Text Available The role of dopamine in behaviour and decision-making is often cast in terms of reinforcement learning and optimal decision theory. Here, we present an alternative view that frames the physiology of dopamine in terms of Bayes-optimal behaviour. In this account, dopamine controls the precision or salience of (external or internal cues that engender action. In other words, dopamine balances bottom-up sensory information and top-down prior beliefs when making hierarchical inferences (predictions about cues that have affordance. In this paper, we focus on the consequences of changing tonic levels of dopamine firing using simulations of cued sequential movements. Crucially, the predictions driving movements are based upon a hierarchical generative model that infers the context in which movements are made. This means that we can confuse agents by changing the context (order in which cues are presented. These simulations provide a (Bayes-optimal model of contextual uncertainty and set switching that can be quantified in terms of behavioural and electrophysiological responses. Furthermore, one can simulate dopaminergic lesions (by changing the precision of prediction errors to produce pathological behaviours that are reminiscent of those seen in neurological disorders such as Parkinson's disease. We use these simulations to demonstrate how a single functional role for dopamine at the synaptic level can manifest in different ways at the behavioural level.

  12. The Role of Private Sector in Meeting Health Care Demand(PartⅠ)%私人部门在满足医疗需求方面的作用(上)

    Institute of Scientific and Technical Information of China (English)

    郑宗美; 莱因哈特; 王宇


    本文就私人部门在满足医疗需求方面的作用进行分析,认为如果私人部门能够得到有效监管,并按照社会道德认同的方式进行运转,一国医疗体系就能够受益于私人部门。本部分探讨了医疗体系的基本功能及其目标,介绍了绝对平均主义、两阶层医疗体系和多阶层医疗体系三种分配医疗服务的观点,指出当前用货币价值衡量医疗产出价值是次优选择;而衡量医疗服务分配效率也存在争议。%This paper analyzes the role of private sector in meeting health care demand and believes that national health care system will be able to benefit from the private sector if the private sector can be effectively regulated and op-erates according to the social moral. In this part,the basic function and target of health care system are discussed,the views of three kinds of health care allocation (the absolute equalitarianism, two-class health care system and multi-class health care system) are introduced and it is suboptimal choice to value health care output by currency is pointed;What’s more,controversies are still existing in how to value the health care allocation efficiency.

  13. The quality of private and public primary health care management of children with diarrhoea and acute respiratory infections in Tlaxcala, Mexico. (United States)

    Bojalil, R; Guiscafré, H; Espinosa, P; Martínez, H; Palafox, M; Romero, G; Gutiérrez, G


    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 correct 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.

  14. 78 FR 8456 - Coverage of Certain Preventive Services Under the Affordable Care Act (United States)


    ...; states; secular organizations; private citizens; and women's rights and reproductive health advocacy..., 2011, HRSA adopted and released guidelines for women's preventive services based on ] recommendations... evidence on women's preventive services (Women's Preventive Services: Required Health Plan...

  15. Refining Grasp Affordance Models by Experience

    DEFF Research Database (Denmark)

    Detry, Renaud; Kraft, Dirk; Buch, Anders Glent;


    We present a method for learning object grasp affordance models in 3D from experience, and demonstrate its applicability through extensive testing and evaluation on a realistic and largely autonomous platform. Grasp affordance refers here to relative object-gripper configurations that yield stabl...

  16. Section 8: Affordable Housing for Exceptional Families (United States)

    Wright, Wesley E.


    Shelter is a basic human need. Unfortunately, affordable housing is a need that low income families who are caring for children and adults with disabilities can rarely afford without assistance. Because participating families generally pay rent of no more than 30 percent of their adjusted monthly income, the Section 8 program can provide…

  17. Small private irrigation: Enhancing benefits and managing trade-offs

    NARCIS (Netherlands)

    Giordano, M.; Fraiture, de C.M.S.


    Millions of smallholder farmers in sub-Saharan Africa and South Asia benefit from readily available and affordable irrigation technologies. The rapid uptake of small private irrigation in South Asia had a proven positive effect on poverty alleviation. In sub-Saharan Africa similar trends are emergin

  18. Public-Private Partnership and Indian Higher Education (United States)

    Shiji, O.


    Today the requirements in higher education are vast and majority of the population in the country cannot afford higher education as their per capita income is very low. Neither the government nor the private sector alone can cater to the requirements of higher education. It is in this context, one should look at the scope, feasibility,…

  19. 7 CFR 1.12 - Handling information from a private business. (United States)


    ... is not exempt by law from disclosure). Afford business information submitter reasonable time in which... 7 Agriculture 1 2010-01-01 2010-01-01 false Handling information from a private business. 1.12... Records § 1.12 Handling information from a private business. Each USDA agency is responsible for...

  20. 42 CFR 434.12 - Contracts with private nonmedical institutions. (United States)


    ... 42 Public Health 4 2010-10-01 2010-10-01 false Contracts with private nonmedical institutions. 434... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS CONTRACTS Contracts with Fiscal Agents and Private Nonmedical Institutions § 434.12 Contracts with private nonmedical institutions. Contracts...

  1. Quantitative analysis of privatization

    CERN Document Server

    Vahabi, M


    In recent years, the economic policy of privatization, which is defined as the transfer of property or responsibility from public sector to private sector, is one of the global phenomenon that increases use of markets to allocate resources. One important motivation for privatization is to help develop factor and product markets, as well as security markets. Progress in privatization is correlated with improvements in perceived political and investment risk. Many emerging countries have gradually reduced their political risks during the course of sustained privatization. In fact, most risk resolution seems to take place as privatization proceeds to its later stage. Alternative benefits of privatization are improved risk sharing and increased liquidity and activity of the market. One of the main methods to develop privatization is entering a new stock to the markets for arising competition. However, attention to the capability of the markets to accept a new stock is substantial. Without considering the above st...

  2. Private Water Districts (United States)

    California Department of Resources — Private Water District boundaries are areas where private contracts provide water to the district in California. This database is designed as a regions polygon...

  3. Private opportunity, public benefit?


    John Hall


    The newly elected Labour government has pledged to ‘reinvigorate the Private Finance Initiative’, as part of the new emphasis on ‘public/private partnerships’ in the delivery of core public services. This article assesses the merits of using private finance to deliver public services against three criteria: whether it will lead to additional investment in social infrastructure, whether it represents good value for the taxpayer’s money and whether the use of private finance will reduce the pub...

  4. Medicaid 'welcome-mat' effect of Affordable Care Act implementation could be substantial. (United States)

    Sonier, Julie; Boudreaux, Michel H; Blewett, Lynn A


    The Affordable Care Act will have important impacts on state Medicaid programs, likely increasing participation among populations that are currently eligible but not enrolled. The size of this "welcome-mat" effect is of concern for two reasons. First, the eligible but uninsured constitute a substantial share of the uninsured population in some states. Second, the newly eligible population will affect states' Medicaid caseloads and budgets. Using the Massachusetts 2006 health reforms as a case study and controlling for other factors, we found that among low-income parents who were previously eligible for Medicaid in Massachusetts, Medicaid enrollment increased by 16.3 percentage points, and Medicaid participation by those without private coverage increased by 19.4 percentage points, in comparison to a group of control states. In many states the potential size of the welcome-mat effect could be even larger than what we observed in Massachusetts. Our analysis has potentially important implications for other states attempting to predict the impact of this effect on their budgets.

  5. Conundrums in merging public policy into private dentistry: experiences from Australia's recent past. (United States)

    Lam, Raymond; Kruger, Estie; Tennant, Marc


    Oral disease continues to be a major problem in Australia impacting quality of life, the economy and broader health system. Although the understanding of caries and periodontal disease has improved along with increased government support, oral diseases continue to be the most prevalent among all health conditions. This is despite unprecedented levels of funding in the Chronic Disease Dental Scheme and the Teen Dental Plan. Access to primary care dentistry in the private sector, where the majority of dental services are provided, remains a critical issue. Under the current system of dentistry, it cannot be assumed that the practice of dentistry represents a prioritised approach to combat disease patterns based on scientific evidence in primary health and prevention. Drawing on data in relation to these two programs, the present study highlights issues impacting dental service provision. This includes issues such as access and affordability to dental care, sustainability of policy and its unintended consequences, private practice pressures and the impact of remuneration on treatment. This paper argues that without structural reform there will continue to be barriers in implementing policies capable of improving oral health.

  6. 私人部门在满足医疗需求方面的作用(下)%The Role of Private Sector in Meeting Health Care Demand(PartⅡ)

    Institute of Scientific and Technical Information of China (English)

    郑宗美; 莱因哈特; 王宇(译)


    本文就私人部门在满足医疗需求方面的作用进行分析,认为如果私人部门能够得到有效监管,并按照社会道德认同的方式进行运转,一国医疗体系就能够受益于私人部门。本部分探讨了私人部门的效率及私人医疗市场的作用。尽管私人部门效率普遍被认为高于公共部门,但私人企业追求低成本、高价格,而且有可能要求患者接受过度医疗。医疗服务并不满足市场运行的基本条件;如果社会成员之间的医疗服务分配由市场主导,分配结果可能与社会期望实现的目标不一致。建立社会医保体系是一种行之有效的医疗服务再分配方法。%This paper analyzes the role of private sector in meeting health care demand and believes that national health care system will be able to benefit from the private sector if the private sector can be effectively regulated and op-erates according to the social moral. This part discusses the efficiency of private sector and the role of private medical market. Although the efficiency of private sector is generally considered to be higher than the public sector,the pursuit of low cost and high prices may cover overtreatment. Medical service does not meet the basic condition of market opera-tion;if the distribution of medical services among social members is dominated by the market, the results may not be consistent with the goal of social expectations. The establishment of social health insurance system is a kind of effective method for medical service redistribution.

  7. Private Money's New Frontier

    Institute of Scientific and Technical Information of China (English)



    @@ Nuclear power,oil exploration and exploitation,railways,telecommunications and other sectors that used to be monopolized by state-owned capital may be new arenas for private capital.Opinions on Encouraging and Guiding Sound Development of Private Investment,issued by the State Council on May 13,opened a new range of government-run industries to the private sector.

  8. Bringing up Private Investment

    Institute of Scientific and Technical Information of China (English)


    The Chinese Government promises private investors a bigger role in the country’s booming industry sector Encouraging and guiding healthy development of private investment was at the forefront of the State Council’s latest measures to invigorate the private sector.

  9. Economic Public Private Partnerships for Development (United States)

    Taylor, Thomas C.; Kistler, Walter P.; Citron, Bob


    Space transportation has evolved to entrepreneurs offering affordable transportation services to LEO. Society expects space tourism to produce low costs quickly, but entrepreneurs need the larger commercial transportation markets to raise the private money to build the orbital vehicles. Early heavy cargo is the logistics model of remote bases on Earth and is likely to be similar for off planet remote bases. Public Private Partnerships (PPP), (Norment, 2006) and other alliances with governments offer new transportation markets and combines private funding with government markets to accelerate the movement of mankind into space, (Kistler, 2004a). Entrepreneurs bring change like a multitude of innovation, changes to the traditional aerospace industry status quo, commercial market forces and the lowering of the cost of transportation to orbit. Within PPPs, government stretches space budgets, increases vehicle innovation without cost and gains cost advantages of larger markets. Examples of PPPs show some opportunity for change in space commerce is possible, (Stainback, 2000 and Spekman, 2000). Some of the items entrepreneurs bring include innovation in hardware, a maturing of the normal market forces such as the pressures from buyers and sellers rather than those from government planners or from regulation. Launch costs are high, society wants orbital hotels and current/future markets are not emerging because of high transportation costs. The paper proposes a new approach with examples, because mankind has taken a long time to transition from expendable launch vehicles to newer more affordable launch innovation and may require the introduction of new innovative approaches.

  10. Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act (United States)


    Office (GAO) study of the costs and processes of ACA implementation, and a Medicare actuarial analysis of the impact of the ACA’s private insurance...86, available at 3 P.L. 113-46, 127 Stat. 558. For more analysis of the various legal and procedural considerations arising is updated periodically to reflect legislative and other developments . Background on the Affordable Care Act4 Among its many provisions, the ACA

  11. Contracepção hormonal: uma comparação entre pacientes das redes pública e privada de saúde Hormonal contraception: a comparison between patients of the private and public health network

    Directory of Open Access Journals (Sweden)

    Patrícia Delage Gomes


    Full Text Available O objetivo deste artigo é avaliar o perfil de pacientes usuárias de contraceptivos hormonais no setor público e fazer a comparação com o serviço privado de saúde, bem como verificar a frequência de efeitos colaterais e a aderência ao tratamento. Realizou-se um estudo de corte transversal com 240 pacientes, sendo 120 da rede privada e 120 da rede pública de saúde. No grupo privado, a dosagem hormonal mais frequentemente prescrita foi a de 15 ou 20 microgramas de etinil-estradiol (EE, associados a gestodeno, desogestrel ou levonogestrel (36,7%. No grupo público, a combinação de 30 microgramas de EE associados a gestodeno, levonogestrel ou desogestrel (48,3% foi a principal medicação contraceptiva prescrita. Não houve diferença entre a frequência dos efeitos colaterais nos dois grupos pesquisados (p>0,05. A aderência ao tratamento foi maior nas pacientes do grupo privado (pThe aim of this paper is to assess the profile of patients using hormonal contraceptives in the public health network and a comparison with the private health service, as well as the frequency of side effects and adherence to treatment. A cross-sectional study was conducted with 240 patients, namely 120 patients from the private health service and 120 patients from the public health network. The most commonly prescribed hormonal dosage on the private group (36.7% was 15 or 20 micrograms of ethinyl estradiol (EE, associated with gestodene, desogestrel or levonorgestrel. On the other hand, the prescribed hormonal dosage in the public group was a combination of 30 micrograms of EE associated with gestodene, levonorgestrel or desogestrel (48.3%. There was no difference between the frequency of side effects in both groups surveyed (p>0.05. Meanwhile, adherence to treatment was higher in patients of the private group. The authors concluded that the most widely used contraceptive method was a low oral dose of ethinyl estradiol and there is no difference between the

  12. Mechanism Research on Standardized Development of Rural Private Finance

    Institute of Scientific and Technical Information of China (English)


    In generalizing the researching conditions of researchers on private finance,the paper introduces the connoted meaning of rural private finance broadly and narrowly.The paper states the forms of rural private finance(including private loaning,private bank,rural private collecting,financing organizations,cooperatives,NGO,small loaning organizations and so on),the relations between rural private finance and rural economic relations,pointing out that it is the combination of the strong and the weak,which may generate benefits with the operation of marketing mechanisms.The paper analyzes the historical causes,supervision causes and cultural causes of rural private finance,discussing mechanisms of standardized development of rural private finance:firstly,standardize the organization management mechanisms,including scaled controlling mechanisms and bank management mechanisms;secondly,complete finance supervision mechanisms;thirdly,moderate government intervention,including affording liberal policy environment and reducing the improper intervention;fourthly,upgrading qualities mechanisms,including cultivating the rural credit culture and improving the quality of regulatory personnel.

