Public and private health-care financing with alternate public rationing rules.

Science.gov (United States)

Cuff, Katherine; Hurley, Jeremiah; Mestelman, Stuart; Muller, Andrew; Nuscheler, Robert

2012-02-01

We develop a model to analyze parallel public and private health-care financing under two alternative public sector rationing rules: needs-based rationing and random rationing. Individuals vary in income and severity of illness. There is a limited supply of health-care resources used to treat individuals, causing some individuals to go untreated. Insurers (both public and private) must bid to obtain the necessary health-care resources to treat their beneficiaries. Given individuals' willingnesses-to-pay for private insurance are increasing in income, the introduction of private insurance diverts treatment from relatively poor to relatively rich individuals. Further, the impact of introducing parallel private insurance depends on the rationing mechanism in the public sector. We show that the private health insurance market is smaller when the public sector rations according to need than when allocation is random. Copyright © 2010 John Wiley & Sons, Ltd.

Going beyond The three worlds of welfare capitalism: regime theory and public health research.

Science.gov (United States)

Bambra, C

2007-12-01

International research on the social determinants of health has increasingly started to integrate a welfare state regimes perspective. Although this is to be welcomed, to date there has been an over-reliance on Esping-Andersen's The three worlds of welfare capitalism typology (1990). This is despite the fact that it has been subjected to extensive criticism and that there are in fact a number of competing welfare state typologies within the comparative social policy literature. The purpose of this paper is to provide public health researchers with an up-to-date overview of the welfare state regime literature so that it can be reflected more accurately in future research. It outlines The three worlds of welfare capitalism typology, and it presents the criticisms it received and an overview of alternative welfare state typologies. It concludes by suggesting new avenues of study in public health that could be explored by drawing upon this broader welfare state regimes literature.

The Social Impact of Communication during Epidemics: Bioethical and Public Health Perspectives

Directory of Open Access Journals (Sweden)

Eduardo Alfredo Duro

2018-06-01

Full Text Available Public health communication and, especially during a crisis scenario such as an epidemics, is mediated by ethical conflicts ranging from values to deontology. In an intercommunicated world, the social support during outbreaks and epidemics becomes global and the state presence is a key to social protection. This should also be translated into timely, urgent and effective communication strategies from the public health perspective as well as efforts to prevent and avoid fake news or skewed information from any sources. Scenarios with lack of connection and obstacles in mass communication in public health major threats are described.

[Current status of bacteriological studies at prefectural and municipal public health institutes in Japan].

Science.gov (United States)

Shinomiya, Hiroto; Seto, Kazuko; Kawase, Jun; Arikawa, Kentaro; Funatogawa, Keiji; Suzuki, Masahiro; Kubota, Hiroaki; Shirabe, Komei

2015-01-01

Prefectural and municipal public health institutes are located in prefectures and ordinance-designated cities in Japan, and play a vital role in the regional surveillance of infectious diseases and foodborne illnesses. These institutes, in close cooperation with national institutes such as the National Institute of Infectious Diseases and the National Institute of Health Sciences, construct the national surveillance network for infectious diseases and their causative agents. Bacteriological examinations and studies on a variety of infectious diseases and foodborne illnesses are core activities of prefectural and municipal public health institutes, through which novel and important bacteriological findings have been acquired. In this article, we report the latest findings regarding bacteriological examinations/studies and interesting cases at these institutes, especially concerning foodborne illnesses, tuberculosis, and antimicrobial resistances.

Public Heath in Colonial and Post-Colonial Ghana: Lesson-Drawing for The Twenty-First Century

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Adu-Gyamfi, Samuel

2017-06-01

Full Text Available Public health in twenty-first century Ghana is mired with several issues ranging from the inadequacy of public health facilities, improper settlement planning, insanitary conditions, and the inadequacy of laws and their implementation. This situation compared to the colonial era is a direct contradiction. Development in the pre-colonial era to the colonial era sought to make the prevention of diseases a priority in the colonial administration. This was begun with the establishment of the health branch in 1909 as a response to the bubonic plague that was fast spreading in the colony. From here public health policies and strategies were enacted to help the diseases prevention cause. Various public health boards, the medical research institute or the laboratory branch, the waste management department, the use of preventive medicine and maintenance of good settlement planning and sanitation were public health measures in the colonial era. This research seeks to analyse the public health system in the colonial era so as to draw basic lessons for twenty-first century Ghana. Archival data and other secondary sources are reviewed and analysed to help draw these lessons. Richard Rose’s lesson-drawing approach was used to draw the lessons.

Epidemics in the news: Health and hygiene in the press in periods of crisis.

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de Almeida, Maria Antónia Pires

2013-10-01

How did scientific knowledge reach the public? Using the press and keeping in mind the population's limited access to written material, this paper establishes how the latest scientific news was divulged to unspecialised audiences. In times of sanitary crisis in Oporto, such as the cholera morbus epidemic of 1854-1856, the bubonic plague in 1899 and the 1918 influenza pandemic, newspapers were important sources to access the information and advice given to the public. A database of 6700 articles, medical reports and advertisements published in daily newspapers reveals the state of the art of medical science. It also reveals the importance given by health authorities and journalists to the publication of recent discoveries and adequate hygiene procedures to prevent the spread of the epidemics. This is a subject that contributes to the debates on the dissemination of science and on the place that Portugal occupied in the international scientific community.

FEATURES OF E-MEDICINE INTRODUCTION IN THE PUBLIC-PRIVATE PARTNERSHIP

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N. O. Sinyenko

2017-03-01

Full Text Available It was discussed the possibilities and the reality of the e-medicine challenges through technology of public-private partnership (PPP. It is shown that the use of e-medicine is one of the most important levers of improving the quality of medical care in Ukraine. Taking into account that the computerization of health care is extremely expensive project its rapid implementation is possible for the widest possible PPP. It is believed that mobile medicine is the best example of modern PPP. It is postulated that for the effective control of the quality of medical care it should be created specialized expertise and advisory mechanisms in a specialized system of state control of the new system of electronic health systems with strictly defined principles such as objectivity, complimentarily, law and so on.

Role of emerging private hospitals in a post-Soviet mixed health system: a mixed methods comparative study of private and public hospital inpatient care in Mongolia.

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Tsevelvaanchig, Uranchimeg; Gouda, Hebe; Baker, Peter; Hill, Peter S

2017-05-01

The collapse of the Soviet Union in 1990 severely impacted the health sector in Mongolia. Limited public funding for the post-Soviet model public system and a rapid growth of poorly regulated private providers have been pressing issues for a government seeking to re-establish universal health coverage. However, the evidence available on the role of private providers that would inform sector management is very limited. This study analyses the current contribution of private hospitals in Mongolia for the improvement of accessibility of health care and efficiency. We used mixed research methods. A descriptive analysis of nationally representative hospital admission records from 2013 was followed by semi-structured interviews that were carried out with purposively selected key informants (N = 45), representing the main actors in Mongolia's mixed health system. Private-for-profit hospitals are concentrated in urban areas, where their financial model is most viable. The result is the duplication of private and public inpatient services, both in terms of their geographical location and the range of services delivered. The combination of persistent inpatient-oriented care and perverse financial incentives that privilege admission over outpatient management, have created unnecessary health costs. The engagement of the private sector to improve population health outcomes is constrained by a series of issues of governance, regulation and financing and the failure of the state to manage the private sector as an integral part of its health system planning. For a mixed system like in Mongolia, a comprehensive policy and plan which defines the complementary role of private providers to optimize private public service mix is critical in the early stages of the private sector development. It further supports the importance of a system perspective that combines regulation and incentives in consistent policy, rather than an isolated approach to provide regulation. © The Author

Public-Private Partnerships in Chronic Disease Prevention-Part 7

Centers for Disease Control (CDC) Podcasts

This podcast is the last installment of a seven part series discussing public health partnerships with the private sector. In this segment, CDC's Elizabeth Majestic and Georgia State University's Michael Eriksen discuss how some lessons learned in the tobacco control experience might be relevant for the obesity epidemic.

['Judicialization' of public health policy for distribution of medicines].

Science.gov (United States)

Chieffi, Ana Luiza; Barata, Rita Barradas

2009-08-01

The supply of medicines in response to court orders or injunctions has become a common practice in the State of São Paulo, Brazil. This 'judicialization' of the health system clashes with basic principles of the Brazilian Unified National Health System (SUS), such as equal opportunity to access health services. The aim of this paper is to analyze the legal action used to obtain medicines through the São Paulo State Health Department, from two main angles: judicialization of public policies and breach of the equity principle. This is a descriptive study of legal action taken to obtain medicines through the São State Health Department, as listed in the Electronic Court Docket System for the year 2006. Most cases were filed through private attorneys; 47% of the patients had obtained their prescriptions through private care; and 73% of the cases involved patients from the three wealthiest areas in the city of São Paulo. The data demonstrate that such legal action violates key principles of the SUS such as equity, thereby privileging individuals with higher purchasing power and more access to information.

[Public and private in times of the pest].

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Caponi, S

1999-01-01

The paper explores how Hannah Arendt's oppositions public-private and intimate-social can be used as an analytical tool to better understand a very concrete, extreme situation: the state of emergency triggered when an epidemiological outbreak hits a city, totally altering its inhabitants lives. Studied observation of what specific individuals (be they imagined or real) feel and think during times of epidemic is an underutilized tool that may prove helpful in studying epidemics themselves. Focusing on Camus' "The pest" and events in the city of Oran, the article looks at how victims of the plague felt about their public or private lives and their intimate and social ties.

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

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Whyle, Eleanor Beth; Olivier, Jill

2016-12-01

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

Private sector in public health care systems

OpenAIRE

Matějusová, Lenka

2008-01-01

This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market o...

[Environmental medicine in public health service--a social responsibility and its consequences].

Science.gov (United States)

Thriene, B

2001-02-01

The special committee for "Environmental Medicine" established by the Federal Association of Doctors in the German Public Health Service presents its paper entitled "Environmental Medicine in the Public Health Service--A Social Responsibility and its Consequences: Propositions with regard to the situation, aims, strategies, and opportunities for action". The paper includes core ideas and responsibilities in the public health service. It aims at providing a number of guidelines for implementing "Environment and Health" ("Umwelt und Gesundheit"), an action programme by the Federal Ministry of Environmental Protection and the Ministry of Health, as well as "Health 21" ("Gesundheit 21"), the framework concept "Health for all" for the WHO's European Region. The paper also aims at initiating and facilitating steps for joint action by the Public Health Service. These theses were passed on to Mrs. Andrea Fischer, the Federal Minister of Health, during a meeting with the Board of the Association. In Germany, environment-related public health protection is well established in the Public Health Departments and state institutes/departments within the scope of public health provision and disease prevention. Typical responsibilities include environmental hygiene and environment-related medical services which have increased in importance. The range of responsibilities and its current political importance are a result of environment-related public health risks, the social situation of the population, also with regard to health issues, and the scope of responsibilities and competencies by doctors and staff in the public health departments. With the people's demands for health, quality of life and life expectancy, this need for action increases. In this paper, judicial, professional, and personal consequence are presented which arise as public health authorities assume these responsibilities.

Corporate Governance and Intellectual Capital: Evidence from Public and Private Universities

Science.gov (United States)

Wahid, Akma Hidayu Dol Abdu; Abu, Nor Asyiqin; Latif, Wannoraini Abdul; Smith, Malcolm

2013-01-01

This study was conducted to examine the perception of academics towards intellectual capital (IC) and governance practice at two Malaysian universities: University A (a Public University) and University B (a Private University). It also examines the factors which contribute to the retention of qualified academics and the relationship between…

[Racism of "Blood" and colonial medicine - Blood group anthropology studies at Keijo Imperial University Department of Forensic Medicine].

Science.gov (United States)

Jung, Joon Young

2012-12-01

This paper attempts to explore implications of Colonial medicine's Blood Type Studies, concerning the characteristics and tasks of racism in the Japanese Colonial Empire. Especially, it focuses on the Blood Group Anthropology Studies at Keijo Imperial University Department of Forensic Medicine. In Colonial Korea, the main stream of Blood Type Studies were Blood Group Anthropology Studies, which place Korean people who was inferior to Japanese people in the geography of the race on the one hand, but on the other, put Koreans as a missing link between the Mongolian and the Japanese for fulfillment of the Japanese colonialism, that is, assimilationist ideology. Then, Compared to the Western medicine and Metropole medicine of Japan, How differentiated was this tendency of Colonial Medicine from them? In this paper, main issues of Blood Group Anthropology Studies and its colonial implications are examined. The Korean Society for the History of Medicine.

The State Public Health Laboratory System.

Science.gov (United States)

Inhorn, Stanley L; Astles, J Rex; Gradus, Stephen; Malmberg, Veronica; Snippes, Paula M; Wilcke, Burton W; White, Vanessa A

2010-01-01

This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance. To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided.

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

Science.gov (United States)

Peters, David H; Chakraborty, Subrata; Mahapatra, Prasanta; Steinhardt, Laura

2010-11-25

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. 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. 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 public sector, where all 17 items had greater discordance for public sector workers than for workers in the private sector (P < 0.001). 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

Public-Private Partnerships In Health

Directory of Open Access Journals (Sweden)

khalid BOUTI

2015-06-01

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....

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

Science.gov (United States)

Krupp, Karl; Madhivanan, Purnima

2009-02-27

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.

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

Directory of Open Access Journals (Sweden)

Madhivanan Purnima

2009-02-01

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.