  13. The impact of a sleep hygiene intervention on residents of a private residential facility for individuals with co-occurring mental health and substance use disorders: results of a pilot study. (United States)

    Morse, Siobhan A; MacMaster, Samuel A; Kodad, Vicki; Robledo, Kathy


    An increasing number of Americans are experiencing sleep problems. There is evidence of a complex, bidirectional relationship between sleep disorders, substance abuse, and mental health symptoms. Institutional settings have been shown to elicit sleep problems as well. This pilot study was conducted with 28 patients in private, residential, dual-diagnosis treatment for addiction and mental health disorders. Upon admission, consenting patients were administered the Addiction Severity Index to assess pretreatment substance use and mental health symptoms. Patients followed a normal course of treatment as well as participated in a nightly sleep hygiene group that included relaxation suggestions. Evaluations with the Addiction Severity Index were completed again 30 days after discharge from treatment. Significant improvements in some substance use patterns as well as mental health symptoms were noted. Although results cannot be directly attributed to the use of a sleep hygiene group, this pilot study lays the foundation for future investigations of interventions supporting sleep in the dual-diagnosis population.

  14. [Private enterprise and family planning]. (United States)


    In the city of Tebicuary, Paraguay, the main local private industry, a sugar refinery, has organized for its workers and their families a consultory for family planning and for materno-infant services. The consultory not only offers advice and services on prenatal diagnosis, medical assistance to infants and children and maternal health, but it sponsors lectures and distributes literature related to family planning problems.

  15. Smoking Bans in Affordable Housing Benefit All (United States)

    ... page: Smoking Bans in Affordable Housing Benefit All: Study Secondhand ... housing properties in Minnesota. All the properties prohibited smoking indoors and three also banned smoking on the ...

  16. Collaborative Affordances of Hybrid Patient Record Technologies in Medical Work

    DEFF Research Database (Denmark)

    Houben, Steven; Frost, Mads; Bardram, Jakob E


    The medical record is a central artifact used to organize, communicate and coordinate information related to patient care. Despite recent deployments of electronic health records (EHR), paper medical records are still widely used because of the affordances of paper. Although a number of approache......PR in a medical simulation. Based on these empirical studies, this paper introduces and discusses the concept of collaborative affordances, which describes a set of properties of the medical record that foster collaborative collocated work.......The medical record is a central artifact used to organize, communicate and coordinate information related to patient care. Despite recent deployments of electronic health records (EHR), paper medical records are still widely used because of the affordances of paper. Although a number of approaches...... explored the integration of paper and digital technology, there are still a wide range of open issues in the design of technologies that integrate digital and paper-based medical records. This paper studies the use of one such novel technology, called the Hybrid Patient Record (HyPR), that is designed...


    Directory of Open Access Journals (Sweden)

    Leigh Argentieri Coogan


    Full Text Available Normal 0 false false false EN-US JA X-NONE Under the Patient Protection and Affordable Care Act (ACA, employers are required to provide employees with health plans, which must include FDA, approved contraceptives with no cost sharing. While Health and Humans Services (HHS revised the regulation to allow for a compromise among religious organizations and non-profits run by religious organizations, private for profit businesses must comply with the ACA even if the business asserts to be founded on religious principles. Several for profit business have sued in district court for an injunction against the requirements. However, a circuit split exists among courts granting preliminary injunctions against the ACA pending a granting of appeal. This note will focus on whether the federal government can compel secular, for profit organizations to provide employee health plans that include contraceptives, the morning after pill and sterilization under the Religious Freedom Restoration Act. Unless the statute or regulation changes, the Supreme Court will likely need to grant certiorari to resolve the issue.

  18. Rethinking Affordable Housing Delivery: An Analytical Insight



    Malaysia currently has a housing shortage of 12 million units. Towards the year 2020, this would require an annual supply of a minimum of 2 million homes. With the current production rate, the deficits will remain over the next 100 years. The crisis will lead to poor standards of living, un-affordable rental price, high mortgage payment, abandonment, and dilapidation of the existing housing stock. Lack of affordable housing is already a source of concern among many Malaysians. The middle and ...

  19. The political economy of healthcare reform in China: negotiating public and private. (United States)

    Daemmrich, Arthur


    China's healthcare system is experiencing significant growth from expanded government-backed insurance, greater public-sector spending on hospitals, and the introduction of private insurance and for-profit clinics. An incremental reform process has sought to develop market incentives for medical innovation and liberalize physician compensation and hospital finance while continuing to keep basic care affordable to a large population that pays for many components of care out-of-pocket. Additional changes presently under consideration by policymakers are likely to further restructure insurance and the delivery of care and will alter competitive dynamics in major healthcare industries, notably pharmaceuticals, medical devices, and diagnostic testing. This article describes the institutional history of China's healthcare system and identifies dilemmas emerging as the country negotiates divisions between public and private in healthcare. Building on this analysis, the article considers opportunities for public-private partnerships and greater systems integration to reconcile otherwise incommensurable approaches to rewarding innovation and improving access. The article concludes with observations on the public function of health insurance and its significance to further development of China's healthcare system.

  20. Affordance Learning Based on Subtask's Optimal Strategy

    Directory of Open Access Journals (Sweden)

    Huaqing Min


    Full Text Available Affordances define the relationships between the robot and environment, in terms of actions that the robot is able to perform. Prior work is mainly about predicting the possibility of a reactive action, and the object's affordance is invariable. However, in the domain of dynamic programming, a robot’s task could often be decomposed into several subtasks, and each subtask could limit the search space. As a result, the robot only needs to replan its sub strategy when an unexpected situation happens, and an object’s affordance might change over time depending on the robot’s state and current subtask. In this paper, we propose a novel affordance model linking the subtask, object, robot state and optimal action. An affordance represents the first action of the optimal strategy under the current subtask when detecting an object, and its influence is promoted from a primitive action to the subtask strategy. Furthermore, hierarchical reinforcement learning and state abstraction mechanism are introduced to learn the task graph and reduce state space. In the navigation experiment, the robot equipped with a camera could learn the objects’ crucial characteristics, and gain their affordances in different subtasks.

  1. Privatization and emergency medical services. (United States)

    Reissman, S G


    Osborne and Gaebler's Reinventing Government has sparked discussion amongst elected officials, civil servants, the media, and the general public regarding advantages of privatizing government services. Its support stems from an effort to provide services to municipalities while reducing taxpayer expenditure. Many echo the sentiment of former New York Governor Mario Cuomo, who said, "It is not government's obligation to provide services, but to see that they're provided." Even in the area of public safety, privatization has found a "market." In many localities, privatizing Emergency Medical Services (EMS) is a popular and successful method for providing ambulance services. Privately owned ambulance services staff and respond to medical emergencies in a given community as part of the 9-1-1 emergency response system. Regulations for acceptable response times, equipment, and other essential components of EMS systems are specified by contract. This allows the municipality oversight of the service provided, but it does not provide the service directly. As will be discussed, this "contracting-out" model has many benefits. Privatizing EMS services is a decision based not only on cost-savings, but on accountability. A thorough evaluation must be utilized in the selection process. Issues of efficiency, effectiveness, quality, customer service, responsiveness, and equity must be considered by the government, in addition to cost of service. The uncertain future of health care in the United States has led those in EMS to look beyond the field's internal market to explore additional opportunities for expanding and redefining its roles beyond emergency care. It is important, however, to consider how emergency medical care, the original role of EMS, can be best delivered. Responding to emergencies is not just one of the functions involved in this field, it is the principal function from which public perception of EMS is formed, and from which support for entering other markets can

  2. Understanding the adoption dynamics of medical innovations: affordances of the da Vinci robot in the Netherlands. (United States)

    Abrishami, Payam; Boer, Albert; Horstman, Klasien


    This study explored the rather rapid adoption of a new surgical device - the da Vinci robot - in the Netherlands despite the high costs and its controversial clinical benefits. We used the concept 'affordances' as a conceptual-analytic tool to refer to the perceived promises, symbolic meanings, and utility values of an innovation constructed in the wider social context of use. This concept helps us empirically understand robot adoption. Data from 28 in-depth interviews with diverse purposively-sampled stakeholders, and from medical literature, policy documents, Health Technology Assessment reports, congress websites and patients' weblogs/forums between April 2009 and February 2014 were systematically analysed from the perspective of affordances. We distinguished five interrelated affordances of the robot that accounted for shaping and fulfilling its rapid adoption: 'characteristics-related' affordances such as smart nomenclature and novelty, symbolising high-tech clinical excellence; 'research-related' affordances offering medical-technical scientific excellence; 'entrepreneurship-related' affordances for performing better-than-the-competition; 'policy-related' affordances indicating the robot's liberalised provision and its reduced financial risks; and 'communication-related' affordances of the robot in shaping patients' choices and the public's expectations by resonating promising discourses while pushing uncertainties into the background. These affordances make the take-up and use of the da Vinci robot sound perfectly rational and inevitable. This Dutch case study demonstrates the fruitfulness of the affordances approach to empirically capturing the contextual dynamics of technology adoption in health care: exploring in-depth actors' interaction with the technology while considering the interpretative spaces created in situations of use. This approach can best elicit real-life value of innovations, values as defined through the eyes of (potential) users.

  3. Motivational Affordance and Risk-Taking Across Decision Domains. (United States)

    Zou, Xi; Scholer, Abigail A


    We propose a motivational affordance account to explain both stability and variability in risk-taking propensity in major decision domains. We draw on regulatory focus theory to differentiate two types of motivation (prevention, promotion) that play a key role in predicting risk-taking. Study 1 demonstrated that prevention motivation is negatively associated with risk-taking across six key decision domains, including health/safety, ethics, recreation, gambling, investment, and social. In contrast, promotion motivation is positively associated with risk-taking in the social and investment domains. Study 2 replicated the same pattern and provided direct evidence that promotion motivation is a strong predictor of risk-taking only in domains where there is true potential for gains. Study 3 manipulated promotion (vs. prevention) motivation experimentally to demonstrate that motivational affordance is a critical mechanism for understanding risk-taking behaviors.

  4. O mix público-privado no Sistema de Saúde Brasileiro: financiamento, oferta e utilização de serviços de saúde The public-private mix in the Brazilian Health System: financing, delivery and utilization of health services

    Directory of Open Access Journals (Sweden)

    Isabela Soares Santos


    Full Text Available O artigo analisa o mix público-privado do sistema de saúde brasileiro a partir da oferta, utilização e financiamento dos serviços de saúde. Contempla os subsídios públicos para o setor privado. Trata-se de um estudo quantitativo, baseado em dados secundários provenientes de bases de dados oficiais. Mostra que existem desigualdades na oferta e na utilização de serviços em prol da população com plano de saúde, em decorrência da peculiar inserção do setor suplementar, que oferece cobertura suplementar e duplicada ao sistema público (SUS, sem desconsiderar que outros fatores podem determinar o uso de serviços de saúde e aumentar as desigualdades. A análise é feita com base na tipologia de mix público-privado desenvolvida pela OECD em 2004, que auxilia a compreensão das desigualdades que ocorrem em cada tipo de mix, e mostra que as que ocorrem no sistema de saúde brasileiro se dão pelo fato de a cobertura de serviços ofertados pelo segmento de seguro privado ser duplicada à cobertura de serviços do SUS. Ainda, as desigualdades verificadas no sistema de saúde brasileiro ocorrem num sistema de saúde em que o financiamento público ao SUS é minoritário e existem grandes subsídios públicos para o setor privado.This paper analyzes the public-private mix in the Brazilian Health System from the perspective of health care delivery, utilization and financing. Moreover, this quantitative study based on secondary data from official databases contemplates the subsidies granted by the government to the private sector. It shows the existence of some inequalities favoring the population having private health plans, a result of the peculiar participation of the private sector in the Brazilian Health System not only offering supplementary care but duplicating the coverage offered by the public system (called SUS. The analysis is made on the basis of the classification of public-private mix in Health Systems developed by the OECD in

  5. Privatization in economic theory

    Directory of Open Access Journals (Sweden)

    Drakić Maja


    Full Text Available In reality privatization has never occurred according to the handbook rules of ordinary market transactions. Not even in advanced market economies can privatization transactions be described by the Walrasian or Arrowian, or Leontiefian equilibrium models, or by the equilibrium models of the game theory. In these economies transactions of privatization take place in a fairly organic way – which means that those are driven by the dominance of private property rights and in a market economy. But despite this fact Western privatization also some peculiar features as compared to ordinary company takeovers, since the state as the seller may pursue non – economic goals. Changes in the dominant form of property change positions and status of many individuals and groups in the society. That’s why privatization can even less be explained by ordinary market mechanisms in transition countries where privatizing state-owned property have happened in a mass scale and where markets and private property rights weren't established at the time process of privatization began. In this paper I’ll discuss and analyze the phenomenon of privatization in context of different economic theories arguing that empirical results go in favor of the public choice theory (Buchanan, 1978, theory of "economic constitution" (Brennan and Buchanan 1985, (Buchanan and Tullock, 1989, and theory of "collective action" (Olson, 1982. These theories argues that transition from one economic system into another, for example transition from collectivistic, socialistic system into capitalism and free market economy with dominant private property, will not happen through isolated changes of only few economic institutions, no matter how deep that changes would be. In other words privatization can not give results if it's not followed by comprehensive change of economic system because privatized companied wouldn't be able to operate in old environment.

  6. Public and private sector interactions: an economic perspective. (United States)

    Maynard, A


    The debate about the public-private mix for health care has been dominated by rhetoric and the failure to evaluate the characteristics of the outcomes of public and private health care systems and to relate these to policy targets. After a brief analysis of the competing, liberal (conservative) and collectivist (socialist), objectives, the nature of the private health care sector in Britain is described and it is shown that growth has faltered due to cost containment problems. This outcome is the product of characteristics of the private health care system, paralleled precisely in the NHS: asymmetry information, monopoly power, moral hazard and third party pays. The final section discusses briefly some remedies for the inefficient and inequitable outcomes which are seen in all health care markets and it is argued that competition within public and private health care systems may enable each system type to achieve its own particular objectives more efficiently.

  7. Oral health care for children in countries using dental therapists in public, school-based programs, contrasted with that of the United States, using dentists in a private practice model. (United States)

    Mathu-Muju, Kavita R; Friedman, Jay W; Nash, David A


    The United States faces a significant problem with access to oral health care, particularly for children. More than 50 countries have developed an alternative dental provider, a dental therapist, practicing in public, school-based programs, to address children's access to care. This delivery model has been demonstrated to improve access to care and oral health outcomes while providing quality care economically. We summarize elements of a recent major review of the global literature on the use of dental therapists, "A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States." We contrast the success of a school-based model of caring for children by dental therapists with that of the US model of dentists providing care for children in private practices.

  8. Building the Future: Summary of Four Studies to Develop the Private Sector, Education, Health Care, and Data for Decisionmaking for the Kurdistan Region - Iraq (with Arabic-language version). (United States)

    Anthony, C Ross; Hansen, Michael L; Kumar, Krishna B; Shatz, Howard J; Vernez, Georges


    In 2010, the Kurdistan Regional Government (KRG) asked the RAND Corporation to undertake four studies aimed at improving the economic and social development of the Kurdistan Region of Iraq. RAND's work was intended to help the KRG expand access to high-quality education and health care, increase private-sector development and employment for the expanding labor force, and design a data-collection system to support high-priority policies. The studies were carried out over the year beginning February 2010. The RAND teams worked closely with the Ministries of Planning, Education, and Health to develop targeted solutions to the critical issues faced by the KRG. This article summarizes the health care study. It is intended to provide a high-level overview of the approaches, followed by the studies, key findings, and major recommendations.

  9. Costs and benefits of private finance initiative schemes. (United States)

    Gittoes, Paula; Trim, Joanna

    The private finance initiative (PFI) is the biggest building programme in the history of the NHS. It aims to raise the quality of health care facilities by utilising the skills and expertise of companies in the private sector. This article outlines what PFI involves, how it works and the benefits to the NHS in raising the quality of health care facilities.

  10. Proposal to Promote the Entry of the Private Sector into Non-clinical Depression Related Businesses as Providers of Low-intensity Mental Health Services (Japanese)


    SO Mirai; Watanabe, Takashi


    There is concern over non-clinical depression (NCD) which has some depressive symptoms but does not meet clinical criteria. Recent epidemic study suggests that the economic costs of mild depression including NCD are quite large, and the risk of developing serious mental illness from NCD cannot be disregarded. Thus, some intervention on NCD is expected. However, people with NCD tend to be treated as healthy in psychiatry, and private service providers tend to refrain from providing services al...

  11. Availability, price and affordability of cardiovascular medicines: A comparison across 36 countries using WHO/HAI data

    Directory of Open Access Journals (Sweden)

    Cameron Alexandra


    Full Text Available Abstract Background The global burden of cardiovascular disease (CVD continues to rise. Successful treatment of CVD requires adequate pharmaceutical management. The aim was to examine the availability, pricing and affordability of cardiovascular medicines in developing countries using the standardized data collected according to the World Health Organization/Health Action International methodology. Methods The following medicines were included: atenolol, captopril, hydrochlorothiazide, losartan and nifedipine. Data from 36 countries were analyzed. Outcome measures were percentage availability, price ratios to international reference prices and number of day's wages needed by the lowest-paid unskilled government worker to purchase one month of chronic treatment. Patient prices were adjusted for inflation and purchasing power, procurement prices only for inflation. Data were analyzed for both generic and originator brand products and the public and private sector and summarized by World Bank Income Groups. Results For all measures, there was great variability across surveys. The overall availability of cardiovascular medicines was poor (mean 26.3% in public sector, 57.3% private sector. Procurement prices were very competitive in some countries, whereas others consistently paid high prices. Patient prices were generally substantially higher than international references prices; some countries, however, performed well. Chronic treatment with anti-hypertensive medication cost more than one day's wages in many cases. In particular when monotherapy is insufficient, treatment became unaffordable. Conclusions The results of this study emphasize the need of focusing attention and financing on making chronic disease medicines accessible, in particular in the public sector. Several policy options are suggested to reach this goal.

  12. At the Crossroads: Hazard Assessment and Reduction of Health Risks from Arsenic in Private Well Waters of Northeastern United States and Atlantic Canada (United States)

    Zheng, Yan; Ayotte, Joseph D.


    This special issue contains 12 papers that report on new understanding of arsenic hydrogeochemistry, performance of household well water treatment systems, and testing and treatment behaviors of well users in several states of the northeastern region of the United States and Nova Scotia, Canada. The responsibility to ensure water safety of private wells falls on well owners. In the U.S., 43 million Americans, mostly from rural areas, use private wells. In order to reduce As exposure in rural populations that rely on private wells for drinking water, risk assessment, which includes estimation of population at risk of exposure to As above the EPA Maximum Contaminant Level, is helpful but insufficient because it does not identify individual households at risk. Persistent optimism bias among well owners against testing and barriers such as cost of treatment mean that a large percentage of the population will not act to reduce their exposure to harmful substances such as As. If households are in areas with known As occurrence, a potentially large percentage of well owners will remain unaware of their exposure. To ensure that everyone, including vulnerable populations such as low income families with children and pregnant women, is not exposed to arsenic in their drinking water, alternative action will be required and warrants further research. PMID:25466685

  13. At the crossroads: Hazard assessment and reduction of health risks from arsenic in private well waters of the northeastern United States and Atlantic Canada (United States)

    Zheng, Yan; Ayotte, Joseph


    This special issue contains 12 papers that report on new understanding of arsenic (As) hydrogeochemistry, performance of household well water treatment systems, and testing and treatment behaviors of well users in several states of the northeastern region of the United States and Nova Scotia, Canada. The responsibility to ensure water safety of private wells falls on well owners. In the U.S., 43 million Americans, mostly from rural areas, use private wells. In order to reduce As exposure in rural populations that rely on private wells for drinking water, risk assessment, which includes estimation of population at risk of exposure to As above the EPA Maximum Contaminant Level, is helpful but insufficient because it does not identify individual households at risk. Persistent optimistic bias among well owners against testing and barriers such as cost of treatment mean that a large percentage of the population will not act to reduce their exposure to harmful substances such as As. If households are in areas with known As occurrence, a potentially large percentage of well owners will remain unaware of their exposure. To ensure that everyone, including vulnerable populations such as low income families with children and pregnant women, is not exposed to arsenic in their drinking water, alternative action will be required and warrants further research.

  14. Affordances for robots: a brief survey

    Directory of Open Access Journals (Sweden)

    Thomas E. Horton


    Full Text Available In this paper, we consider the influence of Gibson's affordance theory on the design of robotic agents. Affordance theory (and the ecological approach to agent design in general has in many cases contributed to the development of successful robotic systems; we provide a brief survey of AI research in this area. However, there remain significant issues that complicate discussions on this topic, particularly in the exchange of ideas between researchers in artificial intelligence and ecological psychology. We identify some of these issues, specifically the lack of a generally accepted definition of "affordance" and fundamental differences in the current approaches taken in AI and ecological psychology. While we consider reconciliation between these fields to be possible and mutually beneficial, it will require some flexibility on the issue of direct perception.

  15. The Transformation of Ergonomic Affordances into Cultural Affordances: The Case of the Alnuset System (United States)

    Chiappini, Giampaolo


    Is it possible to study the ergonomic affordances offered by a system designed for educational aims and their transformation into cultural affordances? To this purpose, what references can we adopt? This work describes the theoretical framework used to realise this study referring to AlNuSet, a system realised within the EC ReMath project to…

  16. Public private partnerships

    NARCIS (Netherlands)

    Miranda Sarmento, J.J.


    Public-private partnerships (PPPs) are increasing in number worldwide and are used to build and manage large public infrastructure projects. In PPPs, the private sector plays a role in developing and maintaining public infrastructure and services, which is usually a public sector responsibility. Des

  17. Private Speech in Ballet (United States)

    Johnston, Dale


    Authoritarian teaching practices in ballet inhibit the use of private speech. This paper highlights the critical importance of private speech in the cognitive development of young ballet students, within what is largely a non-verbal art form. It draws upon research by Russian psychologist Lev Vygotsky and contemporary socioculturalists, to…

  18. Procrustes and Private Schooling. (United States)

    Shaw, Beverley


    R. J. Royce (Journal of Philosophy of Education; v16 p105-13) argues that private school education may be better or worse than state schooling and, because of this inequality, it must be abolished. Royce's arguments are analyzed to determine if abolishing private schooling would create a fairer society. (SR)

  19. Affordances and distributed cognition in museum exhibitions

    DEFF Research Database (Denmark)

    Achiam, Marianne; May, Michael; Marandino, Martha


    consistent framework. Here, we invoke the notions of affordance and distributed cognition to explain in a coherent way how visitors interact with exhibits and exhibit spaces and make meaning from those interactions, and we exemplify our points using observations of twelve visitors to exhibits at a natural...... history museum. We show how differences in exhibit characteristics give rise to differences in the interpretive strategies used by visitors in their meaning-making process, and conclude by discussing how the notions of affordance and distributed cognition can be used in an exhibit design perspective....

  20. Learning to grasp and extract affordances: the Integrated Learning of Grasps and Affordances (ILGA) model. (United States)

    Bonaiuto, James; Arbib, Michael A


    The activity of certain parietal neurons has been interpreted as encoding affordances (directly perceivable opportunities) for grasping. Separate computational models have been developed for infant grasp learning and affordance learning, but no single model has yet combined these processes in a neurobiologically plausible way. We present the Integrated Learning of Grasps and Affordances (ILGA) model that simultaneously learns grasp affordances from visual object features and motor parameters for planning grasps using trial-and-error reinforcement learning. As in the Infant Learning to Grasp Model, we model a stage of infant development prior to the onset of sophisticated visual processing of hand-object relations, but we assume that certain premotor neurons activate neural populations in primary motor cortex that synergistically control different combinations of fingers. The ILGA model is able to extract affordance representations from visual object features, learn motor parameters for generating stable grasps, and generalize its learned representations to novel objects.

  1. Anticipating the effect of the Patient Protection and Affordable Care Act for patients with urologic cancer. (United States)

    Ellimoottil, Chandy; Miller, David C


    The Affordable Care Act seeks to overhaul the US health care system by providing insurance for more Americans, improving the quality of health care delivery, and reducing health care expenditures. Although the law's intent is clear, its implementation and effect on patient care remains largely undefined. Herein, we discuss major components of the Affordable Care Act, including the proposed insurance expansion, payment and delivery system reforms (e.g., bundled payments and Accountable Care Organizations), and other reforms relevant to the field of urologic oncology. We also discuss how these proposed reforms may affect patients with urologic cancers.

  2. Using and joining a franchised private sector provider network in Myanmar.

    Directory of Open Access Journals (Sweden)

    Kathryn O'Connell

    Full Text Available BACKGROUND: Quality is central to understanding provider motivations to join and remain within a social franchising network. Quality also appears as a key issue from the client's perspective, and may influence why a client chooses to use a franchised provider over another type of provider. The dynamic relationships between providers of social franchising clinics and clients who use these services have not been thoroughly investigated in the context of Myanmar, which has an established social franchising network. This study examines client motivations to use a Sun Quality Health network provider and provider motivations to join and remain in the Sun Quality Health network. Taken together, these two aims provide an opportunity to explore the symbiotic relationship between client satisfaction and provider incentives to increase the utilization of reproductive health care services. METHODS AND FINDINGS: Results from a series of focus group discussions with clients of reproductive health services and franchised providers shows that women chose health services provided by franchised private sector general practitioners because of its perceived higher quality, associated with the availability of effective, affordable, drugs. A key finding of the study is associated with providers. Provider focus group discussions indicate that a principle determinate for joining and remaining in the Sun Quality Health Network was serving the poor.

  3. Using and Joining a Franchised Private Sector Provider Network in Myanmar (United States)

    O'Connell, Kathryn; Hom, Mo; Aung, Tin; Theuss, Marc; Huntington, Dale


    Background Quality is central to understanding provider motivations to join and remain within a social franchising network. Quality also appears as a key issue from the client's perspective, and may influence why a client chooses to use a franchised provider over another type of provider. The dynamic relationships between providers of social franchising clinics and clients who use these services have not been thoroughly investigated in the context of Myanmar, which has an established social franchising network. This study examines client motivations to use a Sun Quality Health network provider and provider motivations to join and remain in the Sun Quality Health network. Taken together, these two aims provide an opportunity to explore the symbiotic relationship between client satisfaction and provider incentives to increase the utilization of reproductive health care services. Methods and Findings Results from a series of focus group discussions with clients of reproductive health services and franchised providers shows that women chose health services provided by franchised private sector general practitioners because of its perceived higher quality, associated with the availability of effective, affordable, drugs. A key finding of the study is associated with providers. Provider focus group discussions indicate that a principle determinate for joining and remaining in the Sun Quality Health Network was serving the poor. PMID:22180781

  4. Solution of the Development of High-End Health Insurance Market for Private Insurer%商业保险开拓高端健康保险市场的基本思路

    Institute of Scientific and Technical Information of China (English)



      商业健康保险应在满足民众多层次、多样化健康保障需求,尤其是高端健康保障需求方面下功夫,牢牢把握医改契机,深入分析市场需求,积极争取各地政府和主管部门支持,强化与医疗机构的战略合作,创新服务和管理模式,持续提高服务能力,积极开拓高端健康保险市场。%Private health insurance should make more efforts on meeting people’s needs for multi-level and diversify health security, especially the needs for high level health security, holding the opportunity of the Health Care Reform, indepth analysing the market demand for high-end health insurance, actively seeking the support from local governments and competent departments, strengthening the strategic cooperation with medical institutions, innovating the new model of service and management, enhancing the ability of service, and actively develop the high-end health instance market.