Transnational Academic Capitalism in the Arab Gulf: Balancing Global and Local, and Public and Private, Capitals

Science.gov (United States)

Findlow, Sally; Hayes, Aneta L.

2016-01-01

This article contributes to the emerging theoretical construct of what has been called "transnational academic capitalism", characterised by the blurring of traditional boundaries between public, private, local, regional and international, and between market-driven and critically transformative higher education visions. Here we examine…

Public funding and private investment for R&D: a survey in China's pharmaceutical industry.

Science.gov (United States)

Qiu, Lan; Chen, Zi-Ya; Lu, Deng-Yu; Hu, Hao; Wang, Yi-Tao

2014-06-13

In recent years, China has experienced tremendous growth in its pharmaceutical industry. Both the Chinese government and private investors are motivated to invest into pharmaceutical research and development (R&D). However, studies regarding the different behaviors of public and private investment in pharmaceutical R&D are scarce. Therefore, this paper aims to investigate the current situation of public funding and private investment into Chinese pharmaceutical R&D. The primary data used in the research were obtained from the China High-tech Industry Statistics Yearbook (2002-2012) and China Statistical Yearbook of Science and Technology (2002-2012). We analyzed public funding and private investment in five aspects: total investment in the industry, funding sources of the whole industry, differences between provinces, difference in subsectors, and private equity/venture capital investment. The vast majority of R&D investment was from private sources. There is a significantly positive correlation between public funding and private investment in different provinces of China. However, public funding was likely to be invested into less developed provinces with abundant natural herbal resources. Compared with the chemical medicine subsector, traditional Chinese medicine and biopharmaceutical subsectors obtained more public funding. Further, the effect of the government was focused on private equity and venture capital investment although private fund is the mainstream of this type of investment. Public funding and private investment play different but complementary roles in pharmaceutical R&D in China. While being less than private investment, public funding shows its significance in R&D investment. With rapid growth of the industry, the pharmaceutical R&D investment in China is expected to increase steadily from both public and private sources.

The Public Health Innovation Model: Merging Private Sector Processes with Public Health Strengths.

Science.gov (United States)

Lister, Cameron; Payne, Hannah; Hanson, Carl L; Barnes, Michael D; Davis, Siena F; Manwaring, Todd

2017-01-01

Public health enjoyed a number of successes over the twentieth century. However, public health agencies have arguably been ill equipped to sustain these successes and address the complex threats we face today, including morbidity and mortality associated with persistent chronic diseases and emerging infectious diseases, in the context of flat funding and new and changing health care legislation. Transformational leaders, who are not afraid of taking risks to develop innovative approaches to combat present-day threats, are needed within public health agencies. We propose the Public Health Innovation Model (PHIM) as a tool for public health leaders who wish to integrate innovation into public health practice. This model merges traditional public health program planning models with innovation principles adapted from the private sector, including design thinking, seeking funding from private sector entities, and more strongly emphasizing program outcomes. We also discuss principles that leaders should consider adopting when transitioning to the PHIM, including cross-collaboration, community buy-in, human-centered assessment, autonomy and creativity, rapid experimentation and prototyping, and accountability to outcomes.

The Public Health Innovation Model: Merging Private Sector Processes with Public Health Strengths

Directory of Open Access Journals (Sweden)

Cameron Lister

2017-08-01

Full Text Available Public health enjoyed a number of successes over the twentieth century. However, public health agencies have arguably been ill equipped to sustain these successes and address the complex threats we face today, including morbidity and mortality associated with persistent chronic diseases and emerging infectious diseases, in the context of flat funding and new and changing health care legislation. Transformational leaders, who are not afraid of taking risks to develop innovative approaches to combat present-day threats, are needed within public health agencies. We propose the Public Health Innovation Model (PHIM as a tool for public health leaders who wish to integrate innovation into public health practice. This model merges traditional public health program planning models with innovation principles adapted from the private sector, including design thinking, seeking funding from private sector entities, and more strongly emphasizing program outcomes. We also discuss principles that leaders should consider adopting when transitioning to the PHIM, including cross-collaboration, community buy-in, human-centered assessment, autonomy and creativity, rapid experimentation and prototyping, and accountability to outcomes.

Generating social capital through public health leadership training: a six-year assessment.

Science.gov (United States)

Hawley, Suzanne R; St Romain, Theresa; Rempel, Scott L; Orr, Shirley A; Molgaard, Craig A

2012-08-01

Social capital, or a sense of partnership leading to shared goals, provides a means for addressing today's public health workforce challenges. This concept is particularly important in underserved rural areas, though efforts to intentionally generate social capital have been limited. Within the rural state of Kansas, the Kansas Public Health Leadership Institute (KPHLI) has implemented a social capital pre/post assessment to quantify the impact of KPHLI training on social capital within the state's decentralized public health system. This paper discusses 38 assessment items related to bonding, bridging and linking social capital. The assessment was completed pre and post training by 130 of 148 scholars (87.8%) in six KPHLI training cycles. Data were analyzed using Wilcoxon paired t-tests in SPSS. Thirty-five of 38 items demonstrated statistically significant increases at post-test, across all 10 sub-domains. Leadership training by the KPHLI fosters quantifiable increases in characteristics of social capital, which are essential for public health systems to cope with increased workforce demands and prepare for accreditation. This study represents a key first step in examining the deliberate generation of social capital within a decentralized rural environment.

Capitalism and Public Education in the United States

Science.gov (United States)

Schneller, Peter L.

2017-01-01

The United States democratic system includes characteristics of capitalism as well as socialism. Perhaps the most socialistic endeavor of the US is its K-12 public school system; in fact, US public schools are necessary for democracy to thrive and to create an educated and well-informed populace. However, capitalism and socialism are strange…

Public-Private Partnerships in Chronic Disease Prevention-Part 7

Centers for Disease Control (CDC) Podcasts

2009-04-06

This podcast is the last installment of a seven part series discussing public health partnerships with the private sector. In this segment, CDC's Elizabeth Majestic and Georgia State University's Michael Eriksen discuss how some lessons learned in the tobacco control experience might be relevant for the obesity epidemic.  Created: 4/6/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 4/6/2009.

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

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Longo Francesco

2011-04-01

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

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

Science.gov (United States)

Cappellaro, Giulia; Longo, Francesco

2011-04-19

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. 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. 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. Findings suggests that institutional PPPs enable national health

Private health purchasing practices in the public sector: a comparison of state employers and the Fortune 500.

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Maxwell, James; Temin, Peter; Petigara, Tanaz

2004-01-01

State governments are influential purchasers of health benefits but have not been studied extensively. In a recent survey of senior benefit managers, we examine the extent to which states have followed the private-sector approach to purchasing health care. We found that states have adopted "industrial purchasing" practices similar to those of large private employers but offer greater choice of carriers and pay a higher percentage of premiums. Unions continue to influence health care purchasing in both the public and private sectors. Double-digit increases in health costs and the current budget crisis may force states to align their purchasing practices with the private sector to cut costs.

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

Directory of Open Access Journals (Sweden)

Mahapatra Prasanta

2010-11-01

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.

Public funding and private investment for R&D: a survey in China’s pharmaceutical industry

Science.gov (United States)

2014-01-01

Background In recent years, China has experienced tremendous growth in its pharmaceutical industry. Both the Chinese government and private investors are motivated to invest into pharmaceutical research and development (R&D). However, studies regarding the different behaviors of public and private investment in pharmaceutical R&D are scarce. Therefore, this paper aims to investigate the current situation of public funding and private investment into Chinese pharmaceutical R&D. Methods The primary data used in the research were obtained from the China High-tech Industry Statistics Yearbook (2002–2012) and China Statistical Yearbook of Science and Technology (2002–2012). We analyzed public funding and private investment in five aspects: total investment in the industry, funding sources of the whole industry, differences between provinces, difference in subsectors, and private equity/venture capital investment. Results The vast majority of R&D investment was from private sources. There is a significantly positive correlation between public funding and private investment in different provinces of China. However, public funding was likely to be invested into less developed provinces with abundant natural herbal resources. Compared with the chemical medicine subsector, traditional Chinese medicine and biopharmaceutical subsectors obtained more public funding. Further, the effect of the government was focused on private equity and venture capital investment although private fund is the mainstream of this type of investment. Conclusions Public funding and private investment play different but complementary roles in pharmaceutical R&D in China. While being less than private investment, public funding shows its significance in R&D investment. With rapid growth of the industry, the pharmaceutical R&D investment in China is expected to increase steadily from both public and private sources. PMID:24925505

Europe sees mixed results from public-private partnerships for building and managing health care facilities and services.

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Barlow, James; Roehrich, Jens; Wright, Steve

2013-01-01

Prompted in part by constrained national budgets, European governments are increasingly partnering with the private sector to underwrite the costs of constructing and operating public hospitals and other health care facilities and delivering services. Through such public-private partnerships, governments hope to avoid up-front capital expenditure and to harness private-sector efficiencies, while private-sector partners aim for a return on investment. Our research indicates that to date, experience with these partnerships has been mixed. Early models of these partnerships-for example, in which a private firm builds a hospital and carries out building maintenance, which we term an "accommodation-only" model-arguably have not met expectations for achieving greater efficiencies at lower costs. Newer models described in this article offer greater opportunities for efficiency gains but are administratively harder to set up and manage. Given the shortages in public capital for new infrastructure, it seems likely that the attractiveness of these partnerships to European governments will grow.

Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil.

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Rocha, Juan Stuardo Yazlle; Monteiro, Rosane Aparecida; Moreira, Marizélia Leão

2015-01-01

OBJECTIVE To describe the migration flows of demand for public and private hospital care among the health regions of the state of Sao Paulo, Brazil.METHODS Study based on a database of hospitalizations in the public and private systems of the state of Sao Paulo, Southeastern Brazil, in 2006. We analyzed data from 17 health regions of the state, considering people hospitalized in their own health region and those who migrated outwards (emigration) or came from other regions (immigration). The index of migration effectiveness of patients from both systems was estimated. The coverage (hospitalization coefficient) was analyzed in relation to the number of inpatient beds per population and the indexes of migration effectiveness.RESULTS The index of migration effectiveness applied to the hospital care demand flow allowed characterizing health regions with flow balance, with high emigration of public and private patients, and with high attraction of public and private patients.CONCLUSIONS There are differences in hospital care access and opportunities among health regions in the state of Sao Paulo, Brazil.

The role of sleep hygiene in promoting public health: A review of empirical evidence.

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Irish, Leah A; Kline, Christopher E; Gunn, Heather E; Buysse, Daniel J; Hall, Martica H

2015-08-01

The ineffectiveness of sleep hygiene as a treatment in clinical sleep medicine has raised some interesting questions. If it is known that, individually, each specific component of sleep hygiene is related to sleep, why wouldn't addressing multiple individual components (i.e., sleep hygiene education) improve sleep? Is there still a use for sleep hygiene? Global public health concern over sleep has increased demand for sleep promotion strategies accessible to the population. However, the extent to which sleep hygiene strategies apply outside clinical settings is not well known. The present review sought to evaluate the empirical evidence for sleep hygiene recommendations regarding exercise, stress management, noise, sleep timing, and avoidance of caffeine, nicotine, alcohol, and daytime napping, with a particular emphasis on their public health utility. Thus, our review is not intended to be exhaustive regarding the clinical application of these techniques, but rather to focus on broader applications. Overall, though epidemiologic and experimental research generally supported an association between individual sleep hygiene recommendations and nocturnal sleep, the direct effects of individual recommendations on sleep remains largely untested in the general population. Suggestions for clarification of sleep hygiene recommendations and considerations for the use of sleep hygiene in nonclinical populations are discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Digital Health Communication and Global Public Influence: A Study of the Ebola Epidemic.

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Roberts, Hal; Seymour, Brittany; Fish, Sands Alden; Robinson, Emily; Zuckerman, Ethan

2017-01-01

Scientists and health communication professionals expressed frustration over the relationship between misinformation circulating on the Internet and global public perceptions of and responses to the Ebola epidemic originating in West Africa. Using the big data platform Media Cloud, we analyzed all English-language stories about keyword "Ebola" published from 1 July 2014 to 17 November 2014 from the media sets U.S. Mainstream Media, U.S. Regional Media, U.S. Political Blogs, U.S. Popular Blogs, Europe Media Monitor, and Global Voices to understand how social network theory and models of the networked global public may have contributed to health communication efforts. 109,400 stories met our inclusion criteria. The CDC and WHO were the two media sources with the most inlinks (hyperlinks directed to their sites). Twitter was fourth Significantly more public engagement on social media globally was directed toward stories about risks of U.S. domestic Ebola infections than toward stories focused on Ebola infections in West Africa or on science-based information. Corresponding public sentiments about Ebola were reflected in the policy responses of the international community, including violations of the International Health Regulations and the treatment of potentially exposed individuals. The digitally networked global public may have influenced the discourse, sentiment, and response to the Ebola epidemic.

Technical quality of delivery care in private- and public-sector health facilities in Enugu and Lagos States, Nigeria.