  5. Inovações na intermediação entre os setores público e privado na assistência à saúde Innovations in the intermediation between public and private sectors in health care

    Directory of Open Access Journals (Sweden)

    Rosimary Gonçalves de Souza


    Full Text Available Este artigo busca uma aproximação de algumas das mudanças em curso no sistema de saúde, focalizando especificamente o setor privado prestador de serviços de saúde, que, ao longo das últimas décadas, vem mantendo peso decisivo na condução da política de saúde. Nesse sentido, importa mapear as diferentes modalidades sob as quais se insere a iniciativa privada na prestação de serviços de saúde, mostrando as mudanças mais significativas na relação entre o setor público e o privado, tendo como contraponto o contexto das décadas de 1970 e 1980. Algumas dessas modalidades se constituem, na verdade, de uma intensificação ou consolidação de padrões e tendências presentes desde os anos 70, como o setor que integra as seguradoras de saúde e as empresas de medicina de grupo. Outras, como a atuação das cooperativas médicas junto ao setor público, mostram-se como tendências em expansão numa conjuntura de crise fiscal do estado e regressividade dos investimentos no campo social.This article intends an approach with some of the changes in course in the health system, specifically the private supplier of health services, that comes maintaining along the last decades decisive weight in the conduction of the health policy. In that sense, it imports to show the different modalities under which this sector interferes the private initiative in the installment of health services, showing the more important changes in the relationship between the public and the private sectors, tending as counterpoint the context of the decades of 70 and 80. Some of those modalities are constituted, actually, an consolidation of patterns and present tendencies since the seventies, as the section that integrates the insurance companies of health and the group medicine companies. Other, as the performance of the medical cooperatives close to the public section, they are shown as tendencies in expansion in a conjuncture of fiscal crisis of the state and

  6. No Role for Motor Affordances in Visual Working Memory (United States)

    Pecher, Diane


    Motor affordances have been shown to play a role in visual object identification and categorization. The present study explored whether working memory is likewise supported by motor affordances. Use of motor affordances should be disrupted by motor interference, and this effect should be larger for objects that have motor affordances than for…

  7. Health care spending growth: can we avoid fiscal Armageddon? (United States)

    Chernew, Michael

    Both private and public payers have experienced a persistent rise in health care spending that has exceeded income growth. The issue now transcends the health care system because health care spending growth threatens the fiscal health of the nation. This paper examines the causes and consequences of health care spending growth. It notes that the determinants of spending growth may differ from the determinants of high spending at a point in time. Specifically, the evidence overwhelmingly suggests that the primary driver ofinflation-adjusted, per capita spending growth over the past decades (and thus premium growth) has been the diffusion of new medical technology. The paper argues that while new technology has provided significant clinical benefit, we can no longer afford the persistent gap between health spending and income growth. In simple terms, if the economy is growing 2%, we cannot afford persistent health care spending growth of 4%. Growth in public spending is particularly important. If not abated, high public spending will require either substantially higher taxes or debt, both of which could lead to fiscal Armageddon. Growth in private spending also threatens economic well-being by forcing more resources toward health care and away from other sectors. For example, since the cost of employer-based coverage is always borne by employees (directly or indirectly), salary increases and health care cost increases cannot continue on together. To avoid economic disaster, payers will be forced to have a greater resolve in the future. Specifically, because neither public nor private payers will be able to finance growing health care spending, the coming decade will likely experience significant changes in health care financing. Consumers may be asked to pay more out of pocket when they seek care and both public and private payers will put increasing pressure on payment rates. Furthermore, payment rates to providers are likely to rise more slowly than in the past

  8. Radon in private drinking water wells. (United States)

    Otahal, P; Merta, J; Burian, I


    At least 10% of inhabitants in the Czech Republic are supplied with water from private sources (private wells, boreholes). With the increasing cost of water, the number of people using their own sources of drinking water will be likely to increase. According to the Decree of the State Office for Nuclear Safety about the Radiation Protection 307/2002 as amended by Decree 499/2005, the guideline limit for the supplied drinking water ('drinking water for public supply') for radon concentration is 50 Bq·l(-1). This guideline does not apply to private sources of drinking water. Radon in water influences human health by ingestion and also by inhalation when radon is released from water during showering and cooking. This paper presents results of measurements of radon concentrations in water from private wells in more than 300 cases. The gross concentration of alpha-emitting radionuclides and the concentrations of radium and uranium were also determined.

  9. Post-Graduate Training in Private Practice

    DEFF Research Database (Denmark)

    Petersen, Birgitte; Jacobsen, Claus Haugaard


    obtained in public positions. However, five years ago the Danish Association for Psychologist introduced a “trainee assistant arrangement” allowing neophyte candidates to work in private practice under an experienced psychologist supervision and guidance by psychologists in private practice having...... an arrangement with the public health insurance system. The Trainee Assistant Candidate Arrangement: This Trainee Assistant Candidate Arrangement is a set of requirements making it possible for unauthorized psychologists to work in at private practice for maximum 12 month at least 15 working hours a week, with 2...... hours of supervision a week. The employment can be either as an employee or the unauthorized psychologist can be a private psychologist herself. Some of the requirements are recommendations, others are rules to follow. This Trainee Assistant Candidate Arrangement has never been systematically subjected...

  10. Affordances of Instrumentation in General Chemistry Laboratories (United States)

    Sherman, Kristin Mary Daniels


    The purpose of this study is to find out what students in the first chemistry course at the undergraduate level (general chemistry for science majors) know about the affordances of instrumentation used in the general chemistry laboratory and how their knowledge develops over time. Overall, students see the PASCO(TM) system as a useful and accurate…

  11. Pico-hydro for affordable village power

    Energy Technology Data Exchange (ETDEWEB)



    This project developed and disseminated 'off-the-shelf' hydro generator units of up to 5kW that are: directly affordable by villagers in remote communities of developing counties; financially viable through fuel savings and income generation; and suitable for local manufacture and use in adverse conditions. Work was undertaken in Nepal, Colombia and Peru. (author)

  12. Diabetes and the Affordable Care Act. (United States)

    Burge, Mark R; Schade, David S


    The Affordable Care Act--"Obamacare"--is the most important federal medical legislation to be enacted since Medicare. Although the goal of the Affordable Care Act is to improve healthcare coverage, access, and quality for all Americans, people with diabetes are especially poised to benefit from the comprehensive reforms included in the act. Signed into law in 2010, this massive legislation will slowly be enacted over the next 10 years. In the making for at least a decade, it will affect every person in the United States, either directly or indirectly. In this review, we discuss the major changes in healthcare that will take place in the next several years, including (1) who needs to purchase insurance on the Web-based exchange, (2) the cost to individuals and the rebates that they may expect, (3) the rules and regulations for purchasing insurance, (4) the characteristics of the different "metallic" insurance plans that are available, and (5) the states that have agreed to participate. With both tables and figures, we have tried to make the Affordable Care Act both understandable and appreciated. The goal of this comprehensive review is to highlight aspects of the Affordable Care Act that are of importance to practitioners who care for people with diabetes by discussing both the positive and the potentially negative aspects of the program as they relate to diabetes care.

  13. Brazil's Mixed Public and Private Hospital System. (United States)

    Lewis, Maureen; Penteado, Evandro; Malik, Ana Maria


    Brazil's hospital sector is vibrant and growing. Under the 1988 Brazilian constitution all citizens have the right to health care, anticipating the global commitment to Universal Health Care. Brazil's public sector prides itself on having one of the world's largest single payer health care systems, but complementing that is a significant and larger private sector that is seeing big increase in investment, utilization and prices. This article outlines the structure of the hospital system and analyzes the nature and direction of private health sector expansion. Twenty-six percent of Brazilians have private health insurance and although coverage is concentrated in the urban areas of the Southeastern part of the country, it is growing across the nation. The disease burden shift to chronic diseases affects the nature of demand and the directly affects overall health care costs, which are rising rapidly outstripping national inflation by a factor of 3. Increasingly costs will have to be brought under control to maintain the viability of the private sector. Adaption of integrated care networks and strengthening of the public reimbursement system represent important areas for improvement.

  14. Effects of broken affordance on visual extinction. (United States)

    Wulff, Melanie; Humphreys, Glyn W


    Previous studies have shown that visual extinction can be reduced if two objects are positioned to "afford" an action. Here we tested if this affordance effect was disrupted by "breaking" the affordance, i.e., if one of the objects actively used in the action had a broken handle. We assessed the effects of broken affordance on recovery from extinction in eight patients with right hemisphere lesions and left-sided extinction. Patients viewed object pairs that were or were not commonly used together and that were positioned for left- or right-hand actions. In the unrelated pair conditions, either two tools or two objects were presented. In line with previous research (e.g., Riddoch et al., 2006), extinction was reduced when action-related object pairs and when unrelated tool pairs were presented compared to unrelated object pairs. There was no significant difference in recovery rate between action-related (object-tool) and unrelated tool pairs. In addition, performance with action-related objects decreased when the tool appeared on the ipsilesional side compared to when it was on the contralesional side, but only when the tool handle was intact. There were minimal effects of breaking the handle of an object rather than a tool, and there was no effect of breaking the handle on either tools or objects on single item trials. The data suggest that breaking the handle of a tool lessens the degree to which it captures attention, with this attentional capture being strongest when the tool appears on the ipsilesional side. The capture of attention by the ipsilesional item then reduces the chance of detecting the contralesional stimulus. This attentional capture effect is mediated by the affordance to the intact tool.

  15. Effects of broken affordance on visual extinction

    Directory of Open Access Journals (Sweden)

    Melanie eWulff


    Full Text Available Previous studies have shown that visual extinction can be reduced if two objects are positioned to afford an action. Here we tested if this affordance effect was disrupted by breaking the affordance – if one of the objects actively used in the action had a broken handle. We assessed the effects of broken affordance on recovery from extinction in eight patients with right hemisphere lesions and left-sided extinction. Patients viewed object pairs that were or were not commonly used together and that were positioned for left- or right-hand actions. In the unrelated pair conditions, either two tools or two objects were presented. In line with previous research (e.g., Riddoch et al., 2006, extinction was reduced when action-related object pairs and when unrelated tool pairs were presented compared to unrelated object pairs. There was no significant difference in recovery rate between action-related (object-tool and unrelated tool-tool pairs. In addition, performance with action-related objects decreased when the tool appeared on the ipsilesional side compared to when it was on the contralesional side, but only when the tool handle was intact. There were minimal effects of breaking the handle of an object rather than a tool, and there was no effect of breaking the handle on either tools or objects on single item trials. The data suggest that breaking the handle of a tool lessens the degree to which it captures attention, with this attentional capture being strongest when the tool appears on the ipsilesional side. The capture of attention by the ipsilesional item then reduces the chance of detecting the contralesional stimulus. This attentional capture effect is mediated by the affordance to the intact tool.

  16. Leveraging the Affordances of the Emerging 3d Internet for Entrepreneurial ”Next Practices”

    DEFF Research Database (Denmark)

    Frølunde, Lisbeth; Flåten, Bjørn-Tore

    of entrepreneurs within the creative industries, health services and business-to-business communication. These entrepreneurs are located in or stem from the Nordic countries (Iceland, Norway, Denmark, Sweden, and Finland). The collection methods are in-depth interviews and secondary data. Results/Implications Our...... related to the 3D Internet. Our theoretical basis is affordances, or the material and social properties of any technology in relation to affording actions by humans. Our first research question focuses on the perception of affordances by entrepreneurs: what does the 3D Internet offer or afford as a “space......” for entrepreneurial practices? Our second research question focuses on understanding how entrepreneurs utilize their social networks. Our approach to entrepreneurship is social-- concerned with the dynamics of social interactions and networked information ecology. Methods We are currently conducting 10 case studies...

  17. Private Housing or Alternative Financing? (United States)

    Bruno, Nick


    Explores the history of privatizing university housing and some current financing options, including use of developer and private foundations. Examples of successful alternative financing methods are highlighted. (GR)

  18. Análise econômica da interação entre a infraestrutura da saúde pública e privada no Brasil Economic analysis of the Brazilian public and private health infrastructure

    Directory of Open Access Journals (Sweden)

    Marislei Nishijima


    Full Text Available Este artigo analisa de que forma a interação entre o setor público e privado de saúde da economia brasileira, avaliando como a sua estrutura produtiva, aliada ao aparato legal referente ao período anterior à regulação da Agência Nacional de Saúde Suplementar, pode ter causado um impacto negativo sobre o acesso dos brasileiros de baixa renda aos bens públicos de saúde. Para dar suporte aos argumentos apresentados, foram utilizados os microdados do suplemento saúde da PNAD de 1998, analisados por meio de modelos logit e probit tendo em vista o caráter qualitativo da variável dependente. Os resultados sugerem evidências favoráveis à hipótese proposta.This article analyses how the last Brazilian Constitution - which regulates the universal rights of public health care - has negatively impacted the distribution of health care in terms of the access that Brazilians with lower incomes have to public health care. The specific way that the public and private sectors of health care functions has caused this to happen. This phenomenon was indirectly tested using supplementary health economics survey data, together with a traditional household survey, the "Pesquisa Nacional de Amostra por Domicílio" (PNAD, from 1998. Logit and probit models were used to analyze the data, and the results supported the proposed hypothesis.

  19. Health Seeking Behavior and Utilization of Health Care Services in Eastern Hilly Region of Nepal

    Directory of Open Access Journals (Sweden)

    Sailesh Bhattarai


    Full Text Available noBackground & Objectives: Preventive, promotive, curative, and rehabilitative health care services depend not only in availability & accessibility of it but also on awareness and attitude of the people and various inter-woven social structure that determines in making choice. The objective of this study was to explore health seeking behavior and utilization of health care services in the rural places in VDCs of Ilam district of Eastern Nepal.Materials & Methods: A cross sectional study was conducted in between period of March 25th 2013 to April 10th 2013 Fikkal and Pashupatinagar VDCs in Ilam district with sample of 300 people. Data was collected using a semi-structured questionnaire.Results: One fifth of the populations were found to be seeking traditional healers’ service and 80 percent among modern treatment system were relying on private treatment facility for treating sickness. People who had lived more than 20 years in that place and who felt modern health services were costly were likely to use service of traditional healers. Similarly people suffering from chronic illness, having health facility more than 30 minutes and using stretcher or walking as means of transportation were using government health centers more compared to private services.Conclusion: Significant people still use traditional healers’ service and the government health facility utilization was low as compared to private. The people living for longer period in that place and having the concept that modern health centers are costly were primary user of traditional healing system. Health facility nearby or people who could afford for automobile travel facilities were using costly private health centers.JCMS Nepal. 2015; 11(2:8-16



    Kessler, Tim; Nancy ALEXANDER


    The paper argues that private provision of water and electricity services requires a higher burden of proof than policies reforming existing state services. These utilities are public goods that must be universally affordable and accessible in order to achieve the Millennium Development Goals. In addition to considering productivity, policy-makers should assess social and "off-budget" fiscal impacts, as well as the feasibility of implementation in weak institutional environments. Benefits of ...