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Hirose, Atsumi; Yisa, Ibrahim O; Aminu, Amina; Afolabi, Nathanael; Olasunmbo, Makinde; Oluka, George; Muhammad, Khalilu; Hussein, Julia

2018-06-01

Private-sector providers are increasingly being recognized as important contributors to the delivery of healthcare. Countries with high disease burdens and limited public-sector resources are considering using the private sector to achieve universal health coverage. However, evidence for the technical quality of private-sector care is lacking. This study assesses the technical quality of maternal healthcare during delivery in public- and private-sector facilities in resource-limited settings, from a systems and programmatic perspective. A summary index (the skilled attendance index, SAI), was used. Two-staged cluster sampling with stratification was used to select representative samples of case records in public- and private-sector facilities in Enugu and Lagos States, Nigeria. Information to assess criteria was extracted, and the SAI calculated. Linear regression models examined the relationship between SAI and the private and public sectors, controlling for confounders. The median SAI was 54.8% in Enugu and 85.7% in Lagos. The private for-profit sector's SAI was lower than and the private not-for-profit sector's SAI was higher than the public sector in Enugu [coefficient = -3.6 (P = 0.018) and 12.6 (P private for-profit sector's SAI was higher and the private not-for-profit sector's SAI was lower than the public sector [3.71 (P = 0.005) and -3.92 (P private for-profit providers' care was poorer than public providers where the public provision of care was weak, while private for-profit facilities provided better technical quality care than public facilities where the public sector was strong and there was a relatively strong regulatory body. Our findings raise important considerations relating to the quality of maternity care, the public-private mix and needs for regulation in global efforts to achieve universal healthcare.

Cross-sector partnerships and public health: challenges and opportunities for addressing obesity and noncommunicable diseases through engagement with the private sector.

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Johnston, Lee M; Finegood, Diane T

2015-03-18

Over the past few decades, cross-sector partnerships with the private sector have become an increasingly accepted practice in public health, particularly in efforts to address infectious diseases in low- and middle-income countries. Now these partnerships are becoming a popular tool in efforts to reduce and prevent obesity and the epidemic of noncommunicable diseases. Partnering with businesses presents a means to acquire resources, as well as opportunities to influence the private sector toward more healthful practices. Yet even though collaboration is a core principle of public health practice, public-private or nonprofit-private partnerships present risks and challenges that warrant specific consideration. In this article, we review the role of public health partnerships with the private sector, with a focus on efforts to address obesity and noncommunicable diseases in high-income settings. We identify key challenges-including goal alignment and conflict of interest-and consider how changes to partnership practice might address these.

Shopping on the Public and Private Health Insurance Marketplaces: Consumer Decision Aids and Plan Presentation.

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Wong, Charlene A; Kulhari, Sajal; McGeoch, Ellen J; Jones, Arthur T; Weiner, Janet; Polsky, Daniel; Baker, Tom

2018-05-29

The design of the Affordable Care Act's (ACA) health insurance marketplaces influences complex health plan choices. To compare the choice environments of the public health insurance exchanges in the fourth (OEP4) versus third (OEP3) open enrollment period and to examine online marketplace run by private companies, including a total cost estimate comparison. In November-December 2016, we examined the public and private online health insurance exchanges. We navigated each site for "real-shopping" (personal information required) and "window-shopping" (no required personal information). Public (n = 13; 12 state-based marketplaces and HealthCare.gov ) and private (n = 23) online health insurance exchanges. Features included consumer decision aids (e.g., total cost estimators, provider lookups) and plan display (e.g., order of plans). We examined private health insurance exchanges for notable features (i.e., those not found on public exchanges) and compared the total cost estimates on public versus private exchanges for a standardized consumer. Nearly all studied consumer decision aids saw increased deployment in the public marketplaces in OEP4 compared to OEP3. Over half of the public exchanges (n = 7 of 13) had total cost estimators (versus 5 of 14 in OEP3) in window-shopping and integrated provider lookups (window-shopping: 7; real-shopping: 8). The most common default plan orders were by premium or total cost estimate. Notable features on private health insurance exchanges were unique data presentation (e.g., infographics) and further personalized shopping (e.g., recommended plan flags). Health plan total cost estimates varied substantially between the public and private exchanges (average difference $1526). The ACA's public health insurance exchanges offered more tools in OEP4 to help consumers select a plan. While private health insurance exchanges presented notable features, the total cost estimates for a standardized consumer varied widely on public

The Mediating Effect of Social Capital on the Relationship Between Public Health Managers' Transformational Leadership and Public Health Nurses' Organizational Empowerment in Korea Public Health.

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Jun, Soo Young

2017-12-01

This study was to verify the effect of public health nurse's (PHN's) social capital on the relationship between public health manager's (PHM's) transformational leadership and PHN's organizational empowerment in Korea public health. This was a cross-sectional descriptive study involving 303 PHNs from public health centers in Daegu and Gyeongsangbuk-do cities in South Korea. Data were collected from February 29, 2016 to April 8, 2016, using structured questionnaires which included general characteristics, transformational leadership, organizational empowerment, and social capital. Data were analyzed using descriptive statistics, correlations, and structural equation model. PHM's transformational leadership has a positive effect on PHN's social capital and PHN's organizational empowerment. Social capital had a mediating effect between transformational leadership and organizational empowerment in PHNs. This study suggests that PHM's transformational leadership is a contributing factor to improve PHN's organizational empowerment, and transformational leadership can lead to improve PHN's organizational empowerment through PHN's social capital. So, an intervention program to promote organizational empowerment should include strategies to enhance PHM's transformational leadership as well as to improve PHN's social capital. Copyright © 2017. Published by Elsevier B.V.

Globalizing the history of disease, medicine, and public health in Latin America.

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Espinosa, Mariola

2013-12-01

The history of Latin America, the history of disease, medicine, and public health, and global history are deeply intertwined, but the intersection of these three fields has not yet attracted sustained attention from historians. Recent developments in the historiography of disease, medicine, and public health in Latin America suggest, however, that a distinctive, global approach to the topic is beginning to emerge. This essay identifies the distinguishing characteristic of this approach as an attentiveness to transfers of contagions, cures, and medical knowledge from Latin America to the rest of the world and then summarizes a few episodes that demonstrate its promise. While national as well as colonial and neocolonial histories of Latin America have made important contributions to our understanding, works taking the global approach have the potential to contribute more directly to the decentering of the global history of disease, medicine, and public health.

Public health medicine: the constant dilemma.

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Eskin, Frada

2002-03-01

There is a well-known quotation by the nineteenth-century sociologist Virchow (quoted in Ref. 1) that aptly captures the dilemma that has confronted public health medicine since the specialty was created as a discrete entity in 1848. Virchow said: 'Medicine is politics and social medicine is politics writ large!' What does this mean in relation to effective public health medicine practice and how is it likely to affect its future? There is increasingly limited freedom of expression within the current context of political correctness, central control and a rapidly burgeoning litigious climate. The purpose of this paper is to explore these issues and to propose a means of maintaining public health medicine integrity within a working environment where action is becoming rapidly constrained by political rigidity. An additional factor to be included in the dialogue is the current context within which public health physicians work. Because the majority of public health doctors are employed within the National Health Service (NHS), they are finding themselves being expected to take on tasks and responsibilities marginal to their essential purpose and function. For example, public health physicians spend a great deal of time involved in detailed deliberations about health service provision. Although there is a great deal of evidence to show that good quality health care provision positively affects the health of the individual, there is no evidence to show that this activity has any effect on the population's health status. The essence of public health medicine practice is the prevention of ill-health and the promotion of the health of the population and, consequently, attention needs to be focused on the root causes of disease. However, as these are outside the aegis of the NHS, public health medicine involvement in such issues as education, nutrition, housing, transport and poverty is regarded as marginal to the NHS corporate agenda.

Private management of public schools of Basic Education: a new market under the auspices of the State

Directory of Open Access Journals (Sweden)

Bruno Gawryszewski

2017-09-01

Full Text Available This paper aims to present the private management of public schools of Basic Education as one of the pillars that support a private-market agenda in the Brazilian contemporary field, based on the belief of greater efficiency and quality in order to ensure equal opportunity to all. The theoretical and methodological approach was the analysis of the current Brazilian situation included in the structural crisis of the capital, followed by the examination of private management in American schools, known as charter schools, and initiatives for the education networks in Brazil. We conclude by stating that the private management of public schools can be seen as a resource to prevent the cyclical crises of capital, which has opened up new market opportunities in the education field under the auspices of the Brazilian state.

Assessing the Contributions of Private Health Facilities in a Pioneer Private-Public Partnership in Childhood Immunization in Nigeria

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Oluoha, Chukwuemeka; Ahaneku, Hycienth

2014-01-01

The vision of Nigeria’s immunization program is to reach and sustain routine immunization coverage of greater than 90% for all vaccines by 2020. In order to achieve this, Abia state embarked on a unique private-public partnership (PPP) between private health facilities and the Abia state ministry of health. The aim of this partnership was to collaborate with private health facilities to provide free childhood immunization services in the state - the first of its kind in Nigeria. This is a retrospective study of the 2011 Abia state, Nigeria monthly immunization data. In the 4 local governments operating the PPP, 45% (79/175) of the health facilities that offered immunization services in 2011 were private health facilities and 55% (96/175) were public health facilities. However, 21% of the immunization services took place in private health facilities while 79% took place in public health facilities. Private health facilities were shown to have a modest contribution to immunization in the 4 local governments involved in the PPP. Efforts should be made to expand PPP in immunization nationally to improve immunization services in Nigeria. PMID:28299112

Product development public-private partnerships for public health: a systematic review using qualitative data.

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

2011-10-01

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. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Improvement of hygiene and the combat of epidemics as Russian state concerns during World War I: Prince Alexander von Oldenburg and the POWs of the Central Powers in Russia].

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Nachtigal, Reinhard

2004-01-01

When Russia joined the war against the Central Powers in 1914, she immediately faced problems of public health care among the masses of people who were forced to move across far distances in the country: soldiers, refugees, and prisoners of war. Because of poor organisation and the unexpectedly long duration of the war, the POWs fared worst of all war victims in Russia. Subjected to an overstrained military organisation in the rear, the fate of this broadly neglected group illustrates how and with what success Russia strove to meet its deficiencies in administrative structure during wartime. The "Evacuation and Sanitation Section" was put under the command of a member of the Imperial family, Prince Alexander of Oldenburg, a high ranking official of German origin. This amateur scientist and initiator of medical institutions was an energetic and courageous personality who became vital for the fate of millions of POWs in epidemic-stricken Russia. The role of this "silent" ally of the German and Austro-Hungarian governments has hitherto been unknown. Newly found sources in Russian archives now shed an interesting light on a weak spot of Russia's administration and a generally neglected chapter of the history of medicine, the handling of epidemics and of deficits in hygiene.

Public health and precision medicine share a goal.

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Vaithinathan, Asokan G; Asokan, Vanitha

2017-05-01

The advances made in genomics and molecular tools aid public health programs in the investigation of outbreaks and control of diseases by taking advantage of the precision medicine. Precision medicine means "segregating the individuals into subpopulations who vary in their disease susceptibility and response to a precise treatment" and not merely designing of drugs or creation of medical devices. By 2017, the United Kingdom 100,000 Genomes Project is expected to sequence 100,000 genomes from 70,000 patients. Similarly, the Precision Medicine Initiative of the United States plans to increase population-based genome sequencing and link it with clinical data. A national cohort of around 1 million people is to be established in the long term, to investigate the genetic and environmental determinants of health and disease, and further integrated to their electronic health records that are optional. Precision public health can be seen as administering the right intervention to the needy population at an appropriate time. Precision medicine originates from a wet-lab while evidence-based medicine is nurtured in a clinic. Linking the quintessential basic science research and clinical practice is necessary. In addition, new technologies to employ and analyze data in an integrated and dynamic way are essential for public health and precision medicine. The transition from evidence-based approach in public health to genomic approach to individuals with a paradigm shift of a "reactive" medicine to a more "proactive" and personalized health care may sound exceptional. However, a population perspective is needed for the precision medicine to succeed. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

Public Knowledge, Private Knowledge: The Intellectual Capital of Entrepreneurs. NBER Working Paper No. 14797

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Link, Albert; Ruhm, Christopher

2009-01-01

This paper focuses on the innovative actions of entrepreneurs, namely their tendency to reveal the intellectual capital that results from their research efforts either in the form of public knowledge (publications) or private knowledge (patents). Using data collected by the National Research Council within the U.S. National Academies from their…

Developing a flexible core Dental Public Health curriculum for predoctoral dental and dental hygiene schools.

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Atchison, Kathryn; Mascarenhas, Ana Karina; Bhoopathi, Vinodh

2015-01-01

The curriculum for graduating dental and dental hygiene students must prepare them to contribute to the improvement or maintenance of health for individual patient's and the public's health. The objective is to describe the background for and the process used to develop a core Dental Public Health Curriculum for such students. The process used was to solicit and review existing dental public health curriculum in dental and dental hygiene schools; review curriculum for other health professionals; identify the themes needed to frame the curriculum; select usable materials and identify gaps in existing curricular materials; and develop appropriate curriculum materials that would embody the competencies developed for undergraduate dental and dental hygiene education. Twenty-three topics were identified as embodying the eight competencies. Based on these topics, six courses, Principles of Dental Public Health, Evidence-Based Dentistry, Ethics and Dental Public Health, Dental Public Health Policy and Advocacy, Oral Health Promotion and Disease Prevention, and Oral Health Literacy and Dental Public Health, were prepared. Each course includes syllabus, PowerPoint presentations, student assignments and activities, instructor guide, and classroom discussion points. Depending on the hours available in the existing curriculum at the dental or hygiene school, lecture presentations and take home assignments/discussions may be used independently or in combination with presentations from other courses. In addition, individual discussions and activities may be used to integrate dental public health materials into other courses. A flexible curriculum is available at the AAPHD website to enable the incorporation of DPH topics into the curriculum. © 2015 American Association of Public Health Dentistry.

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

NARCIS (Netherlands)

Clarke, L.

2014-01-01

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

The role and utilisation of public health evaluations in Europe: a case study of national hand hygiene campaigns

Science.gov (United States)

2014-01-01

Background Evaluations are essential to judge the success of public health programmes. In Europe, the proportion of public health programmes that undergo evaluation remains unclear. The European Centre for Disease Prevention and Control sought to determine the frequency of evaluations amongst European national public health programmes by using national hand hygiene campaigns as an example of intervention. Methods A cohort of all national hand hygiene campaigns initiated between 2000 and 2012 was utilised for the analysis. The aim was to collect information about evaluations of hand hygiene campaigns and their frequency. The survey was sent to nominated contact points for healthcare-associated infection surveillance in European Union and European Economic Area Member States. Results Thirty-six hand hygiene campaigns in 20 countries were performed between 2000 and 2012. Of these, 50% had undergone an evaluation and 55% of those utilised the WHO hand hygiene intervention self-assessment tool. Evaluations utilised a variety of methodologies and indicators in assessing changes in hand hygiene behaviours pre and post intervention. Of the 50% of campaigns that were not evaluated, two thirds reported that both human and financial resource constraints posed significant barriers for the evaluation. Conclusion The study identified an upward trend in the number of hand hygiene campaigns implemented in Europe. It is likely that the availability of the internationally-accepted evaluation methodology developed by the WHO contributed to the evaluation of more hand hygiene campaigns in Europe. Despite this rise, hand hygiene campaigns appear to be under-evaluated. The development of simple, programme-specific, standardised guidelines, evaluation indicators and other evidence-based public health materials could help promote evaluations across all areas of public health. PMID:24507086

King Chulalongkorn: biography and his activities in medicine and public health.

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Charulukananan, Somrat; Sueblinvong, Tada

2003-06-01

King Rama V, or Chulalongkorn, was the fifth monarch of the Chakri Dynasty. He was one of the most beloved of the Thai kings due to his many activities including abolishing slavery without bloodshed and especially his skillful diplomacy which succeeded in steering Siam out of the grips of the colonial powers. His activities also included reform of the administration of the kingdom according to the European model and in bringing Siam into the modern era with such exquisite skills that he is still vividly remembered today. His reign also saw many developments in medicine and public health. The King's role in these areas, however, were clouded by his more visible activities in politics and diplomacy. The result is that the Thai public learned rather little about his role in these areas. This article aims at collecting this and to show the King's very important role in modernizing medicine and public health in Siam.

Start Later, Sleep Later: School Start Times and Adolescent Sleep in Homeschool vs. Public/Private School Students

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Meltzer, Lisa J.; Shaheed, Keisha; Ambler, Devon

2014-01-01

Homeschool students provide a naturalistic comparison group for later/flexible school start times. This study compared sleep patterns and sleep hygiene for homeschool students and public/private school students (grades 6-12). Public/private school students (n=245) and homeschool students (n=162) completed a survey about sleep patterns and sleep hygiene. Significant school group differences were found for weekday bedtime, wake time, and total sleep time, with homeschool students waking later and obtaining more sleep. Homeschool students had later school start times, waking at the same time that public/private school students were starting school. Public/private school students had poorer sleep hygiene practices, reporting more homework and use of technology in the hour before bed. Regardless of school type, technology in the bedroom was associated with shorter sleep duration. Later school start times may be a potential countermeasure for insufficient sleep in adolescents. Future studies should further examine the relationship between school start times and daytime outcomes, including academic performance, mood, and health. PMID:25315902

[Social capital as a determinant of public health].

Science.gov (United States)

Bravo Vallejos, N D

The concept of Social Capital (SC), originally described by Durkheim (1893), is composed of dimensions related to cohesion and trust between members of a social group, and considered by the Word Health Organization (WHO) as part of the social determinants of public health for the decrease of inequities and inequalities in health provision. To contribute to the dissemination of the concept of SC related to the social determinants of Public Health, in order to offer the reader in-depth content to observe the potential applications and practices in this field. Literature search (Google Academics™, PubMed, Science direct™, Ebsco Host™). A total of 294 full-text publications were obtained, and those selected were the most influential sources on the evolution and application of the concept of Social Capital, socioeconomic development and health in the last decade. Although the current evidence shows that Social Capital is a determinant related to health, standards are still needed for its measurement. This could allow the concept to be measured, and facilitate its integration into the form of actions that exert positive influence and contribute to the implementation of institutional interventions planned for development and public health. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

'Where is the public health sector?' Public and private sector healthcare provision in Madhya Pradesh, India.

Science.gov (United States)

De Costa, Ayesha; Diwan, Vinod

2007-12-01

This paper aims to empirically demonstrate the size and composition of the private health care sector in one of India's largest provinces, Madhya Pradesh. It is based on a field survey of all health care providers in Madhya Pradesh (60.4 million in 52,117 villages and 394 towns). Seventy-five percent of the population is rural and 37% live below poverty line. This survey was done as part of the development of a health management information system. The distribution of health care providers in the province with regard to sector of work (public/private), rural-urban location, qualification, commercial orientation and institutional set-up are described. Of the 24,807 qualified doctors mapped in the survey, 18,757 (75.6%) work in the private sector. Fifteen thousand one hundred forty-two (80%) of these private physicians work in urban areas. The 72.1% (67793) of all qualified paramedical staff work in the private sector, mostly in rural areas. The paper empirically demonstrates the dominant heterogeneous private health sector and the overall the disparity in healthcare provision in rural and urban areas. It argues for a new role for the public health sector, one of constructive oversight over the entire health sector (public and private) balanced with direct provision of services where necessary. It emphasizes the need to build strong public private partnerships to ensure equitable access to healthcare for all.

Public-Private health sector mix- way forward | Buso | South African ...

African Journals Online (AJOL)

The debate on Public-Private mix has been around in South Africa (SA) for the past ten years. The debate arose out of a realisation of the weaknesses in the public health parallel with the ever-increasing private sector worldwide. The concept has been referred to in different terminologies, public-private mix, public private ...

[Parmentier hygiene and public health].

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Lafont, O

2014-05-01

The legend about Parmentier is quite reductive when it limits his activity to the promotion of potato. This military pharmacist intended mainly to make science serve human being, whatever could be his various activities. Actor of the foundation of food chemistry, reorganizer of military pharmacy, he has always been highly concerned with hygiene and public health. He then studied the quality of water, particularly in the case of river Seine, or the purity of air, especially in hospitals. The affair of Dunkerque exhumations or that of cesspools, or the utilisation of human excrements in agriculture were parts of the occurrences for which he had the opportunity to find a scientific approach allowing to solve the difficult questions that were asked to him, for the best benefit of public health. The exhaustive study he published in "Bulletin de pharmacie" for the conservation of meat shows that he did not ignore anything about freezing of food in order to preserve it. It is necessary not to forget the important role he played, as soon as he were informed of Jenner's discovery, for the diffusion of vaccination in France. It is simply astounding to observe how modern were the questions he solved and how intense was his spirit of dedication to the public good, when exerting his functions in "Comité de Salubrité de la Seine" or "Conseil de Santé des Armées", as well as outside these prestigious institutions. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Public and private health insurance in Germany: the ignored risk selection problem.

Science.gov (United States)

Grunow, Martina; Nuscheler, Robert

2014-06-01

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. Copyright © 2013 John Wiley & Sons, Ltd.

Human rights, public health and medicinal cannabis use.

Science.gov (United States)

Bone, Melissa; Seddon, Toby

2016-01-01

This paper explores the interplay between the human rights and drug control frameworks and critiques case law on medicinal cannabis use to demonstrate that a bona fide human rights perspective allows for a broader conception of 'health'. This broad conception, encompassing both medicalised and social constructionist definitions, can inform public health policies relating to medicinal cannabis use. The paper also demonstrates how a human rights lens can alleviate a core tension between the State and the individual within the drug policy field. The leading medicinal cannabis case in the UK highlights the judiciary's failure to engage with an individual's human right to health as they adopt an arbitrary, externalist view, focussing on the legality of cannabis to the exclusion of other concerns. Drawing on some international comparisons, the paper considers how a human rights perspective can lead to an approach to medicinal cannabis use which facilitates a holistic understanding of public health.

Public health workforce employment in US public and private sectors.

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Kennedy, Virginia C

2009-01-01

The purpose of this study was to describe the number and distribution of 26 administrative, professional, and technical public health occupations across the array of US governmental and nongovernmental industries. This study used data from the Occupational Employment Statistics program of the US Bureau of Labor Statistics. For each occupation of interest, the investigator determined the number of persons employed in 2006 in five industries and industry groups: government, nonprofit agencies, education, healthcare, and all other industries. Industry-specific employment profiles varied from one occupation to another. However, about three-fourths of all those engaged in these occupations worked in the private healthcare industry. Relatively few worked in nonprofit or educational settings, and less than 10 percent were employed in government agencies. The industry-specific distribution of public health personnel, particularly the proportion employed in the public sector, merits close monitoring. This study also highlights the need for a better understanding of the work performed by public health occupations in nongovernmental work settings. Finally, the Occupational Employment Statistics program has the potential to serve as an ongoing, national data collection system for public health workforce information. If this potential was realized, future workforce enumerations would not require primary data collection but rather could be accomplished using secondary data.

Cooperation or Competition: Does Game Theory Have Relevance for Public Health?

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Westhoff, Wayne W.; Cohen, Cynthia F.; Cooper, Elizabeth Elliott; Corvin, Jaime; McDermott, Robert J.

2012-01-01

In this paper, we use game theory to understand decisions to cooperate or to compete in the delivery of public health services. Health care is a quasi-public good that is often associated with altruistic behavior, yet it operates in an increasingly competitive environment. With mounting health care regulation and changes in privatization,…

Public and Private Responsibility for Mental Health: Mental Health's Fourth Revolution.

Science.gov (United States)

Dokecki, Paul R.

Three revolutions in the history of mental health were identified by Nicholas Hobbs: the humane revolution, the scientific and therapeutic revolution, and the public health revolution. The shift of responsibilities for mental health and substance abuse services from the public to the private sector may constitute a fourth mental health revolution.…

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

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

2012-01-01

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

Diffusion theory and knowledge dissemination, utilization, and integration in public health.

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Green, Lawrence W; Ottoson, Judith M; García, César; Hiatt, Robert A

2009-01-01

Legislators and their scientific beneficiaries express growing concerns that the fruits of their investment in health research are not reaching the public, policy makers, and practitioners with evidence-based practices. Practitioners and the public lament the lack of relevance and fit of evidence that reaches them and barriers to their implementation of it. Much has been written about this gap in medicine, much less in public health. We review the concepts that have guided or misguided public health in their attempts to bridge science and practice through dissemination and implementation. Beginning with diffusion theory, which inspired much of public health's work on dissemination, we compare diffusion, dissemination, and implementation with related notions that have served other fields in bridging science and practice. Finally, we suggest ways to blend diffusion with other theory and evidence in guiding a more decentralized approach to dissemination and implementation in public health, including changes in the ways we produce the science itself.

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

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

2002-03-01

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

Comparison of health literacy in privately insured and public hospital orthopaedic patients.

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Cosic, Filip; Porter, Tabitha; Norsworthy, Cameron; Price, Rohan; Bedi, Harvinder

2018-05-14

Objective The aim of the present study was to quantify and compare patient health literacy between privately insured and public orthopaedic patients. Methods As part of the present cross-sectional study, elective postoperative orthopaedic patients across two sites were recruited and asked to complete a questionnaire at the first postoperative out-patient review. Patients were divided into three groups: (1) a public group (Public); (2) a private group (Private-pre); and (3) a private group that completed the questionnaire immediately after the out-patient review (Private-post). The questionnaire consisted of six questions regarding surgical management, expected recovery time and postoperative instructions. Patients were further asked to grade their satisfaction regarding information received throughout their management. Results In all, 150 patients completed the questionnaire, 50 in each of the three groups. Patients in the Public, Private-pre and Private-post groups answered a mean 2.74, 3.24 and 4.70 of 6 questions correctly respectively. The Private-pre group was 1.46-fold more likely to demonstrate correct health literacy than the Public group, whereas the Private-post group was 2.44-fold more likely to demonstrate improved health literacy than the Private-pre group. Patient satisfaction with information received was not associated with health literacy. Conclusion Limited health literacy in orthopaedic patients continues to be an area of concern. Both private and public orthopaedic patients demonstrated poor health literacy, but private patients demonstrated significant improvement after the out-patient review. What is known about the topic? Limited health literacy is a growing public health issue worldwide, with previous literature demonstrating a prevalence of low health literacy of 26% and marginal health literacy of 20% among all patient populations. Of concern, limited health literacy has been shown to result in a range of adverse health outcomes, including

Who are more responsive? Mixed-methods comparison of public and private sector physicians in rural Bangladesh.