  1. The role of Public Private Partnership: the Brazilian experience of modernizing hospitals in the São Paulo Prefecture Health Secretariat. (United States)

    Vicente, Roser; Castillejo, Joan


    Within the health sector, the aim of the PPP model is to improve management efficiency and innovation in health care services while it also helps to accelerate the modernization of national health systems. Gesaworld's experience in Brazil, including the modernization of the hospital network of the São Paulo Prefecture, has contributed to improvements in the health of the population by offering better health care facilities. The scope of the project, which is based on the legal model of an administrative concession contract, includes sustainability criteria as part of the project.

  2. The Benefit Aftereffects of ACA--Accelerating Toward a New Health Economy. (United States)

    Mansur, Greg; Thompson, Michael


    While the Affordable Care Act (ACA) focused largely on improving access to health care coverage for the uninsured, its broader and longer-term influence may have been its impact on accelerating key trends and strategies that major employers and other stakeholders have been targeting for years. This article looks at some of these trends, where we were pre-ACA and how ACA (through benefit mandates, shared responsibility penalties, Cadillac plan tax, health information technology, accountable care organizations, etc.) has helped to accelerate and refocus efforts. In addition, the public exchange paradigm has given rise to a private exchange movement that is helping further accelerate the transformation of the New Health Economy.

  3. "Private Views" Ungaris

    Index Scriptorium Estoniae


    9. juulist Dunaujvarosi Kaasaegse Kunsti Instituudis eesti ja briti kunstnike ühisnäitus "Private Views. Ruum taasavastatud eesti ja briti kaasaegses kunstis". Kuraatorid Pam Skelton, Mare Tralla. Osalejad.

  4. "Private Views" Ungaris

    Index Scriptorium Estoniae


    9. juulist Dunaujvarosi Kaasaegse Kunsti Instituudis eesti ja briti kunstnike ühisnäitus "Private Views. Ruum taasavastatud eesti ja briti kaasaegses kunstis" Kuraatorid Pam Skelton, Mare Tralla. Osalejad

  5. Invigorating Private Investment

    Institute of Scientific and Technical Information of China (English)


    Chinese Premier Wen Jiabao set in motion the policies and measures to encourage and guide the sound development of private investment at an executive meeting of the State Council on March 24. While aimed at improving the overall private investment environment, these measures will help promote China’s economic restructuring and maintain its growth momentum, said Sun Lijian,a professor of finance at Fudan University in Shanghai, in an article for Shanghai Securities News.Edited excerpts follow:

  6. Invigorating Private Investment

    Institute of Scientific and Technical Information of China (English)


    @@ Chinese Premier Wen Jiabao set in motion the policies and measures to encourage and guide the sound development of private investment at an executive meeting of the State Council on March24.While aimed at improving the overall private investment environment,these measures will help promote China's economic restructuring and maintain its growth momentum,said Sun Lijian,a professor of finance at Fudan University in Shanghai,in an article for Shanghai Securities News.

  7. Assessment of levels of hospice care coverage offered to commercial managed care plan members in California: implications for the California Health Insurance Exchange. (United States)

    Chung, Kyusuk; Jahng, Joelle; Petrosyan, Syuzanna; Kim, Soo In; Yim, Victoria


    The implementation of the Affordable Care Act that provides for the expansion of affordable insurance to uninsured individuals and small businesses, coupled with the provision of mandated hospice coverage, is expected to increase the enrollment of the terminally ill younger population in hospice care. We surveyed health insurance companies that offer managed care plans in the 2014 California health insurance exchange and large hospice agencies that provided hospice care to privately insured patients in 2011. Compared with Medicare and Medicaid hospice benefits, hospice benefits for privately insured patients, particularly those enrolled in managed care plans, varied widely. Mandating hospice care alone may not be sufficient to ensure that individuals enrolled in different managed care plans receive the same level of coverage.

  8. Estilos de vida e uso de serviços preventivos de saúde entre adultos filiados ou não a plano privado de saúde (inquérito de saúde de Belo Horizonte Lifestyle and preventive health care utilization among adults covered or not by private health plan (the Belo Horizonte health survey

    Directory of Open Access Journals (Sweden)

    Maria Fernanda Lima-Costa


    Full Text Available O objetivo deste estudo foi investigar as associações entre filiação a plano privado de saúde, alguns estilos de vida, aconselhamento médico sobre fumo e consumo de álcool e uso de serviços preventivos. O trabalho foi desenvolvido em uma amostra representativa de residentes na Região Metropolitana de Belo Horizonte com > 20 anos (13.851 participaram. Desses 34% eram filiados a plano privado e 66% dependiam exclusivamente do SUS. Os primeiros apresentavam hábitos mais saudáveis: fumavam menos, consumiam menos bebidas alcóolicas, praticavam mais exercícios e consumiam, mais freqüentemente, cinco ou mais porções diárias de frutas, verduras ou legumes frescos. Além disso, haviam recebido, com mais freqüência, aconselhamento médico sobre o consumo de álcool e cigarros. As prevalências de usos de serviços preventivos (pressão arterial, colesterol, mamografia, exame de papanicolau e pesquisa de sangue oculto nas fezes eram significativamente mais altas entre os filiados a plano privado de saúde. Todas as associações acima mencionadas eram independentes do sexo, da idade, e da escolaridade. Esses resultados apontam para a premente necessidade de superação dessas iniqüidades.This study aimed at examining the associations among private health plan affiliation and health lifestyles, medical counseling about alcohol consumption and tobacco, as well as preventive health care use. The study was carried out in a representative sample of 13,851 residents in the Metropolitan Area of Belo Horizonte (RMBH, aged > 20 years. From these, 34% were covered by a private health plan and 66% were under exclusive public coverage. The former, in comparison with the latter, had healthy lifestyles, regarding current smoking, binge drinking, physical activities during leisure time and consumption of fruits, green and vegetables on daily basis. They had also received more frequent medical advice about smoking and drinking habits. The prevalences

  9. Synergies between veterinarians and para-professionals in the public and private sectors: organisational and institutional relationships that facilitate the process of privatising animal health services in developing countries. (United States)

    Woodford, J D


    The delivery of veterinary services in most developing countries was, until recently, considered to be the responsibility of the public sector. However, over the past four decades, economic constraints and the imposition of structural adjustment policies (SAPs) have led to a gradual decline in public sector investment in real terms and thus a reduction in the quality and quantity of services available to livestock keepers. Many governments acknowledged that they were no longer able to provide services that were essentially of a 'private good' nature and introduced radical policy changes which sought to introduce the concepts of a market orientated approach towards agriculture and livestock production in particular. The role of government, in the future, would be to provide a reduced range of essential 'public good' services and to create a favourable environment in which the private sector could become established as a provider of 'private good' services and at the same time act as a partner in carrying out certain public functions under contract or 'sanitary mandates'. In almost all developing countries, however, these policy changes were not accompanied by appropriate development strategies. The reasons for this are complex. Firstly, SAPs may be considered to have been foisted upon governments by donors and are thus perceived by many policy-makers as the cause of financial problems, rather than a solution to them. Secondly, most animal health senior policy-makers in the public sector have been trained as veterinarians and lack the required management skills to plan change effectively. Furthermore, as regards clinical veterinary service delivery, especially in rural or more remote areas, the solution fostered by donor investment, which involves deregulation and the deployment of privately operating para-professionals, is often perceived as a threat to the veterinary profession and might result in limiting access to international markets for the trade of livestock

  10. Municipal household solid waste collection strategies in an African megacity: analysis of public private partnership performance in Lagos. (United States)

    Aliu, Ibrahim Rotimi; Adeyemi, Oluwagbemiga Ezekiel; Adebayo, Adeolu


    Managing municipal solid waste is a pervasive urban problem globally. While several strategies have been applied for efficient municipal solid waste management in developing economies, their performance level has not been critically investigated. Among these strategies, the public private partnership has widest appeal. This study examines the performance of public private partnership in household solid waste collection in Lagos, Nigeria. We collected primary data using a municipal solid waste survey in three residential density areas of Lagos megacity. Descriptive and inferential statistics were used to analyse the data. Two indexes of service performance, namely the service reliability index and operational quality index, were created to produce evidence on public private partnership performance in municipal solid waste collection in Lagos. Results show that the average amount of household solid waste generation per week ranges between 22.75 kg in the medium residential density area and 30.39 kg in the high residential density region of the city. The estimated per capita waste generated in Lagos Megacity is 0.95 kg day(-1). Regression models indicate that the public private partnership performance is significantly influenced by economic status, affordability, flexibility, consistency, cleanliness, coverage and accessibility, as well as number of waste collection vehicles, vehicle maintenance, capacity, trip rate, frequency, number of personnel and quality of personnel. Findings from this study reveal that Lagos residents have strong positive perception of public private partnership as a waste collection policy framework. The study has important policy and practical implications for urban waste management, public health and sustainability in developing economies.

  11. Public Supervision over Private Relationships : Towards European Supervision Private Law?

    NARCIS (Netherlands)

    Cherednychenko, O.O.


    The rise of public supervision over private relationships in many areas of private law has led to the development of what, in the author’s view, could be called ‘European supervision private law’. This emerging body of law forms part of European regulatory private law and is made up of contract-rela

  12. Affordances and the musically extended mind

    Directory of Open Access Journals (Sweden)

    Joel eKrueger


    Full Text Available I defend a model of the musically extended mind. I consider how acts of musicking grant access to novel emotional experiences otherwise inaccessible. First, I discuss the idea of musical affordances and specify both what musical affordances are and how they invite different forms of entrainment. Next, I argue that musical affordances—via soliciting different forms of entrainment—enhance the functionality of various endogenous, emotion-granting regulative processes, drawing novel experiences out of us with an expanded complexity and phenomenal character. I suggest that music therefore ought to be thought of as part of the vehicle needed to realize these emotional experiences. I appeal to different sources of empirical work to develop this idea.

  13. The Affordable Care Act and the future of clinical medicine: the opportunities and challenges. (United States)

    Kocher, Robert; Emanuel, Ezekiel J; DeParle, Nancy-Ann M


    The Affordable Care Act is a once-in-a-generation change to the U.S. health system. It guarantees access to health care for all Americans, creates new incentives to change clinical practice to foster better coordination and quality, gives physicians more information to make them better clinicians and patients more information to make them more value-conscious consumers, and changes the payment system to reward value. The Act and the health information technology provisions in the American Recovery and Reinvestment Act remove many barriers to delivering high-quality care, such as unnecessary administrative complexity, inaccessible clinical data, and insufficient access to primary care and allied health providers. We hope that physicians will embrace the opportunities created by the Affordable Care Act that will enable them to provide better care for their patients and lead the U.S. health system in a more positive direction. To fully realize the benefits of the Affordable Care Act for their practices and their patients, physicians will design their offices for seamless care, employing new practice models and using technology to integrate patient information with professional society guidelines to keep patients with chronic conditions healthy and out of the hospital. Under the Affordable Care Act, physicians who effectively collaborate with other providers to improve patient outcomes, the value of medical services, and patient experiences will thrive and be the leaders of the health care system.

  14. Health technology assessment in Singapore. (United States)

    Pwee, Keng Ho


    The Republic of Singapore is an island city-state in Southeast Asia. Its population enjoys good health and the Singapore Ministry of Health's mission is to promote good health and reduce illness, ensure access to good and affordable health care, and pursue medical excellence. This is achieved through a healthcare system that includes both private and public sector elements. The financing philosophy of Singapore's healthcare delivery system is based on individual responsibility and community support. Health care in Singapore is financed by a combination of taxes, employee medical benefits, compulsory health savings, insurance, and out-of-pocket payment. The capability for health technology assessment in Singapore was developed concurrently with its medical device regulation system in the 1990s. The first formal unit with health technology assessment (HTA) functions was established in September 1995. Today, HTA features in decision making for the Standard Drug List, licensing of medical clinics, the Health Service Development Programme, healthcare subsidies, and policy development. The public sector healthcare delivery clusters have also recently started health services research units with HTA functions. Singapore is organizing the 6th Health Technology Assessment International (HTAi) Annual Meeting in June 2009. Bringing this prestigious international conference to Asia for the first time will help raise awareness of HTA in the region.

  15. Americans' Experiences with ACA Marketplace Coverage: Affordability and Provider Network Satisfaction: Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February--April 2016. (United States)

    Gunja, Munira Z; Collins, Sara R; Doty, Michelle M; Beutel, Sophie


    For people with low and moderate incomes, the Affordable Care Act's tax credits have made premium costs roughly comparable to those paid by people with job-based health insurance. For those with higher incomes, the tax credits phase out, meaning that adults in marketplace plans on average have higher premium costs than those in employer plans. The law's cost-sharing reductions are reducing deductibles. Lower-income adults in marketplace plans were less likely than higher-income adults to report having deductibles of $1,000 or more. Majorities of new marketplace enrollees and those who have changed plans since they initially obtained marketplace coverage are satisfied with the doctors participating in their plans. Overall, the majority of marketplace enrollees expressed confidence in their ability to afford care if they were to become seriously ill. This issue brief explores these and other findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February--April 2016.

  16. Privatization Process in Kosovo

    Directory of Open Access Journals (Sweden)

    Ing. Florin Aliu


    Full Text Available Privatization is considered an initial step toward market economy, restructuring financial and economic sector that enables competition in the economy. Privatization is the most painful process in economy where beside legal establishment and political will, it includes also the aspect of fairness and honesty. Analysis of this process is based on the models and comparisons between Kosovo and countries of central and Eastern Europe, in order to give a clearer picture on the overall process of privatization in Kosovo Methodology that is used to analyze this issue is based on empirical results and also qualitative interpretation of the models and also on studying particular asset privatization process. A widely discussed case of privatization in Kosovo is that of Post and Telecom of Kosovo (PTK. Since each company has its own value, I have focused my appraising analysis on the financial statements with a special observation on Cash Flow from Operation, as the most significant indicator on showing how company is using her physical and human recourses to generate money. I have based my research on using methodology of discounted cash flow from operation analysis, even though the company valuation was done using net cash flow from operation analysis. Cash Flow valuation then was discounted by the T-bonds interest rate. This paper tries to bring a conclusion that privatization process in Kosovo have not brought the results excepted, firstly by setting an inappropriate price of assets and lastly by restructuring overall privatization sector and the overall industry. Kosovo, consequently, lost a big opportunity to create a competitive environment of financial industry: starting from the banking industry followed the pension trust which remained at their initial steps of development

  17. The production of critical theories in Health Systems Research and Education. An epistemological approach to emancipating public research and education from private interests

    Directory of Open Access Journals (Sweden)

    Jean-Pierre Unger


    Full Text Available This paper aims at offering alternative methodological perspectives in health systems research, to produce critical, theoretical knowledge in domains such as health policy and management of health care, organization of disease control, political economy of health and medical practice.We first examined the reasons to believe that worldwide economic agents have driven publicly funded schools of public health to adopt their preferred policies and to orient their priority research topics. We then studied whether this hidden leadership has also contributed to shape research methodologies, which we contrasted with the epistemological consequences of a quest for intellectual independence, that is, the researcher’s quest to critically understand the state of health systems and generalize results of related action-research. To do so, we applied concepts of what could be named the ‘French School of Critical Sociology’ to qualitative research methodologies in descriptive health systems research. To do so, we applied concepts of what could be named the ‘French School of Critical Sociology’ to qualitative research methodologies in descriptive health systems research.