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Joarder, Taufique; George, Asha; Sarker, Malabika; Ahmed, Saifuddin; Peters, David H

2017-11-01

Responsiveness of physicians (ROPs) reflects the social actions by physicians to meet the legitimate expectations of health care users. Responsiveness is important since it improves understanding and care seeking by users, as well as fostering trust in health systems rather than replicating discrimination and entrenching inequality. Given widespread public and private sector health care provision in Bangladesh, we undertook a mixed-methods study comparing responsiveness of public and private physicians in rural Bangladesh. The study included in-depth interviews with physicians (n = 12, seven public, five private) and patients (n = 7, three male, four female); focus group discussions with users (four sessions, two male and two female); and observations in consultation rooms of public and private sector physicians (1 week in each setting). This was followed by structured observation of patient consultations with 195 public and 198 private physicians using the ROPs Scale, consisting of five domains (Friendliness; Respecting; Informing and guiding; Gaining trust; and Financial sensitivity). Qualitative data were analysed by framework analysis and quantitative data were analyzed using two-sample t-test, multiple linear regression, multivariate analysis of variance, and descriptive discriminant analyses. The mean responsiveness score of public sector physicians was statistically different from private sector physicians: -0.29 vs 0.29, i.e. a difference of - 0.58 (P-value private sector, according to qualitative findings, neither of the sectors performed optimally. Private physicians scored higher in Friendliness, Respecting and Informing and guiding; while public sector physicians scored higher in other domains. 'Respecting' domain was found as the most important. Unlike findings from other studies in Bangladesh, instead of seeing one sector as better than the other, this study identified areas of responsiveness where each sector needs improvements. © The Author

an examination of risk allocation preferences in public-private

African Journals Online (AJOL)

Chikara Onda

tension in many negotiations between the public and private sector in PPPs ... compensates for higher cost of capital used by private sector partners .... this study, both the public sector client and private sector contractor should share the risks.

Identifying public health competencies relevant to family medicine.

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Harvey, Bart J; Moloughney, Brent W; Iglar, Karl T

2011-10-01

Public health situations faced by family physicians and other primary care practitioners, such as severe acute respiratory syndrome (SARS) and more recently H1N1, have resulted in an increased interest to identify the public health competencies relevant to family medicine. At present there is no agreed-on set of public health competencies delineating the knowledge and skills that family physicians should possess to effectively face diverse public health challenges. Using a multi-staged, iterative process that included a detailed literature review, the authors developed a set of public health competencies relevant to primary care, identifying competencies relevant across four levels, from "post-MD" to "enhanced." Feedback from family medicine and public health educator-practitioners regarding the set of proposed "essential" competencies indicated the need for a more limited, feasible set of "priority" areas to be highlighted during residency training. This focused set of public health competencies has begun to guide relevant components of the University of Toronto's Family Medicine Residency Program curriculum, including academic half-days; clinical experiences, especially identifying "teachable moments" during patient encounters; resident academic projects; and elective public health agency placements. These competencies will also be used to guide the development of a family medicine-public health primer and faculty development sessions to support family medicine faculty facilitating residents to achieve these competencies. Once more fully implemented, an evaluation will be initiated to determine the degree to which these public health competencies are being achieved by family medicine graduates, especially whether they attained the knowledge, skills, and confidence necessary to effectively face diverse public health situations-from common to emergent. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Public health insurance under a nonbenevolent state.

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Lemieux, Pierre

2008-10-01

This paper explores the consequences of the oft ignored fact that public health insurance must actually be supplied by the state. Depending how the state is modeled, different health insurance outcomes are expected. The benevolent model of the state does not account for many actual features of public health insurance systems. One alternative is to use a standard public choice model, where state action is determined by interaction between self-interested actors. Another alternative--related to a strand in public choice theory--is to model the state as Leviathan. Interestingly, some proponents of public health insurance use an implicit Leviathan model, but not consistently. The Leviathan model of the state explains many features of public health insurance: its uncontrolled growth, its tendency toward monopoly, its capacity to buy trust and loyalty from the common people, its surveillance ability, its controlling nature, and even the persistence of its inefficiencies and waiting lines.

Alternative solutions for public and private catastrophe funding in Austria

Science.gov (United States)

Gruber, M.

2008-07-01

The impacts of natural hazards as well as their frequency of occurrence during the last decades have increased decisively. Therefore, the public as well as the private sector are expected to react to this development by providing sufficient funds, in particular for the improvement of protection measures and an enhanced funding of damage compensation for affected private individuals, corporate and public entities. From the public stance, the establishment of an appropriate regulatory environment seems to be indispensable. Structural and legal changes should, on the one hand, renew and improve the current distribution system of public catastrophe funds as well as the profitable investment of these financial resources, and on the other hand, facilitate the application of alternative mechanisms provided by the capital and insurance markets. In particular, capital markets have developed alternative risk transfer and financing mechanisms, such as captive insurance companies, risk pooling, contingent capital solutions, multi-trigger products and insurance securitisation for hard insurance market phases. These instruments have already been applied to catastrophic (re-)insurance in other countries (mainly the US and off-shore domiciles), and may contribute positively to the insurability of extreme weather events in Austria by enhancing financial capacities. Not only private individuals and corporate entities may use alternative mechanisms in order to retain, thus, to finance certain risks, but also public institutions. This contribution aims at analysing potential solutions for an improved risk management of natural hazards in the private and the public sector by considering alternative mechanisms of the capital and insurance markets. Also the establishment of public-private-partnerships, which may contribute to a more efficient cat funding system in Austria, is considered.

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

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Nandi, Sulakshana; Schneider, Helen; Dixit, Priyanka

2017-01-01

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

Integration of health care organizations: using the power strategies of horizontal and vertical integration in public and private health systems.

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Thaldorf, Carey; Liberman, Aaron

2007-01-01

Integration in health care attempts to provide all elements in a seamless continuum of care. Pressures influencing development of system-wide integration primarily come from unsustainable cost increases in the United States over the later part of the 20th century and the early 21st century. Promoters of health care integration assume that it will lead to increased effectiveness and quality of care while concurrently increasing cost-effectiveness and possibly facilitating cost savings. The primary focus of this literature review is on the Power Strategies of Horizontal and Vertical Integration. The material presented suggests that vertical integration is most effective in markets where the partners involved are larger and dominant in the regions they serve. The research has also found that integrating health care networks had little or no significant effect on improving overall organizational efficiencies or profits. Capital investment in information technologies still is cost prohibitive and outweighs its benefits to integration efficiencies in the private sector; however, there are some indications of improvements in publicly provided health care. Further research is needed to understand the reasons the public sector has had greater success in improving effectiveness and efficiency through integration than the private sector.

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.

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

2016-09-01

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. © The Author 2016. Published by Oxford

A means of improving public health in low- and middle-income countries? Benefits and challenges of international public-private partnerships.

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Kostyak, L; Shaw, D M; Elger, B; Annaheim, B

2017-08-01

In the last two decades international public-private partnerships have become increasingly important to improving public health in low- and middle-income countries. Governments realize that involving the private sector in projects for financing, innovation, development, and distribution can make a valuable contribution to overcoming major health challenges. Private-public partnerships for health can generate numerous benefits but may also raise some concerns. To guide best practice for public-private partnerships for health to maximize benefits and minimize risks, the first step is to identify potential benefits, challenges, and motives. We define motives as the reasons why private partners enter partnerships with a public partner. We conducted a systematic review of the literature using the PRISMA guidelines. We reviewed the literature on the benefits and challenges of public-private partnerships for health in low- and middle-income countries provided by international pharmaceutical companies and other health-related companies. We provide a description of these benefits, challenges, as well as of motives of private partners to join partnerships. An approach of systematic categorization was used to conduct this research. We identified six potential benefits, seven challenges, and three motives. Our main finding was a significant gap in the available academic literature on this subject. Further empirical research using both qualitative and quantitative approaches is required. From the limited information that is readily available, we conclude that public-private partnerships for health imply several benefits but with some noticeable and crucial limitations. In this article, we provide a description of these benefits and challenges, discuss key themes, and conclude that empirical research is required to determine the full extent of the challenges addressed in the literature. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights

A double-voiced reading of Romans 13:1–7 in light of the imperial cult

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Sung U. Lim

2015-03-01

Full Text Available Drawing on Mikhail Bakhtin’s theory of double-voicedness and James Scott’s theory of public and hidden transcripts, this essay investigates the colonial context of Romans 13:1–7 with particular attention to the Roman imperial cult. It is my contention that Paul attempts to persuade the audience to resist the imperial cult, whilst negotiating colonial power and authority. It is assumed that colonial discourse is, by nature, a double-voiced discourse in that the public transcript of the dominant and the hidden transcript of the suppressed coexist in a continued state of internal tension and conflict. Seen in this light, Paul as a colonised subject parodies the public transcript of the elites in his own hidden transcript. However, Paul’s doubled-voiced discourse finally turns out to be subversive against the dominant culture by suggesting that ultimate honour, fear, and authority should not be due to the rulers of the Roman Empire but to God.

Public Health System Research in Public Health Emergency Preparedness in the United States (2009-2015): Actionable Knowledge Base.

Science.gov (United States)

Savoia, Elena; Lin, Leesa; Bernard, Dottie; Klein, Noah; James, Lyndon P; Guicciardi, Stefano

2017-09-01

communication barriers experienced by public health and health care personnel. Forty-eight studies provided evidence on how to create and sustain preparedness systems. Results included how to build social capital across organizations and citizens and how to develop sustainable and useful planning efforts that maintain flexibility and rely on available medical data. Twenty-six studies provided evidence on the usefulness of measurement efforts, such as community and organizational needs assessments, and new methods to learn from the response to critical incidents. In the United States, the field of public health emergency preparedness system research has been supported by the US Centers for Disease Control and Prevention since the release of the 2008 Institute of Medicine letter report. The first definition of public health emergency preparedness appeared in 2007, and before 2008 there was a lack of research and empirical evidence across all 4 research areas identified by the Institute of Medicine. This field can be considered relatively new compared with other research areas in public health; for example, tobacco control research can rely on more than 70 years of knowledge production. However, this review demonstrates that, during the past 7 years, public health emergency preparedness system research has evolved from generic inquiry to the analysis of specific interventions with more empirical studies. Public Health Implications: The results of this review provide an evidence base for public health practitioners responsible for enhancing key components of preparedness and response such as communication, training, and planning efforts.

Alternative mechanisms of state public health institutions financing in Ukraine

Directory of Open Access Journals (Sweden)

Hural, Anastasiya

2011-05-01

Full Text Available BACKGROUND. The main source of state public health institutions financing in Ukraine is budgetary funding. In order to overcome the underfunding, the idea of multichannel health financing was proposed in the late 1990s. The main forms of extrabudgetary financial support of public health institutions in Ukraine are voluntary health insurance, non-profit self-financing, charity and sponsorship. The study aims to deeper understand the nature of alternative financing mechanisms of state public health institutions in Ukraine and peculiarities of their use in practice.METHODS. The proposed study is exploratory. Case-study was selected as research method. Nine unstructured interviews were conducted in six health care facilities that have agreed to participate in the study. All studied facilities were in-patient.RESULTS. The sources of financial revenues of the studied institutions were as follows: reimbursement for treatment of insured patients, reimbursement for treatment of sickness funds members, payments for services (medical examinations, counseling, transportation to the hospital, rental of premises, payment for internship from the students of paid forms of medical education, charitable contributions, contracts with companies, contracts with private clinics based in public institutions’ premises (limited liability companies, private entrepreneurs, sponsorship, grants, gifts, payments for services for foreigners, and in-kind revenues. Major health facilities expenditures were the following: salaries (not covered from extrabudgetary revenues; ranged from 70% to 92% of the funds provided to the institutions from state (municipal, regional budget, energy carriers (partially covered from extrabudgetary funds, patients nutrition, medicines, materials, household expenditures, reparation of premises, and purchase of equipment (mostly covered from extrabudgetary revenues. In the studied cases, funds raised by alternative funding mechanisms amounted from

Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka.

Science.gov (United States)

Pallegedara, Asankha; Grimm, Michael

2017-11-01

This paper examines healthcare utilization behaviour in Sri Lanka with special emphasis on the choice between costly private and free public healthcare services. We use a data set that combines nationwide household survey data and district level healthcare supply data. Our findings suggest that even with universal public healthcare policy, richer people tend to use private sector healthcare services rather than public services. We also find significant regional and ethnic discrepancies in healthcare access bearing the risk of social tensions if these are further amplified. Latent class analysis shows in addition that the choice between private and public sector healthcare significantly differs between people with and without chronic diseases. We find in particular that chronically ill people rely for their day-to-day care on the public sector, but for their inpatient care they turn more often than non-chronically ill people to the private sector, implying an additional financial burden for the chronically ill. If the observed trend continues it may not only increase further the health-income gradient in Sri Lanka but also undermine the willingness of the middle class to pay taxes to finance public healthcare. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Enhancing the Macedonian Health System through Implementation of the Public-Private Partnership Model

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Dr.Sc. Iskra Belazelkoska Borizovska

2017-06-01

Full Text Available The research involves determination of the extent to which the public-private partnership model can contribute to the improvement and enhancement of the healthcare services in Macedonia. To achieve this purpose, the research embraces comprehension of the common advantages and disadvantages of this model, encompassed with a case study of the public-private partnership in the specialized-consultative health protection for the health activity-dialysis, together with other efforts to ensure high quality health protection. It also reflects the attitudes of the public authorities and private sector entities regarding the significance of the public-private partnership model, consideration of the advantages and disadvantages before entering public-private partnerships and the ways public-private partnerships affect the employees and employments. The study outlines planned and realised efforts to implement this model to ensure better and more efficient healthcare system. Generally, the results from the survey and the outlined case study present this model as good solution for many healthcare challenges, since public-private partnerships offer different services to the citizens that neither the public nor the private sector could separately achieve. The public-private partnership model leads to new employment opportunities according to the opinion of the public authorities, while the private sector entities consider that public-private partnerships increase the responsibility of the employees in such partnership in comparison to the public sector. The outlined case study is an example of successful public-private partnership model in the field of healthcare and can serve as motivation for further implementation of this model to ensure better, enhanced and modern health system.