  18. Private Sector Involvement in Healthcare and UHC : An Assessment in Light of the Right to the Highest Attainable Standard of Health

    NARCIS (Netherlands)

    Toebes, Brigit; Hallo de Wolf, Antenor


    The goal of UHC (Universal Health Coverage) is to ‘ensure that all people obtain the health services they need without suffering financial hardship when paying for them’. There are many dense connections between the goal of UHC, and the State’s legal obligation to realize the human right to the high

  19. The impact of the Patient Protection and Affordable Care Act on radiology: beyond reimbursement. (United States)

    Krishnaraj, Arun; Norbash, Alexander; Allen, Bibb; Ellenbogen, Paul H; Kazerooni, Ella A; Thorwarth, William; Weinreb, Jeffrey C


    The 2014 ACR Forum focused on the noneconomic implications of the Affordable Care Act on the field of radiology, with specific attention to the importance of the patient experience, the role of radiology in public and population health, and radiology's role in the effort to lower overall health care costs. The recommendations generated from the Forum seek to inform ACR leadership on the best strategies to pursue to best prepare the radiology community for the rapidly evolving health care landscape.

  20. Where Does My Private Data Go?

    DEFF Research Database (Denmark)

    Khajuria, Samant; Sørensen, Lene Tolstrup


    Privacy has become a leading concern for manyusers using online services of any kind: social media activities, health care or shopping. As a consequence, targeted services offer information visualizations of private data for users on a browser or app level. This paper focuses on comparing existing...

  1. 76 FR 41501 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH09-907 (United States)


    ... submitted under funding opportunity EH09-907, ``National Environmental Public Health Tracking Program... health and help restrain the rate of growth in private and public sector health care costs.'' The ACA and... public health and environmental sectors to improve health tracking, hazard monitoring and...

  2. 42 CFR 440.80 - Private duty nursing services. (United States)


    ... 42 Public Health 4 2010-10-01 2010-10-01 false Private duty nursing services. 440.80 Section 440... nursing services. Private duty nursing services means nursing services for recipients who require more individual and continuous care than is available from a visiting nurse or routinely provided by the...

  3. Saúde suplementar no Brasil: abordagens sobre a articulação público/privada na assistência à saúde Salud suplementaria en Brasil: enfoques sobre la vertebración pública/privada en la asistencia a la salud Private health insurance in Brazil: approaches to public/private patterns in healthcare

    Directory of Open Access Journals (Sweden)

    Lígia Bahia


    estricto como foco de la discusión sobre salud suplementaria. Por ello, es evidente que la comprensión de la vertebración pública/privada en la salud requiere el desarrollo de una sólida base empírica, analizada fundamentándose en presupuestos teóricos adecuados al grado de complejidad inherente de la línea divisoria en la vertebración entre lo público y lo privado en el ámbito de la asistencia a la salud.This article draws on a previous review of 270 articles on private health plans published from 2000 to 2010 and selects 17 that specifically address the issue of the relationship between the public and private healthcare sectors. Content analysis considered the studies' concepts and terms, related theoretical elements, and predominant lines of argument. A reading of the argumentative strategies detected the existence of a critical view of the modus operandi in the public/private relationship based on Social Medicine and the theoretical tenets of the Brazilian Health Reform Movement. The study also identified contributions based on neoliberal business approaches that focus strictly on economic issues to discuss private health insurance. Understanding the public/private link in healthcare obviously requires the development of a solid empirical base, analyzed with adequate theoretical assumptions due to the inherent degree of complexity in the public/private healthcare interface.

  4. Transformações e desafios da atenção privada em saúde no Brasil nos anos 90 Transformations and challenges in private health care in Brazil in the 1990s

    Directory of Open Access Journals (Sweden)

    Maria de Fátima Siliansky de Andreazzi


    Full Text Available Este texto procura extrair, da heterogeneidade apresentada pelo setor privado em saúde, no Brasil, o dado qualitativamente novo dos anos 90, bem como os desafios da nova dinâmica desse setor, especialmente em sua relação com o Estado. Apresenta uma introdução, apontando elementos considerados essenciais para a compreensão das mudanças ocorridas no setor saúde. Nessa perspectiva, localiza as mudanças no quadro de referência do modelo econômico adotado pelo país, nos anos 90, com foco nos desenvolvimentos vinculados aos ditames da globalização produtiva e, sobretudo, financeira. Em seguida, na segunda e terceira seções, são apresentadas as principais mudanças no interior do setor privado em saúde, quanto a demanda, oferta e suas inter-relações. Finalmente, à guisa de epílogo, são apresentados alguns dos desafios interpostos na relação entre os provedores e os consumidores de atenção à saúde, dita suplementar, ou a assistência à saúde "hors-SUS".This paper attempts to extract from the heterogeneity of the Brazilian private health care sector a qualitatively new characteristic of the 1990s, as well as the challenges of the sector's new dynamics, especially in its relationship to the public sector. The article's introduction discusses what are considered essential elements for understanding the changes occurring in the health sector. It situates the challenges within the framework of the economic model adopted in Brazil in the 1990s, focusing on developments linked to the dictates of productive (and especially financial globalization. The second and third sections present the principal changes in the private health care sector in relation to supply and demand and their interrelations. Finally, by way of epilogue, the article discusses some of the challenges arising in the relationship between suppliers and consumers of so-called supplementary health care, i.e., "à la National Health System".

  5. Why do so many Americans oppose the Affordable Care Act? (United States)

    Dalen, James E; Waterbrook, Keith; Alpert, Joseph S


    The Patient Protection and Affordable Care Act (ACA) was passed by a Democratic Congress and signed into law by a Democratic president in 2010. Republican congressmen, governors, and Republican candidates have consistently opposed the ACA and have vowed to repeal it. Polls have consistently shown that it is supported by care. Yet Medicare, a mandatory insurance for seniors administered by the federal government since 1965, is overwhelmingly approved by the American public. The opposition to a government role in health care is based on the fact that that the vast majority of our citizens do not trust their government. Republicans are much less trusting of the federal government and much less supportive of a government role in health care than Democrats. The overwhelmingly negative TV ads against the ACA by the Republican candidates in the elections of 2012 and 2014 have had a major impact on Americans' views of the ACA. More than 60% of Americans have stated that most of what they know about the ACA came from watching TV. Opposition to a government role in health care and to mandatory health insurance makes it unlikely that the US will be able to insure that all of its citizens have ongoing access to health care in the near future.

  6. Differentially Private Spatial Decompositions

    CERN Document Server

    Cormode, Graham; Shen, Entong; Srivastava, Divesh; Yu, Ting


    Differential privacy has recently emerged as the de facto standard for private data release. This makes it possible to provide strong theoretical guarantees on the privacy and utility of released data. While it is well-known how to release data based on counts and simple functions under this guarantee, it remains to provide general purpose techniques to release different kinds of data. In this paper, we focus on spatial data such as locations and more generally any data that can be indexed by a tree structure. Directly applying existing differential privacy methods to this type of data simply generates noise. Instead, we introduce a new class of "private spatial decompositions": these adapt standard spatial indexing methods such as quadtrees and kd-trees to provide a private description of the data distribution. Equipping such structures with differential privacy requires several steps to ensure that they provide meaningful privacy guarantees. Various primitives, such as choosing splitting points and describi...

  7. A comparative study on the availability of modern contraceptives in public and private health facilities in a peri-urban community in Ghana


    Adjei, Kwame K.; Laar, Amos K.; Narh, Clement T.; Abdulai, Martha A.; Newton, Sam; Owusu-Agyei, Seth; Adjei, Sam


    Background Sub-Saharan Africa reports low use of family planning methods and high unmet need. Availability of these methods is one of the major barriers to contraceptive use in the region. This study determined the availability of modern contraceptives and perceived factors affecting this in health facilities in the Ga East municipality of Ghana. Methods This was a cross-sectional study involving quantitative and qualitative techniques. Data was obtained from 51 randomly selected health facil...

  8. Active Affordance Learning in Continuous State and Action Spaces

    NARCIS (Netherlands)

    Wang, C.; Hindriks, K.V.; Babuska, R.


    Learning object affordances and manipulation skills is essential for developing cognitive service robots. We propose an active affordance learning approach in continuous state and action spaces without manual discretization of states or exploratory motor primitives. During exploration in the action

  9. Osteoporosis-Related Health Services Utilization Following First Hip Fracture Among a Cohort of Privately-Insured Women in the United States, 2008-2014: An Observational Study. (United States)

    Gillespie, Catherine W; Morin, Pamela E


    Timely identification and treatment of osteoporosis following hip fracture is recommended to mitigate future fracture risk, yet prior work has demonstrated a disconnect between evidence-based recommendations and real-world implementation. We sought to describe contemporary patterns of osteoporosis screening and initiation of pharmacotherapy following hip fracture based on medical and pharmacy claims in the OptumLabs™ Data Warehouse. From a national sample, we identified 8349 women aged 50+ years enrolled in private commercial or Medicare Advantage plans with no prior history of osteoporosis diagnosis, osteoporosis pharmacotherapy, or hip fracture who experienced a hip fracture between 2008 and 2013. Just 17.1% and 23.1% of these women had evidence of osteoporosis assessment and/or treatment within 6 or 12 months of their fractures, respectively. Women aged 80+ years were one-third less likely to utilize recommended services within 6 months, compared to those aged 50 to 79 years (13.8% versus 20.8%; p measurement increased significantly among women aged 65+ years over the study period (p Accounting for differences in all measured characteristics, receipt of primary care was the strongest and most consistent predictor of osteoporosis assessment or treatment following fracture. © 2017 American Society for Bone and Mineral Research.

  10. Experiments on affordance in the journal "ecological psychology"

    DEFF Research Database (Denmark)

    Trettvik, Johan


    There are two general aims: 1) to review how the concept of affordance is construed, in theory as well as in practice/experiments, and 2) to review the experiments on affordances.......There are two general aims: 1) to review how the concept of affordance is construed, in theory as well as in practice/experiments, and 2) to review the experiments on affordances....

  11. Contraceptive Coverage and the Affordable Care Act. (United States)

    Tschann, Mary; Soon, Reni


    A major goal of the Patient Protection and Affordable Care Act is reducing healthcare spending by shifting the focus of healthcare toward preventive care. Preventive services, including all FDA-approved contraception, must be provided to patients without cost-sharing under the ACA. No-cost contraception has been shown to increase uptake of highly effective birth control methods and reduce unintended pregnancy and abortion; however, some institutions and corporations argue that providing contraceptive coverage infringes on their religious beliefs. The contraceptive coverage mandate is evolving due to legal challenges, but it has already demonstrated success in reducing costs and improving access to contraception.

  12. Breastfeeding and the Affordable Care Act. (United States)

    Hawkins, Summer Sherburne; Dow-Fleisner, Sarah; Noble, Alice


    Mothers who receive or qualify for the Women, Infants, and Children (WIC) program or have lower income are less likely to start and continue breastfeeding than their more advantaged counterparts. The Patient Protection and Affordable Care Act (ACA) requires employers to provide break time and space to express breast milk and requires insurance companies to cover breastfeeding support, supplies, and counseling at no cost to mothers. This ACA benefit does not extend to all Medicaid recipients or women in the WIC program. Legislative and regulatory efforts are needed to provide comprehensive coverage for all women and reduce disparities in breastfeeding.

  13. 78 FR 15559 - Patient Protection and Affordable Care Act; Establishment of the Multi-State Plan Program for the... (United States)


    ... plans in the small group markets.\\2\\ This research also indicates that the OPM- selected EHB-benchmark... Assistant Secretary for Planning and Evaluation, ASPE Research Brief, Essential Health Benefits: Comparing... in the health insurance market, improve choice of affordable health insurance, and give...

  14. Quality of mental health care at a student-run clinic: care for the uninsured exceeds that of publicly and privately insured populations. (United States)

    Liberman, Kate M; Meah, Yasmin S; Chow, Andrew; Tornheim, Jeffrey; Rolon, Omayra; Thomas, David C


    Diagnosing and treating depression in a primary care practice is an important, yet difficult task, especially for safety-net practices serving the uninsured. In the United States healthcare system, there is a mismatch between the need for mental health care and access to services. This disparity is most striking among the uninsured. Mental health disorders are more prevalent among the uninsured, and even when diagnosed with mental illness, they are less likely to obtain necessary treatment than insured patients. Given the increasing burden of depression on society, growing numbers of uninsured and negative repercussions of untreated mental illness, improvements in screening and management protocols are becoming more important in primary care practices serving this population. The quality of depression treatment at commercial and public insurance plans in New York City (NYC) and New York State (NYS) were compared to that of the East Harlem Health Outreach Partnership (EHHOP), the student-run clinic of the Mount Sinai School of Medicine. Based on the comparison, the study made recommendations for an integrated, on-site mental health service program at the community health clinic. A cohort of 49 depressed patients were evaluated and treated at the EHHOP clinic. The quality of the mental health care was evaluated according to variables from the Healthcare Effectiveness Data and Information Set (HEDIS). Indicators of quality included demographics, method of diagnosis, type of pharmacological treatment, referral to specialty care, patient adherence to follow-up care and adherence to pharmacologic treatment. When compared to insured patients in NYS, more EHHOP patients had the appropriate number of physician contacts after being diagnosed with depression than patients with commercial health plans (P = 0.008) and Medicaid (P = 0.09). Similarly, a greater number of EHHOP patients had better acute phase (P = 0.001; P = 0.096) and continuous phase (P = 0.049; P

  15. 77 FR 17219 - Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and... (United States)


    ... risk, or the calculation of payments and charges, or that are used for validation or audit of such data... Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment; Final Rule #0;#0...; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment AGENCY: Department of Health and...

  16. California's Working Families and Their Uninsured Children: A Big Problem with an Affordable Solution. (United States)

    O'Sullivan, Maryann; Burgmaier, Michael; Freeman, Patricia; Reich, Jessica

    Although California lags behind other states in insuring children of low-income working families, the state could provide assistance by building on existing public health programs. This report provides a primer on the problems of low-income uninsured children and explores the public policy building blocks needed to adequately and affordably insure…

  17. The Patient Protection and Affordable Care Act: The Role of the School Nurse. Position Statement (United States)

    Combe, Laurie G.; Sharpe, Susan; Feeser, Cynthia Jo; Ondeck, Lynnette; Fekaris, Nina


    It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) serves a vital role in the delivery of health care to our nation's students within the healthcare system reshaped by the Patient Protection and Affordable Care Act of 2010, commonly known as…

  18. Awareness, Perceptions, and Communication Needs about the Affordable Care Act across the Life Span (United States)

    Bergeron, Caroline D.; Friedman, Daniela B.; Sisson, Diana C.; Tanner, Andrea; Kornegay, Vance L.; Owens, Otis L.; Weis, Megan A.; Patterson, Lee L.


    Background: By March 2014, all U.S. citizens were required to have health insurance according to the Affordable Care Act (ACA). Purpose: Study objectives were to explore individuals' opinions, perceptions, and communication sources and needs about the ACA and to assess differences by age group. Methods: In November 2013, 10 1-hour focus groups (5…

  19. 76 FR 51201 - Patient Protection and Affordable Care Act; Exchange Functions in the Individual Market... (United States)


    ... U.S.C. section 1001, et seq.) FPL Federal Poverty Level HHS U.S. Department of Health and Human... of Contents I. Background A. Legislative Overview B. Request for Comment C. Structure of the Proposed... I. Background A. Legislative Overview Section 1311(b) and section 1321 of the Affordable Care...

  20. A Private Controversy

    Institute of Scientific and Technical Information of China (English)


    DISCUSSIONS on privacyflamed at the 1998 book fair.Absolute Privacy waspublished at the beginning of the year,immediately followed by SinglePrivacy and Very Private. And thereare others: Inside Marriage andBeyond, Observations of Lovers, andmore. Most are written by journalists,

  1. Private Airlines Take Off

    Institute of Scientific and Technical Information of China (English)



    OKAY Airways, the first wholly private airline in China, took off from the Tianjin Binhai International Airport on March Ⅱ. Carrying a total of 80 passengers, the 189-seat Boeing 737-900 leased from Korea Airlines was bound for Kunming, capital of Yunnan Province, via Changsha,

  2. Small public private partnerships

    DEFF Research Database (Denmark)

    Koch, Christian; Jensen, Jesper Ole


    Public Private Partnerships (PPP) are frequently mobilized as a purchasing form suitable for large infrastructure projects. And it is commonly assumed that transaction costs linked to the establishment of PPP make them prohibitive in small sizes. In a Danish context this has been safeguarded...

  3. Public-Private Partnerships

    DEFF Research Database (Denmark)

    Lehmann, Martin; Jeppesen, S.


    Public-private partnerships in the environmental field have emerged as one option in the pursuit of sustainable development. So-called ‘Green Networks’, ‘Cleaner Production Centres’, ‘Waste Minimisation Clubs’ are among others highlighted as alternatives to governmental regulation. While being...

  4. Public-Private Partnerships

    DEFF Research Database (Denmark)

    Weihe, Gudrid

    There is a great deal of confusion about the meaning of the concept public-private partnership (PPP). Much is written on the subject but only rarely do authors give an adequate account of what they mean when they talk about PPP, nor do they acknowledge that there exist qualitatively different PPP...

  5. Public-Private Partnerships

    DEFF Research Database (Denmark)

    Helby Petersen, Ole

    This PhD dissertation studies national similarities and differences in policy and regulation of public-private partnerships (PPPs), with an empirical focus on Denmark and Ireland. The starting point and motivation for the study is the observation that whereas PPPs are often depicted in the academic...

  6. A private function. (United States)

    Dean, Erin

    Hinchingbrooke Hospital in Cambridgeshire is the first NHS trust to be run by a private company, Circle. The trust has shown signs of improvements in services and greater financial stability since it was taken over. However, Circle's initial willingness to involve staff in decisions appears to have waned, and there are concerns over job losses.

  7. At private den

    DEFF Research Database (Denmark)

    Winther, Ida


    club (teens between 12-16 years) in Denmark will be presented. The teens are always situated end located when they use the cell phone. When they use it, temporary personal reserves are created, in which they do territorial demands. As the most obvious they forget themselves and ?go private?. It has...

  8. Valuing Private Equity

    DEFF Research Database (Denmark)

    Sørensen, Morten; Wang, Neng; Yang, Jinqiang


    We investigate whether the performance of private equity (PE) investments is sufficient to compensate investors (LPs) for risk, long-term illiquidity, management, and incentive fees charged by the general partner (GP).We analyze the LPs’ portfolio-choice problem and find that management fees...

  9. Clans in Private Economy

    Institute of Scientific and Technical Information of China (English)

    ZhaoHongmei,; ZhuShida; DavidKelly


    In traditional China, clans were dominant segments of society. Clan ideology is widespread in China, where private firms generally choose clan operation as their business form. Greater trust in family or clan members and resources distribution in terms of human affinity are all manifestations of the influence of the clan ideology on economic life.


    Directory of Open Access Journals (Sweden)

    Angela van der Berg


    Full Text Available It is anticipated that the occurrence and intensity of disasters will increase globally and in South Africa where typical disasters include droughts, floods, extreme hailstorms, gales, fires and earthquakes, as well as sinkholes arising from mining activity in dolomitic areas. Disasters such as these result in human suffering and damage to the resources and infrastructure on which South Africans rely for their survival and the maintenance of their quality of life. Section 24 of the Constitution of the Republic of South Africa, 1996 affords to everyone the right to an environment that is not harmful to his or her health and well-being. It may be argued that a person's sense of environmental security in relation to the potential risks and dangers of disaster falls within the scope of the protection provided by section 24. The responsibility to intervene for the protection of the interests inherent in the constitutional environmental right lies with the government of South Africa. Disaster management specifically is a functional area of competence of national and provincial government, but practice has shown that the actual implementation of and planning for disaster management happens in the local government sphere. Against the backdrop of these introductory discussions and, given the fact that several municipalities in South Africa are under-resourced, this article very specifically aims to critically discuss and describe from a legal perspective the potential and function of public-private partnerships (PPPs between local government (municipalities and the private sector (such as industries in fulfilling the legally entrenched disaster management mandate of municipalities. Through a critical evaluation of some existing PPPs, this article illustrates that the private sector has a key role to play in assisting municipalities to fulfil their legally entrenched disaster management mandate.

  11. Self-medication in academic course graduate of health in a private university of the state of Rio Grande do Sul

    Directory of Open Access Journals (Sweden)

    Thricy Dhamer


    Full Text Available Rationale and Objectives: The World Health Organization defi nes self-medication as the selection and use of medicines by individuals to treat their illnesses or symptoms. It is considered a public health problem that deserves special attention, since it presents risks, because of adverse drug reactions, bringing serious consequences and may lead to the death. To determine the prevalence and characteristics of self-medication realized by undergraduate students enrolled in health courses in a community college, as well the symptoms that led to this practice. Methods: This study was an observational and quantitative research, where it was used structured and pre-coded questionnaires to obtains the data, among students enrolled at 5th and 6th semesters of Biology, Physical Education, Nursing, Pharmacy, Physiotherapy, Medicine, Nutrition, Dentistry and Psychology at the University of Santa Cruz do Sul. Results: 342 students were evaluated, 74% female, aged between 18 and 50, which was the most prevalent age group of 21-30 years, which were 71.4% of students. The prevalence of medicines used among those surveyed was 68.7% last month, with an average of 2 medications per student. The medications were distributed by medical prescription in 282 cases (59.1%, under self-medication in 139 cases (29.1%, oriented by a pharmaceutical in 25 cases (5.2% and no response in 31 cases (6.6%. The classes of drugs most used were analgesics/antipyretics (48.2%, NSAIDs (14.2% and antacids (9.9%. The main purpose of motivating self medication were headache (14.4%, digestive disorders (13.2%, contraception (7.2% and general pain (6.0%. Conclusion: Self medication is a common practice among students in the health area, where about a third reported conduct such practice. KEYWORDS Self-medication. Student Health Occupations. Drugs.

  12. What are the affordances of information and communication technologies?

    Directory of Open Access Journals (Sweden)

    Grainne Conole


    Full Text Available The paper examines the notion that Information and Communication Technologies (ICT have affordances that epitomize the features of our late modern age (Giddens, 1991 and explores whether these affordances (Salomon, 1993, p. 51 can be used to facilitate particular approaches to educational practice. It argues that a clear articulation of these affordances would enable us to understand how these technologies can be most effectively used to support learning and teaching. We believe that any one affordance can be considered to have both positive and negative connotations and the paper draws on social and educational theory to provide an initial taxonomy of these affordances.

  13. The Thirteenth and Fourteenth Amendments: Constitutional Authority for Federal Legislation Against Private Sex Discrimination (United States)

    Calhoun, Emily


    Court cases are cited to indicate that twentieth century federal legislation does not prohibit private discrimination based on sex as rigorously as it does that based on race. Enforcement measures afforded by the thirteenth and fourteenth amendments are noted. For journal availability see HE 509 251. (LBH)

  14. Private Telecom Projects : Private Activity Down 15 Percent in 2003


    Izaguirre, Ada Karina


    Drawing on the World Bank's private participation in infrastructure project database, this note reviews developments in the telecommunications sector in 2003. Data for the year show that investment in projects with private participation was back to 1996 levels. Two regions -the Middle East and North Africa and Europe and Central Asia-saw private activity grow in 2003. And developing countr...

  15. Private Security Training. Phase 3: Private Investigator. Instructor Edition. (United States)

    Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

    This curriculum guide provides instructional materials for the private investigator phase of a private security training course of study. Five units cover the following topics: understanding responsibilities to clients; interpreting laws of private investigations; complying with the Fair Credit Reporting Act; conducting investigations and…

  16. The Affordable Care Act: the ethical call to transform the organizational culture. (United States)

    Piper, Llewellyn E


    The Patient Protection and Affordable Care Act will require health care leaders and managers to develop strategies and implement organizational tactics for their organization to survive and thrive under the federal mandates of this new health care law. Successful health care organizations and health care systems will be defined by their adaptability in the new value-based marketplace created by the Affordable Care Act. The most critical underlining challenge for this success will be the effective transformation of the organizational culture. Transformational value-based leadership is now needed to answer the ethical call for transforming the organizational culture. This article provides a model and recommendations to influence change in the most difficult leadership duty-transforming the organizational culture.

  17. The Affordable Care Act: the ethical call for value-based leadership to transform quality. (United States)

    Piper, Llewellyn E


    Hospitals in America face a daunting and historical challenge starting in 2013 as leadership navigates their organizations toward a new port of call-the Patient Protection and Affordable Care Act. Known as the Affordable Care Act (ACA) was signed into law in March 2010 and held in abeyance waiting on 2 pivotal points-the Supreme Court's June 2012 ruling upholding the constitutionality of the ACA and the 2012 presidential election of Barack Obama bringing to reality to health care organizations that leadership now must implement the mandates of health care delivery under the ACA. This article addresses the need for value-based leadership to transform the culture of health care organizations in order to be successful in navigating uncharted waters under the unprecedented challenges for change in the delivery of quality health care.

  18. Social affordances and the possibility of ecological linguistics. (United States)

    Kono, Tetsuya


    This paper includes an effort to extend the notion of affordance from a philosophical point of view the importance of ecological approach for social psychology, ethics, and linguistics. Affordances are not always merely physical but also interpersonal and social. I will conceptualize affordance in general and social affordance in particular, and will elucidate the relation between intentional action and affordances, and that between affordances and free will. I will also focus on the relation between social institution and affordance. An extended theory of affordances can provide a way to analyze in concrete ways how social institution works as an implicit background of interpersonal interactions. Ecological approach considers social institution as the producer and maintainer of affordances. Social institutions construct the niches for human beings. Finally, I will argue the possibility of the ecological linguistics. Language is a social institution. The system of signs is the way to articulate and differentiate interpersonal affordances. Language acquires its meaning, i.e. communicative power in the interpersonal interactions, and interpersonal interactions, in turn, develop and are elaborated through the usage of signs. Communication is seen as never aimed to transmit inner ideas to others, but to guide and adjust the behaviors of others thorough articulating the affordance of responsible-ness.

  19. 76 FR 41262 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH11-1103 (United States)


    ... funding authority language will read: --This program is authorized under Section 317(k)(2) of the Public... health and help restrain the rate of growth in private and public sector health care costs.'' The ACA and... public health and environmental sectors to improve health tracking, hazard monitoring and...

  20. Offentlig-private partnerskaber (OPP)

    DEFF Research Database (Denmark)

    Thomsen, Christa


    Artiklen diskuterer centrale kommunikative problemstillinger i forbindelse med udviklingen og implementeringen af en model for Social Ansvarlighed i en privat virksomhed. Modellen udvikles og implementeres inden for rammerne af et offentlig-privat partnerskab.......Artiklen diskuterer centrale kommunikative problemstillinger i forbindelse med udviklingen og implementeringen af en model for Social Ansvarlighed i en privat virksomhed. Modellen udvikles og implementeres inden for rammerne af et offentlig-privat partnerskab....

  1. Pharmaceutical pricing: a review of proposals to improve access and affordability of prescription drugs. (United States)

    Tironi, Paula


    This article discusses how pharmaceutical innovation achieves remarkable improvements in human health but a significant portion of the U.S. population cannot afford prescription drugs. The author examines ways that patent protection, generics, supply chain complexity, and the cost of innovation and promotion affect access and affordability. The author then looks at the influences of marketing strategies and industry trends such as the patent cliff and pipeline for new drugs, innovations in biotechnology and genomics, comparative effectiveness analysis, and payor and employer strategies on drug prices. An analysis of reform proposals in the context of industry trends suggests that promoting generic drug use and availability through education, prohibiting authorized generics, and restricting the practice of developing follow-on drugs and discontinuing the original formulations upon patent expiration could improve access and affordability most quickly and significantly.