Alternative solutions for public and private catastrophe funding in Austria

Directory of Open Access Journals (Sweden)

M. Gruber

2008-07-01

Full Text Available The impacts of natural hazards as well as their frequency of occurrence during the last decades have increased decisively. Therefore, the public as well as the private sector are expected to react to this development by providing sufficient funds, in particular for the improvement of protection measures and an enhanced funding of damage compensation for affected private individuals, corporate and public entities.

From the public stance, the establishment of an appropriate regulatory environment seems to be indispensable. Structural and legal changes should, on the one hand, renew and improve the current distribution system of public catastrophe funds as well as the profitable investment of these financial resources, and on the other hand, facilitate the application of alternative mechanisms provided by the capital and insurance markets.

In particular, capital markets have developed alternative risk transfer and financing mechanisms, such as captive insurance companies, risk pooling, contingent capital solutions, multi-trigger products and insurance securitisation for hard insurance market phases. These instruments have already been applied to catastrophic (re-insurance in other countries (mainly the US and off-shore domiciles, and may contribute positively to the insurability of extreme weather events in Austria by enhancing financial capacities. Not only private individuals and corporate entities may use alternative mechanisms in order to retain, thus, to finance certain risks, but also public institutions.

This contribution aims at analysing potential solutions for an improved risk management of natural hazards in the private and the public sector by considering alternative mechanisms of the capital and insurance markets. Also the establishment of public-private-partnerships, which may contribute to a more efficient cat funding system in Austria, is considered.

[Hygiene in schools - an important issue for the public health services].

Science.gov (United States)

Heudorf, U; Voigt, K; Eikmann, Th; Exner, M

2011-11-01

According to the Protection against Infection Act (IfSG), schools have to identify their arrangements of standard operating procedures (SOPs) for hygienic conditions, and the public health departments are obliged to check the hygienic conditions in schools. Here, practical experience with these topics in Frankfurt/Main, Germany, is presented.Although all schools had been informed about their duties according to IfSG in 2001, only 44% (80/180 schools) of them were able to present their SOPs when requested to do so by the public health department in 2006. Complaints about bad sanitary hygiene in schools have to be confirmed, often even in recently redeveloped facilities, because of vandalism. The equipment of washing basins was improved very well during the influenza pandemic in 2009. In 2010, however, a tendency to deterioration had been observed. With data on high levels on indoor contamination (particles and CO2) in class rooms in 2006, the city increased the frequency of cleaning and launched a programme on proper ventilation in classrooms. However, a study on ventilation in 29 schools in 2009 resulted in very high levels of CO2; obviously the recommendation to ventilate the classrooms every break are neglected. Large studies on drinking water quality exhibited good data, with the exception of high Legionella contaminations in hot water systems supplying the showers in gymnasiums. Major redevelopment measures were necessary.Hygienic conditions in schools should be improved urgently. The public health departments should increase their consulting services as well as their control visits in schools - with the aim to improve hygiene in schools. Responsibility of the schools as well as of the individuals in the schools is demanded as well. More public attention to this topic seems mandatory, may be via a "signal light - red-yellow-green" for schools? © Georg Thieme Verlag KG Stuttgart · New York.

Who owns what? Private ownership and the public interest in recombinant DNA technology in the 1970s.

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Yi, Doogab

2011-09-01

This essay analyzes how academic institutions, government agencies, and the nascent biotech industry contested the legal ownership of recombinant DNA technology in the name of the public interest. It reconstructs the way a small but influential group of government officials and university research administrators introduced a new framework for the commercialization of academic research in the context of a national debate over scientific research's contributions to American economic prosperity and public health. They claimed that private ownership of inventions arising from public support would provide a powerful means to liberate biomedical discoveries for public benefit. This articulation of the causal link between private ownership and the public interest, it is argued, justified a new set of expectations about the use of research results arising from government or public support, in which commercialization became a new public obligation for academic researchers. By highlighting the broader economic and legal shifts that prompted the reconfiguration of the ownership of public knowledge in late twentieth-century American capitalism, the essay examines the threads of policy-informed legal ideas that came together to affirm private ownership of biomedical knowledge as germane to the public interest in the coming of age of biotechnology and genetic medicine.

Reforms are needed to increase public funding and curb demand for private care in Israel's health system.

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Chernichovsky, Dov

2013-04-01

Historically, the Israeli health care system has been considered a high-performance system, providing universal, affordable, high-quality care to all residents. However, a decline in the ratio of physicians to population that reached a modern low in 2006, an approximate ten-percentage-point decline in the share of publicly financed health care between 1995 and 2009, and legislative mandates that favored private insurance have altered Israel's health care system for the worse. Many Israelis now purchase private health insurance to supplement the state-sponsored universal care coverage, and they end up spending more out of pocket even for services covered by the entitlement. Additionally, many publicly paid physicians moonlight at private facilities to earn more money. In this article I recommend that Israel increase public funding for health care and adopt reforms to address the rising demand for privately funded care and the problem of publicly paid physicians who moonlight at private facilities.

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

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Sulakshana Nandi

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

[ACTUAL PROBLEMS OF HYGIENE SCIENCE AND PRACTICE IN THE PRESERVATION OF PUBLIC HEALTH].

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Onishchenko, G G

2015-01-01

In the article there are designated the state and actual hygiene tasks on the issue of environmental pollution and its effects on health of the population. There was emphasized the growing importance of chemical contamination of various objects of environment--air water, soil, and living environment. There is presented the analysis of data on different types of treatment of municipal waste in selected countries. There were shown the significance of the developed Guidance on risk assessmentfor public health as a toolfor making sound management decisions, prospects of using of the methodology of epidemiological mapping based on geoinformational technology (GIS technology). There was marked an important role of the younger generation of hygienists and health officers in further work on both preservation and improvement the health of the population in their countries, harmonization of scientific and practical solutions of actual problems of hygiene.

eHealth Search Patterns: A Comparison of Private and Public Health Care Markets Using Online Panel Data.

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Schneider, Janina Anne; Holland, Christopher Patrick

2017-04-13

Patient and consumer access to eHealth information is of crucial importance because of its role in patient-centered medicine and to improve knowledge about general aspects of health and medical topics. The objectives were to analyze and compare eHealth search patterns in a private (United States) and a public (United Kingdom) health care market. A new taxonomy of eHealth websites is proposed to organize the largest eHealth websites. An online measurement framework is developed that provides a precise and detailed measurement system. Online panel data are used to accurately track and analyze detailed search behavior across 100 of the largest eHealth websites in the US and UK health care markets. The health, medical, and lifestyle categories account for approximately 90% of online activity, and e-pharmacies, social media, and professional categories account for the remaining 10% of online activity. Overall search penetration of eHealth websites is significantly higher in the private (United States) than the public market (United Kingdom). Almost twice the number of eHealth users in the private market have adopted online search in the health and lifestyle categories and also spend more time per website than those in the public market. The use of medical websites for specific conditions is almost identical in both markets. The allocation of search effort across categories is similar in both the markets. For all categories, the vast majority of eHealth users only access one website within each category. Those that conduct a search of two or more websites display very narrow search patterns. All users spend relatively little time on eHealth, that is, 3-7 minutes per website. The proposed online measurement framework exploits online panel data to provide a powerful and objective method of analyzing and exploring eHealth behavior. The private health care system does appear to have an influence on eHealth search behavior in terms of search penetration and time spent per

Imperial or postcolonial governance? Dissecting the genealogy of a global public health strategy.

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Brown, Tim; Bell, Morag

2008-11-01

During the last decades of the 20th century it became increasingly apparent that the inter-relationship between globalisation and health is extremely complex. This complexity is highlighted in debates surrounding the re-emergence of infectious diseases, where it is recognised that the processes of globalisation have combined to create the conditions where once localised, microbial hazards have come to pose a threat to many western nations. By contrast, in an emerging literature relating to the epidemic of non-communicable diseases, and reflected in the WHO 'Global strategy on diet, physical activity and health', it is the so-called 'western lifestyle' that has been cast as the main threat to a population's health. This paper explores critically global responses to this development. Building on our interest in questions of governance and the ethical management of the healthy body, we examine whether the global strategy, in seeking to contain the influence of a 'western lifestyle', also promotes contemporary 'western-inspired' approaches to public health practices. The paper indicates that a partial reading of the WHO strategy suggests that certain countries, especially those outside the West, are being captured or 'enframed' by the integrative ambitions of a western 'imperial' vision of global health. However, when interpreted critically through a postcolonial lens, we argue that 'integration' is more complex, and that the subtle and dynamic relations of power that exist between countries of the West/non-West, are exposed.

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

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

2014-12-12

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

PROBLEMS OF THE DEVELOPMENT OF PUBLIC-PRIVATE PARTNERSHIP IN THE RUSSIAN FEDERATION

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Vladimir B. Zotov

2015-01-01

Full Text Available Public-private partnership (PPP is a complex mechanism, which includes a variety of industry legislation, which together form a system of legislative regulation of relations at the interaction of private and public parties in the realization of long-term capital-intensive investment projects for the development of public infrastructure. The article describes the current state of PPP in the Russian Federation, the analysis of the main problems and needs integrated action (regulatory, institutional and investment to improve and develop this project.

The crisis of the western system of medicine in contemporary capitalism.

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Navarro, V

1978-01-01

This article makes a critique of current interpretations of the crises of the western system of medicine and presents alternative explanations for those crises. It indicates that the crises of medicine--reflected in its ubiquitous problems of costs and ineffectiveness--are due to and reflect the crises of legitimation and capital accumulation of contemporary capitalism. The article is divided into six parts: the first two define the characteristics of the crises of western contemporary capitalism and of its system of medicine, with a critique of current theories which try to explain them. Parts three and four contrapose to these theories a Marxist interpretation of the crises, tracing their causes to the needs created by the process of capital accumulation and to the demands expressed by the working population. The needs and demands generated by Capital and Labor are intrinsically in conflict, and are realized in the daily practice of class struggle. The characteristics and consequences of that struggle for health and for the organization, content, and ideology of medicine are analyzed in the fifth part. This class struggle takes place within a political context in which Capital and its social expression, the bouregeoisie or corporate class, have the dominant influence on the organs of the State. The sixth part of the article shows how that dominance determines the nature of the State responses to the crises of medicine. A primary thesis of this paper is that social class, class struggle, capitalism, and imperialism are not passé categories, as most ideologists of capitalism postulate, but rather they are the most important paradigms for understanding the crises of the western system of power and its medicine.

Exogenous factors and market value: an appraisal model of capital gains in urban redevelopment programs in public/ private partnerships

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Francesco Calabrò

2013-08-01

Full Text Available The proposed article aims to illustrate an experimental model applicable, in the planning stage, to an appraisal of the capital gains in a residential requalification in public/ private partnership. The model develops a method using a conventional cost value through a multicriteria model which evaluates the influence of qualitative exogenous variables to the market value of the property. The aim is to develop a synthetic procedure, transparent, shared and easy to use by the public authorities, in determining the total benefits associated with urban transformations, in order to achieve a fair sharing of profits between public and private entities.

Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries.

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Cameron, Alexandra; Roubos, Ilse; Ewen, Margaret; Mantel-Teeuwisse, Aukje K; Leufkens, Hubertus G M; Laing, Richard O

2011-06-01

To investigate potential differences in the availability of medicines for chronic and acute conditions in low- and middle-income countries. Data on the availability of 30 commonly-surveyed medicines - 15 for acute and 15 for chronic conditions - were obtained from facility-based surveys conducted in 40 developing countries. Results were aggregated by World Bank country income group and World Health Organization region. The availability of medicines for both acute and chronic conditions was suboptimal across countries, particularly in the public sector. Generic medicines for chronic conditions were significantly less available than generic medicines for acute conditions in both the public sector (36.0% availability versus 53.5%; P = 0.001) and the private sector (54.7% versus 66.2%; P = 0.007). Antiasthmatics, antiepileptics and antidepressants, followed by antihypertensives, were the drivers of the observed differences. An inverse association was found between country income level and the availability gap between groups of medicines, particularly in the public sector. In low- and lower-middle income countries, drugs for acute conditions were 33.9% and 12.9% more available, respectively, in the public sector than medicines for chronic conditions. Differences in availability were smaller in the private sector than in the public sector in all country income groups. Current disease patterns do not explain the significant gaps observed in the availability of medicines for chronic and acute conditions. Measures are needed to better respond to the epidemiological transition towards chronic conditions in developing countries alongside current efforts to scale up treatment for communicable diseases.

School health services and its practice among public and private primary schools in Western Nigeria.