  2. Affordable Hybrid Heat Pump Clothes Dryer

    Energy Technology Data Exchange (ETDEWEB)

    TeGrotenhuis, Ward E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Butterfield, Andrew [Jabil, St. Petersburg, FL (United States); Caldwell, Dustin D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Crook, Alexander [Jabil, St. Petersburg, FL (United States)


    This project was successful in demonstrating the feasibility of a step change in residential clothes dryer energy efficiency by demonstrating heat pump technology capable of 50% energy savings over conventional standard-size electric dryers with comparable drying times. A prototype system was designed from off-the-shelf components that can meet the project’s efficiency goals and are affordable. An experimental prototype system was built based on the design that reached 50% energy savings. Improvements have been identified that will reduce drying times of over 60 minutes to reach the goal of 40 minutes. Nevertheless, the prototype represents a step change in efficiency over heat pump dryers recently introduced to the U.S. market, with 30% improvement in energy efficiency at comparable drying times.

  3. Affordances of form in stanzaic narrative poetry

    Directory of Open Access Journals (Sweden)

    B. McHale


    Full Text Available This article develops the notion that poetry is crucially distinguished from other forms of verbal art by its foregrounding of segmentivity, the spacing of language. If a measure is regarded as the smallest unit of resistance to meaning, measure determines where gaps open up in a poetic text. Poetry is, however, not only measured, but typically countermeasured and narrative in poetry can also be countermeasured against the segmentation that is specific to narrative. The present article investigates segmentivity in one particular type of narrative poem, namely poems in discontinuous stanzaic forms. The concept of affordances (referring to different potentials for use is applied to the stanzaic form in Edmund Spenser’s “The faerie queene” (1590; 1596 and to the “ottava rima” stanza, as exemplified by Kenneth Koch’s postmodernist narrative poem, “Seasons on earth” (1960; 1977; 1987.

  4. Visual Descriptor Learning for Predicting Grasping Affordances

    DEFF Research Database (Denmark)

    Thomsen, Mikkel Tang


    consisting of surface features was performed. Dimensions in the visual space were varied and the effects were evaluated with the task of grasping unknown object. The evaluation was performed using a novel probabilistic grasp prediction approach based on neighbourhood analysis. The resulting success...... by the task of grasping unknown objects given visual sensor information. The contributions from this thesis stem from three works that all relate to the task of grasping unknown objects but with particular focus on the visual representation part of the problem. First an investigation of a visual feature space......-rates for predicting grasps were between 75% and 90% depending on the object class. The investigations also provided insights into the importance of selecting a proper visual feature space when utilising it for predicting affordances. As a consequence of the gained insights, a semi-local surface feature, the Sliced...

  5. Auctioning Concessions for Private Roads

    NARCIS (Netherlands)

    Ubbels, Barry; Verhoef, Erik


    Private toll roads are now seriously considered as an alternative to public (free-access) road infrastructure. Nevertheless, complete private provision without governmental control is only rarely considered. A main consideration against private roads would be that operators would be primarily intere

  6. Film Images of Private Schools. (United States)

    Resnick, David


    Examines public debate over private education in the context of the Hollywood dramatic feature film. Analyses four recent films that all portray private schools negatively. Film representation of public schools is more optimistic. Asserts that the films ignore or misrepresent three strengths of private education: effective leadership, small school…

  7. Stimuli, Reinforcers, and Private Events (United States)

    Nevin, John A.


    Radical behaviorism considers private events to be a part of ongoing observable behavior and to share the properties of public events. Although private events cannot be measured directly, their roles in overt action can be inferred from mathematical models that relate private responses to external stimuli and reinforcers according to the same…

  8. The Private Higgs

    CERN Document Server

    Porto, Rafael A


    We introduce Higgs democracy in the Yukawa sector by constructing a model with a private Higgs field for each fermion, and an O(1) Yukawa coupling between them, thus addressing the large hierarchy among fermion masses. The Standard Model phenomenology is recovered, in particular no tree level FCNCs are present. We discuss some phenomenological implications which include new Higgses at the TeV scale and a candidate for dark matter.

  9. Private bankers pengeskabelse

    DEFF Research Database (Denmark)

    Ravn, Ib


    Gennem kredit- og långivning bidrager private banker til at øge pengemængden og blæse finansbobler op. Hvorfra kommer bankernes særlige ret til pengeskabelse? Bl.a. fra de engelske guldsmede i 1600-tallet, der først lånte ud af deres guld, men snart fandt det mere lukrativt blot at udlåne...

  10. Imagined Affordance: Reconstructing a Keyword for Communication Theory

    Directory of Open Access Journals (Sweden)

    Peter Nagy


    Full Text Available In this essay, we reconstruct a keyword for communication—affordance. Affordance, adopted from ecological psychology, is now widely used in technology studies, yet the term lacks a clear definition. This is especially problematic for scholars grappling with how to theorize the relationship between technology and sociality for complex socio-technical systems such as machine-learning algorithms, pervasive computing, the Internet of Things, and other such “smart” innovations. Within technology studies, emerging theories of materiality, affect, and mediation all necessitate a richer and more nuanced definition for affordance than the field currently uses. To solve this, we develop the concept of imagined affordance. Imagined affordances emerge between users’ perceptions, attitudes, and expectations; between the materiality and functionality of technologies; and between the intentions and perceptions of designers. We use imagined affordance to evoke the importance of imagination in affordances—expectations for technology that are not fully realized in conscious, rational knowledge. We also use imagined affordance to distinguish our process-oriented, socio-technical definition of affordance from the “imagined” consensus of the field around a flimsier use of the term. We also use it in order to better capture the importance of mediation, materiality, and affect. We suggest that imagined affordance helps to theorize the duality of materiality and communication technology: namely, that people shape their media environments, perceive them, and have agency within them because of imagined affordances.

  11. Lifetime cover in private insurance markets. (United States)

    Brown, H Shelton; Connelly, Luke B


    In the last few decades, private health insurance rates have declined in many countries. In countries and states with community rating, a major cause is adverse selection. In order to address age-based adverse selection, Australia has recently begun a novel approach which imposes stiff penalties for buying private insurance later in life, when expected costs are higher. In this paper, we analyze Australia's Lifetime Cover in the context of a modified version of the Rothschild-Stiglitz insurance model (Rothschild and Stiglitz, 1976). We allow empirically-based probabilities to increase by age for low-risk types. The model highlights the shortcomings of the Australian plan. Based on empirically-based probabilities of illness, we predict that Lifetime Cover will not arrest adverse selection. The model has many policy implications for government regulation encouraging long-term health coverage.

  12. A Agência Nacional de Saúde e a política de saúde mental no contexto do sistema suplementar de assistência à saúde: avanços e desafios The Brazilian National Health Agency and the mental health policy in the context of the private health system: developments and challenges

    Directory of Open Access Journals (Sweden)

    Rachel Torres Salvatori


    Full Text Available O presente estudo trata das políticas de saúde mental conduzidas pela Agência Nacional de Saúde Suplementar - ANS, no cenário da assistência dispensada pelos planos privados de assistência à saúde. Dessa forma, analisa o modelo de regulação econômica e assistencial do setor suplementar, a forma de atuação da ANS como organismo regulador e o tratamento dispensado à assistência à saúde mental nos normativos emanados pela Agência. Concluiu-se que, apesar de avanços como a obrigatoriedade de cobertura para todas as doenças listadas na CID-10, a inclusão do tratamento das tentativas de suicídio e das lesões autoinfligidas, o atendimento por uma equipe multiprofissional, a ampliação do número de sessões com psicólogo, com terapeuta ocupacional e de psicoterapia, e a inclusão do hospital-dia na rede credenciada da operadora, a assistência à saúde mental ainda é pouco normatizada pelos regramentos vigentes no sistema de atenção à saúde suplementar, existindo muitas lacunas a serem preenchidas. A regulamentação dos mecanismos de coparticipação e franquia, a coparticipação crescente como limitador da internação psiquiátrica sem o repensar em uma rede substitutiva e a limitação do número de sessões de psicoterapia de crise são alguns dos desafios colocados para a ANS, no sentido de que esta cumpra realmente o seu papel institucional de promoção da defesa do interesse público na assistência suplementar à saúde.This work analyses the mental health policy-making activity of the Brazilian National Health Agency (ANS, responsible for controlling health insurance companies. Three points are discussed: a the framework of an economic and private health assistance regulatory activity, b the ANS and its regulation activity and c the rules produced by ANS in the mental health care field. It was concluded that, despite advances like the legal obligation to ensure medical treatment to all the diseases listed in

  13. Comparison of substance use, subjective well-being and interpersonal relationships among young people in foster care and private households: a cross sectional analysis of the School Health Research Network survey in Wales (United States)

    Evans, Rhiannon E; Fletcher, Adam; Hewitt, Gillian; Murphy, Simon; Young, Honor; Moore, Graham F


    Objective To investigate the association of living in foster care (FC) with substance use and subjective well-being in a sample of secondary school students (11–16 years) in Wales in 2015/16, and to examine whether these associations are attenuated by the perceived quality of interpersonal relationships. Design Cross-sectional, population-based health behaviour and lifestyle questionnaire. Setting and participants Wales, UK; young people who took part in the 2015/16 School Health Research Network (SHRN) questionnaire (n=32 479). Primary outcome Health behaviours among young people in FC were compared with those from private households. Results The prevalence of all adverse outcomes was higher among young people in FC. Those in FC were significantly more likely to report mephedrone use (OR=9.24, 95% CI 5.60 to 15.34), multiple substance misuse behaviours (OR=3.72, 95% CI 2.30 to 6.00), poorer relationships with peers (RR=1.88, 95% CI 1.23 to 2.88) and teachers (RR=1.83, 95% CI 1.31 to 2.56), having experienced bullying (OR=1.80, 95% CI 1.38 to 2.35), dating violence (OR=1.66, 95% CI 1.13 to 2.43) and poor well-being (RR=1.72, 95% CI 1.20 to 2.46). The association between FC and substance use remained significant, though was attenuated after accounting for relationship variables. The association between FC and subjective well-being became non-significant after adjustment for relationship variables. Conclusions Young people living in FC experience significantly worse outcomes than young people not in care, likely due to a range of care and precare factors, which impact adversely on subsequent social relationships. The analyses are consistent with the hypothesis that the associations of FC with substance use and life satisfaction are partially explained by poorer quality social relationships. Large scale, longitudinal studies are required to investigate the relationship between being in care and health, educational and social outcomes. Mental health interventions

  14. Evolution of US Health Care Reform. (United States)

    Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A


    Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.

  15. 75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program... (United States)


    ... HUMAN SERVICES Administration on Aging Funding Opportunity: Affordable Care Act Medicare Beneficiary...: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care Act... Protection and Affordable Care Act of 2010 (Affordable Care Act). Catalog of Federal Domestic......

  16. Bootstrapping Relational Affordances of Object Pairs using Transfer

    DEFF Research Database (Denmark)

    Fichtl, Severin; Kraft, Dirk; Krüger, Norbert;


    leverage past knowledge to accelerate current learning (which we call bootstrapping). We learn Random Forest based affordance predictors from visual inputs and demonstrate two approaches to knowledge transfer for bootstrapping. In the first approach (direct bootstrapping), the state-space for a new...... affordance predictor is augmented with the output of previously learnt affordances. In the second approach (category based bootstrapping), we form categories that capture underlying commonalities of a pair of existing affordances and augment the state-space with this category classifier’s output. In addition....... We also show that there is no significant difference in performance between direct and category based bootstrapping....

  17. Priority Setting, Cost-Effectiveness, and the Affordable Care Act. (United States)

    Persad, Govind


    The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA's provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the healthcare system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry.

  18. The Affordable Care Act: implications for cardiothoracic surgery. (United States)

    Ferguson, T Bruce; Babb, Joseph A


    The Affordable Care Act legislation that was passed by the US Congress and signed into law by President Obama on March 23, 2010 is having a substantial effect throughout all of health care in the United States. Cardiothoracic surgeons, as hospital-based procedural specialists, bring unique assets and certain important liabilities into this massive restructuring of our health care delivery system. This article highlights how each of the 10 titles in the Obamacare legislation might affect our specialty; its collaborative relationship with our cardiovascular, medical specialty, and primary care colleagues; and our clinical practice roles and responsibilities in accountable care organizations and primary care medical homes. This article also addresses the unique assets in clinical data in medicine and quality improvement demonstrated by our specialty that have been used to help shape the current and future landscape. Finally, key resources are identified to allow the cardiothoracic community to monitor the ongoing progress of Obamacare as implementation begins. Keeping abreast of these rapidly changing developments will be an important role for our specialty societies and for practitioners alike going forward.

  19. Factors influencing the future of paediatric private practice in Malta

    Directory of Open Access Journals (Sweden)

    Victor Grech


    Full Text Available In Malta, the health system is hybrid, with similarities to both UK system and the US system, where the National Health Service is supplemented by private practice. This is widely performed either as a primary job or as a supplement to a government salary. This article reviews unfavourable secular trends in Maltese fertility, births, marriages, separations, single parenthood and loans incurred after marriage, and relates them to (equally unfavourable in terms of private practice escalating numbers of paediatricians working in private practice. Overall, future prospects appear bleak for private practice in this branch of medicine, with a dwindling patient pool being shared by an ever-increasing number of paediatricians. The only identifiable factor that may mitigate is the potential for more private health insurance uptake. This must be coupled with a movement to improve the perception of a substantial proportion of the public that facilities are poorer in the private health sector than in the NHS service. Since Malta is a developed, EU country, these results may (cautiously be extrapolated to other, larger developed countries.

  20. Initial lessons from public-private partnerships in drug and vaccine development. (United States)

    Wheeler, C; Berkley, S


    In recent years, venture capital approaches have delivered impressive results in identifying and funding promising health discoveries and bringing them to market. This success has inspired public sector experiments with "social venture capital" approaches to address the dearth of affordable treatment and prevention for diseases of the developing world. Employing the same focus on well-defined and measurable objectives, and the same type of connections to pool and deploy resources as their for-profit counterparts, social venture capitalists seek to use the tools and incentives of capitalism to solve one of its biggest failures: the lack of drugs and vaccines for diseases endemic to low-income populations. As part of a larger trend of partnerships emerging in health product donation and distribution, public-private partnerships for pharmaceutical development have led research and development (R&D) efforts to generate more accessible and efficacious products for diseases such as malaria, tuberculosis, and AIDS. In this article, three R&D-focused partnerships are explored: the International AIDS Vaccine Initiative; the Medicines for Malaria Venture; and the newly formed Global Alliance for TB Drug Development. The article highlights key elements essential to the success of these ventures.