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Kuponiyi, Olugbenga Temitope; Amoran, Olorunfemi Emmanuel; Kuponiyi, Opeyemi Temitola

2016-04-06

Globally the number of children reaching school age is estimated to be 1.2 billion children (18% of the world's population) and rising. This study was therefore designed to determine the school health services available and its practices in primary schools in Ogun state, Western Nigeria. The study was a comparative cross-sectional survey of private and public primary schools in Ogun state using a multi-stage sampling technique. Participants were interviewed using a structured, interviewer administered questionnaire and a checklist. Data collected was analyzed using the SPSS version 15.0. A total of 360 head teachers served as respondents for the study with the overall mean age of 45.7 ± 9.9 years. More than three quarters of the respondents in both groups could not correctly define the school health programme. There were no health personnel or a trained first aider in 86 (47.8%) public and 110 (61.1%) private schools but a nurse/midwife was present in 57 (31.7%) and 27 (15.0%) public and private schools. (χ(2) = 17.122, P = 0.002). In about 95% of the schools, the teacher carried out routine inspection of the pupils while periodic medical examination for staff and pupils was carried out in only 13 (7.2%) public and 31 (17.2%) private schools (χ(2) = 8.398, P = 0.004). A sick bay/clinic was present in 26 (14.4%) and 67 (37.2%) public and private schools respectively (χ(2) = 24.371, P = 0.001). The practice of school health programme was dependent on the age (χ(2) = 12.53, P = 0.006) and the ethnicity of the respondents (χ(2) = 6.330, P = 0.042). Using multivariate analysis only one variable (type of school) was found to be a predictor of school health programme. (OR 4.55, CI 1.918-10.79). The study concludes that the practice of the various components of school health services was poor but better in private primary schools in Nigeria. Routine inspection by teachers was the commonest form of health appraisal. This may suggest that more health personnel need to

Herbal medicine use among hypertensive patients attending public and private health facilities in Freetown Sierra Leone.

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James, Peter Bai; Kamara, Halimatu; Bah, Abdulai Jawo; Steel, Amie; Wardle, Jon

2018-05-01

This study aimed to determine the prevalence, determinants and pattern of herbal medicine use among hypertensive patients in Freetown. We conducted a cross-sectional study among hypertensive patients attending public and private health facilities in Freetown, Sierra Leone between August and October 2016. We analyzed the data using SPSS version 24. We used Chi-square, Fisher exact two-tailed test and regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant. Out of 260 study participants, over half (n = 148, 56.9%) reported using herbal medicine for the treatment of hypertension alone or together with comorbid condition(s). The most commonly used herbal medicine among users were honey (n = 89, 33.3%), moringa (n = 80, 30.0%) and garlic (n = 73, 27.3%). No significant difference existed between users and non-users of herbal medicine with regards to socio-demographic and health-related factors. The majority (n = 241, 92.7%) of respondents considered herbal medicine beneficial if it was recommended by a healthcare provider yet 85.1% (n = 126) did not disclose their herbal medicine use to their health care provider. There is a high use of herbal medicines among hypertensive patients in Freetown, Sierra Leone. It is essential for healthcare providers to take heed of the findings of this study and routinely ask their patients about their herbal medicine use status. Such practice will provide the opportunity to discuss the benefits and risks of herbal medicine use with the aim of maximizing patient desired therapeutic outcomes. Copyright © 2018 Elsevier Ltd. All rights reserved.

The impact of globalization on public health: implications for the UK Faculty of Public Health Medicine.

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Lee, K

2000-09-01

There has been substantial discussion of globalization in the scholarly and popular press yet limited attention so far among public health professionals. This is so despite the many potential impacts of globalization on public health. Defining public health broadly, as focused on the collective health of populations requiring a range of intersectoral activities, globalization can be seen to have particular relevance. Globalization, in turn, can be defined as a process that is changing the nature of human interaction across a wide range of spheres and along at least three dimensions. Understanding public health and globalization in these ways suggests the urgent need for research to better understand the linkages between the two, and effective policy responses by a range of public health institutions, including the UK Faculty of Public Health Medicine. The paper is based on a review of secondary literature on globalization that led to the development of a conceptual framework for understanding potential impacts on the determinants of health and public health. The paper then discusses major areas of public health in relation to these potential impacts. It concludes with recommendations on how the UK Faculty of Public Health Medicine might contribute to addressing these impacts through its various activities. Although there is growing attention to the importance of globalization to public health, there has been limited research and policy development in the United Kingdom. The UK Faculty of Public Health Medicine needs to play an active role in bringing relevant issues to the attention of policy makers, and encourage its members to take up research, teaching and policy initiatives. The potential impacts of globalization support a broader understanding and practice of public health that embraces a wide range of health determinants.

'A great beneficial disease': colonial medicine and imperial authority in J.G. Farrell's The Siege of Krishnapur.

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Goodman, Sam

2015-06-01

This article examines J. G. Farrell's depictions of colonial medicine as a means of analysing the historical reception of the further past and argues that the end-of-Empire context of the 1970s in which Farrell was writing informed his reappraisal of Imperial authority with particular regard to the limits of medical knowledge and treatment. The article illustrates how in The Siege of Krishnapur (1973), Farrell repeatedly sought to challenge the authority of medical and colonial history by making direct use of period material in the construction of his fictional narrative; by using these sources with deliberate critical intent, Farrell directly engages with the received historical narrative of colonial India, that the British presence brought progress and development, particularly in matters relating to medicine and health. To support these assertions the paper examines how Farrell employed primary sources and period medical practices such as the nineteenth-century debate between miasma and waterborne Cholera transmission and the popularity of phrenology within his novels in order to cast doubt over and interrogate the British right to rule. Overall the paper will argue that Farrell's critique of colonial medical practices, apparently based on science and reason, was shaped by the political context of the 1970s and used to question the wider moral position of Empire throughout his fiction.

Public-private partnership from theory to practice: Walgreens and the Boston Public Health Commission supporting each other before and after the Boston bombings.

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Martin, Atyia; Williams, Jim

2014-01-01

This paper presents an overview of the public health and medical services continuity of operations, response and recovery efforts in the aftermath of the Boston bombings. Countless public and private organisations and agencies came together to support the community and the survivors. The efforts of these organisations define what it means to be Boston Strong.

Ebola policies that hinder epidemic response by limiting scientific discourse.

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Asgary, Ramin; Pavlin, Julie A; Ripp, Jonathan A; Reithinger, Richard; Polyak, Christina S

2015-02-01

There is an unprecedented epidemic of Ebola virus disease (EVD) in west Africa. There has been a strong response from dedicated health professionals. However, there have also been irrational and fear-based responses that have contributed to misallocation of resources, stigma, and deincentivizing volunteers to combat Ebola at its source. Recently, the State of Louisiana Department of Health and Hospitals issued a ban on those coming from affected countries wishing to attend the annual meetings of American Society of Tropical Medicine and Hygiene and the American Public Health Association, both of which were held in New Orleans. We argue against such policies, question evidence and motivations, and discuss their practical and ethical implications in hampering effective responses to EVD by the scientific community. We aim to shed light on this issue and its implications for the future of public health interventions, reflect on the responsibility of health providers and professional societies as advocates for patients and the public health, and call for health professionals and societies to work to challenge inappropriate political responses to public health crises. © The American Society of Tropical Medicine and Hygiene.

Political instability and discontinuity in Nigeria: The pre-colonial past and public goods provision under colonial and post-colonial political orders

NARCIS (Netherlands)

Papaioannou, K.I.; Dalrymple-Smith, A.E.

2015-01-01

This article explores the relative importance of pre-colonial institutional capacity and the effects of periods of peace and stability on long-term development outcomes in Nigeria. We use data on education, health, and public works at a provincial level from a variety of colonial and Nigerian state

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

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

2016-01-01

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.

Transitions in state public health law: comparative analysis of state public health law reform following the Turning Point Model State Public Health Act.

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Meier, Benjamin Mason; Hodge, James G; Gebbie, Kristine M

2009-03-01

Given the public health importance of law modernization, we undertook a comparative analysis of policy efforts in 4 states (Alaska, South Carolina, Wisconsin, and Nebraska) that have considered public health law reform based on the Turning Point Model State Public Health Act. Through national legislative tracking and state case studies, we investigated how the Turning Point Act's model legal language has been considered for incorporation into state law and analyzed key facilitating and inhibiting factors for public health law reform. Our findings provide the practice community with a research base to facilitate further law reform and inform future scholarship on the role of law as a determinant of the public's health.

Ten Years of Medicinal Chemistry (2005-2014) in the Journal of Medicinal Chemistry: Country of Contributors, Topics, and Public-Private Partnerships.

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Costantino, Luca; Barlocco, Daniela

2016-08-25

This review analyzes the articles that have appeared during the past 10 years in the Journal of Medicinal Chemistry, the leading journal in the field of medicinal chemistry, to provide a picture of the changing trends in this research area. Our analysis involved the country of the corresponding author, assuming that he/she was the leader of the research group, the interaction between private and public sectors, and the research topics. This analysis provides information on the contributions to the journal of authors from each country and highlights the differences between the public and private sectors regarding the research topics pursued. Moreover, changes in the number of articles that describe work on hits, leads, or clinical candidates during these years have been correlated with the affiliation of the contributors (public or private). An analysis of top-cited articles that have appeared in the journal has also been included. The data will provide the basis for understanding the evolution that is taking place in medicinal chemistry.

Public-Private Partnerships in Chronic Disease Prevention-Part 6

Centers for Disease Control (CDC) Podcasts

This podcast is the sixth of a seven part series discussing public health partnerships with the private sector. In this segment, CDC's Elizabeth Majestic and Georgia State University's Michael Eriksen discuss whether the tobacco industry has forfeited its opportunity to participate in traditional public-private partnerships.

Training physician investigators in medicine and public health research.

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Gourevitch, Marc N; Jay, Melanie R; Goldfrank, Lewis R; Mendelsohn, Alan L; Dreyer, Benard P; Foltin, George L; Lipkin, Mack; Schwartz, Mark D

2012-07-01

We have described and evaluated the impact of a unique fellowship program designed to train postdoctoral, physician fellows in research at the interface of medicine and public health. We developed a rigorous curriculum in public health content and research methods and fostered linkages with research mentors and local public health agencies. Didactic training provided the foundation for fellows' mentored research initiatives, which addressed real-world challenges in advancing the health status of vulnerable urban populations. Two multidisciplinary cohorts (6 per cohort) completed this 2-year degree-granting program and engaged in diverse public health research initiatives on topics such as improving pediatric care outcomes through health literacy interventions, reducing hospital readmission rates among urban poor with multiple comorbidities, increasing cancer screening uptake, and broadening the reach of addiction screening and intervention. The majority of fellows (10/12) published their fellowship work and currently have a career focused in public health-related research or practice (9/12). A fellowship training program can prepare physician investigators for research careers that bridge the divide between medicine and public health.

Public and private in italian health care: trends and market quotas

Directory of Open Access Journals (Sweden)

Maria Michela Gianino

2006-12-01

Full Text Available

Background: The Italian healthcare system has two components: public and private healthcare providers. Both deliver services on behalf of and payable by the national health care service. This study explores therelationships between public and private healthcare providers.

Methods: The number of hospital admissions and length of stay or number of times the service was accessed stratified by year 2000, 2001, 2002; DRG; type of hospital admission (ordinary or day hospital/surgery; health provider category: public institutions without a specific reference territory, public institutions with a specific reference territory and accredited private institutions and medical or surgery DRGs. A distinction is made between those DRGs defined as belonging to the private sector and those falling within the public sector, assuming there is a majority market portion for services primarily supplied by the private sector. Case-mix index was utelised as the indicator for the complexity of the cases treated and the comparative performance index was used as the indicator for efficiency. Lastly in order to evaluate the services delivered with an inappropriate organizational profile reference is made the rulings defining Essential Level of assistance.

Results: The results showed a shift in the reallocation of service volumes for ordinary admissions towards the private sector; the reallocation relates to the volumes but not to the types of cases treated, since the DRG mix remained substantially unchanged over the 3-year period and those DRG that absorb 51% of services were essentially constant. The private sector never achieved a market majority quota but rather controlled market niches with minority quotas. The private institutions treated less complex cases and worked with lower efficiency levels than the public sector. There was also a shift in the distribution of admissions from ordinary admissions to

Does Government Public Capital Expenditure Matter?: Evidence for Canada

OpenAIRE

Dadgostar, Bahram; Mirabelli, Frank

1998-01-01

Does the provision of Canadian government capital expenditures and government deficits displace private economic activity? In the U.S., Erenburg (1993) found that private sector investment spending is enhanced by expected increases in public spending on infrastructure, while also showing that deficit spending has no significant effect on private investment. There is no empirical study to date that addresses the relationship between government capital investment and government debt on private ...

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

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

2015-03-01

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

The Impact of Public Capital Investments on the Revenue Growth of Medium Enterprise in Indonesia

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Darius Tirtosuharto

2012-09-01

Full Text Available Public capital investment represents the role of state and local governments in supporting greater capacity of private enterprises to gain success in a market economy measured by revenue growth. Medium enterprises are considered as the catalysts for economic growth and competitiveness particularly in developing countries due to efficiency and flexibility in an adverse economic environment. Using aggregate data of 30 states (provinces in Indonesia from 1997-2002, the impact of public capital investment on the revenue growth of medium enterprise is examined. The paper finds that only medium enterprises in the industrial and trading sector benefited from public capital investments and the most optimum capital investment is in transport infrastructure.

PPACA and public health: creating a framework to focus on prevention and wellness and improve the public's health.

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Majette, Gwendolyn Roberts

2011-01-01

PPACA epitomizes comprehensive health care reform legislation. Public health, disease prevention, and wellness were integral considerations in its development. This article reveals the author's personal experiences while working on the framework for health care reform in the United States Senate and reviews activity in the United States House of Representatives. This insider's perspective delineates PPACA's positive effect on public health by examining the infrastructure Congress designed to focus on prevention, wellness, and public health, with a particular focus on the National Prevention, Health Promotion and Public Health Council; the National Prevention, Health Promotion, Public Health, and Integrative Health Care Strategy; and the Prevention and Public Health Fund. The Council, strategy, and fund are especially important because they reflect compliance with some of the Institute of Medicine's recommendations to improve public health in the United States, as well as international health and human rights norms that protect the right to health. © 2011 American Society of Law, Medicine & Ethics, Inc.

Social capital in Japan: What characteristics do public health nurses see in their communities?

Science.gov (United States)

Honda, Hikaru; Kawaharada, Mariko; Shindo, Yukari; Tanaka, Rie; Nakajima, Ayaka; Nimura, Yuki

2018-04-01

A concept of social capital that accounts for a community's cultural background and incorporates social capital into public health nursing practice are needed. This study aimed to describe the characteristics of social capital in the context of public health nursing in Japan. The study interviewed 11 veteran public health nurses from five municipalities across Japan and undertook a qualitative research analysis. A digital voice recorder was used to collect qualitative data by using a background data sheet and semistructured interviews. Trustworthiness in interpreting the data was ensured by conducting 13 additional interviews with residents and collating the two sets of results. All the participants were female: 10 were veterans with ≥15 years' experience. Nine worked in management. The methods yielded six categories: (i) the richness of the interactions among the residents; (ii) the community residents who showed concern for those in need; (iii) community civic activities; (iv) the residents' willingness to contribute to the community; (v) the health promotion volunteers who work alongside the public health nurses; and (vi) an enriched community environment. The results contribute to an understanding of social capital in the context of public health nursing activities and further research on social capital. It also is discussed how social capital can be incorporated into public health nursing activities in the future. © 2017 Japan Academy of Nursing Science.

Hazard analysis critical control point (HACCP) in public catering services: a modified method, combined to bacteriologic assay.

Science.gov (United States)

Ferrari, P

1992-01-01

During 1990 and 1991 the Veterinary and Public Health Services of USL 35 of Ravenna carried out a research programme aimed at the control of food-borne diseases in the sector of public catering services, in collaboration with the Public Health Laboratory (Presidio Multizonale di Prevenzione). The objectives were: obtaining sure information about health hazards in public catering services; checking structural characteristics and equipment of workrooms in restaurants, hotels and refectories; verifying food preparation and preservation methods; promoting health education to increase employees' awareness of hygiene-related problems. The first objective, evaluation of the level of the control of the workrooms exerted on the food contamination hazard by pathogenic or potentially pathogenic organisms, was carried out by allotting specific scores to several characteristics of laboratories or workers' habits, as suggested by the "Hazard Analysis Critical Control Point" (HACCP) method for butcher's shops and fish markets. Five hundred ninety-eight public catering service units have been inspected in restaurants, hotels, school-refectories, factories, hospitals and social houses; 2,097 bacteriological examinations by agar-contact plates and swabs were carried out; 118 preserved-food temperatures were measured, especially in deep-frozen and cooked food; 70 food specimens were tested to search for Salmonella spp. and Staphylococcus aureus and measure Total Aerobic Mesophilic Weight. The presence of Enterobacteriaceae and Escherichia coli was also tested.

Is there a crack epidemic among students in Brazil?: comments on media and public health issues.

Science.gov (United States)

Nappo, Solange Aparecida; Sanchez, Zila M; Ribeiro, Luciana Abeid

2012-09-01

In the past year, the Brazilian Federal Government and society have reported and acted on a crack use epidemic, which has been exacerbated by the media. This study hypothesized that crack use has not increased at the rate suggested by the Brazilian media. A cross-sectional survey was carried out in 2010 using a multistage probabilistic representative sample of Brazilian middle and high school students in the country's 27 state capitals. A total of 50,890 valid questionnaires were weighted, analyzed and results compared to the 2004 national school survey dataset. Considering lifetime and past year crack use, no change in consumption was found between 2004 and 2010. Official data in Brazil on middle and high school students does not support the assertion of a crack epidemic widely publicized by the media. Government measures to treat and prevent crack use are encouraged; however, the term epidemic has been inappropriately used to represent the static prevalence of crack consumption among students.

Linking public relations processes and organizational effectiveness at a state health department.

Science.gov (United States)

Wise, Kurt

2003-01-01

This qualitative case study explored a state health department's relationships with strategic constituencies from a public relations perspective. The relationships were explored within the theoretical framework of the Excellence Theory, the dominant paradigm in public research. Findings indicate application of the Excellence Theory has the potential to increase organizational effectiveness at public health entities. With respect to the case investigated, findings indicate that the state health department could increase its organizational effectiveness through the adoption of recommendations based on the Excellence Theory.

Public health emergencies and the public health/managed care challenge.

Science.gov (United States)

Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra

2002-01-01

The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

The Impact of Public Capital Investments on the Revenue Growth of Medium Enterprise in Indonesia

OpenAIRE

Tirtosuharto, Darius

2012-01-01

Public capital investment represents the role of state and local governments in supporting greater capacity of private enterprises to gain success in a market economy measured by revenue growth. Medium enterprises are considered as the catalysts for economic growth and competitiveness particularly in developing countries due to efficiency and flexibility in an adverse economic environment. Using aggregate data of 30 states (provinces) in Indonesia from 1997-2002, the impact of public capital ...

Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs

Science.gov (United States)

Gifford, Gregory A.; Edwards, Kevan R.; Knutson, David J.

2004-01-01

This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model. PMID:25372356

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

Directory of Open Access Journals (Sweden)

Peter Waiswa

2015-03-01

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

[Public-private relations in the Colombian health system from 1991 to 2015].

Science.gov (United States)

Cárdenas, William Iván López; Pereira, Adelyne Maria Mendes; Machado, Cristiani Vieira

2017-07-27

The case of Colombia's health system exemplifies the neoliberal reforms conducted in Latin America, characterized by the private sector's broad participation in the administration of resources and provision of health services. The system includes a set of benefits for persons that can afford to pay and a package of basic services with state financing for poor persons. This study aimed to analyze the public-private arrangements in the Colombian health system from 1991 and 2015, including the dimensions of insurance and financing. A case study was performed that included a literature review and analysis of documents and secondary data. The results suggest that the 1993 reform conceived of health as a public service to be provided by the market. There were changes in the state's role, delegating health care functions to the private sector through regulatory and contractual measures. Beginning in 2000, incremental reforms included instrumental changes in the system, while other initiatives aimed to expand the state's responsibilities in guaranteeing the right to health. In terms of health insurance, the main advances were the expansion of insurance coverage and harmonization of baskets of benefits between different insurance systems (although late). As for financing, there are important inequities in per capita spending between the different insurance systems and inefficiency in the financial intermediation. The Colombian case underscores the limits of structuring health systems with heavy market participation, and the study contributes to the debate on the challenges for social protection in health in Latin American countries.

Public-Private Partnerships in Chronic Disease Prevention-Part 6

Centers for Disease Control (CDC) Podcasts

2009-04-06

This podcast is the sixth of a seven part series discussing public health partnerships with the private sector. In this segment, CDC's Elizabeth Majestic and Georgia State University's Michael Eriksen discuss whether the tobacco industry has forfeited its opportunity to participate in traditional public-private partnerships.  Created: 4/6/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 4/6/2009.

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

Science.gov (United States)

Sikder, Shegufta S; Labrique, Alain B; Ali, Hasmot; Hanif, Abu A M; Klemm, Rolf D W; Mehra, Sucheta; West, Keith P; Christian, Parul

2015-01-31

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 to healthcare and key constraints to EmOC provision. Using data from a large population-based community trial, we identified and surveyed the 14 health facilities (7 public, 7 private) most frequently visited for obstetric complications and near misses as reported by women. Availability of EmOC was based on provision of medical services, assessed through clinician interviews and record review. Levels of EmOC availability were defined as basic or comprehensive. Readiness for EmOC provision was based on scores in four categories: staffing, equipment, laboratory capacity, and medicines. Readiness scores were calculated using unweighted averages. Costs of C-section procedures and geographic locations of facilities were described. Textual analysis was used to identify key constraints. The seven surveyed private facilities offered comprehensive EmOC compared to four of the seven public facilities. With 100% representing full readiness, mean EmOC readiness was 81% (range: 63%-91%) among surveyed private facilities compared to 67% (range: 48%-91%) in public facilities (p = 0.040). Surveyed public clinics had low scores on staffing and laboratory capacity (69%; 50%). The mean cost of the C-section procedure in private clinics was $77 (standard deviation: $16) and free in public facilities. The public sub-district facilities were the only facilities located in rural areas, with none providing comprehensive EmOC. Shortages in specialized staff were listed as the main barrier to EmOC provision in

Medical police and the nanny state: public health versus private autonomy.

Science.gov (United States)

Baron, Jeremy Hugh

2006-07-01

Rome tried to increase both the numbers of its people and their well-being, and hence their wealth, but it was not until the 16th century that European rulers were urged to achieve these aims by the power of the state to enforce public health. By the 17th century, absolutist states such as France, Austria and especially Germany had created an administrative profession of enlightened despotism, with medical police to encourage healthy and thus wealth-producing citizens. Johann Peter Frank (1745-1821) was the profession's exemplar with his 6,262 page System einer vollstländigen medischiner Polizey, leading to comprehensive public health legislation in German-speaking states, followed by more libertarian countries such as Britain and the United States. However, controversy continues on the role of government in trying to save its citizens, and especially their children, from harming themselves and/or others by their actions and omissions.

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

Science.gov (United States)

Waiswa, Peter; Akuze, Joseph; Peterson, Stefan; Kerber, Kate; Tetui, Moses; Forsberg, Birger C; Hanson, Claudia

2015-01-01

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. To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. 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. 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 (pprivate 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. 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 slightly lower in private compared to public facilities, calling for quality improvement in both

Public Health Promoted by the Cabildo of Lima in the Colonial Period

Directory of Open Access Journals (Sweden)

Paula Ermila Rivasplata

2014-01-01

Full Text Available In the Colonial period, the city of Lima featured such overcrowding that it generated all sorts of garbage and faced problems regarding the final disposal of solid, liquid, and gas waste. The purpose of this article is to discuss the active participation of the cabildo (council in the city’s public health, from a cultural perspective and on the basis of administrative documents and secondary sources. The study shows that the cabildo was engaged in disease prevention, sanitary control, the city’s supply system, and even the conservation of its resources. Through commissions, the regidores (council members supervised markets, butcher shops, slaughterhouses, mills, bakeries, tanneries, corner shops, and pharmacies. However, these and other efforts were never enough to keep the city clean and free of epidemics.

The public-private partnership regulatory support of the healthcare sector in Ukraine

Directory of Open Access Journals (Sweden)

N. G. Gojda

2013-10-01

Full Text Available Summary: Article is devoted to the legislation review of the public-private partnership projects of the healthcare sector inUkraine. Authors focused attention on the basic problems of public-private partnership projects inUkraine. Objective: Analysis of the legal framework provides the possibility of public-private partnerships in health care ofUkraine and confirms the relevance of the scientific concept of development of public-private partnerships in health care ofUkraine. Methods: There were used periodic data of legal, economic and medical research publications inUkraine and CIS countries on regulatory support public-private partnerships. Results: The researches in many countries have proven the established of state regulatory bodies that carefully study various aspects of the business partnership in the services of provision of health care. Developed numerical models as simple infrastructure projects implement business participation in providing non-medical services (construction, hotels and utilities, technical re-equipment etc. to complex integrated models that involve the transfer of important state functions to private partner (strategic planning, highly specialized medical care, research, medical education, etc.. Conclusion: The development of public-private partnerships in health care of Ukraine is possible only in condition of further improvement of legislation to the line with the norms and principles of international law, providing a clear and coordinated cooperation of all branches and friendly to business partnership administrative environment.

Blogging how our private thoughts went public

CERN Document Server

Wolfe, Kristin Roeschenthaler

2014-01-01

Public vs. private is an ongoing concern in communication. This book examines this phenomenon through self-representational writing and the philosophical lens of Hannah Arendt's public vs. private theory, the Boundary Management theory, and the Parasocial Framework theory to examine the first social networking platform: personal blogs. By starting with a look back at self-representational writing, the book also examines how much information individuals have shared with each other through this format historically.

The response of public and private credit markets to typhoons in China

Science.gov (United States)

Bao, X.; Hsiang, S. M.

2011-12-01

When natural disasters strike, both public and private credit markets may finance the reconstruction of lost capital. We examine the response of public and private credit markets to cyclone events in China, using provincial fiscal data from 1978 to 2008, and find striking differences in the sectors targeted by public and private creditors. Following a cyclone event, public loans to the agricultural sector expand 2% for every additional 10 m/s in local wind exposure, while private loans to industrial and commercial sectors grow 7% for the same event. In addition, we find that these expansions to local credit markets persist at these levels for at least one year following exposure to a storm. We then demonstrate that these results are consistent with a model in which private creditors maximize profits and the government maximizes equity. In this stylized model, we show that when governments value short-term equity and finance risky sectors with plausibly negative net present value, this may have the perverse effect of encouraging populations and capital to remain in disaster-prone regions and lower equity in the long-run.

Patient perceptions of asthma-related financial burden: public vs. private health insurance in the United States.

Science.gov (United States)

Patel, Minal R; Caldwell, Cleopatra H; Song, Peter X K; Wheeler, John R C

2014-10-01

Given the complexity of the health insurance market in the United States and the confusion that often stems from these complexities, patient perception about the value of health insurance in managing chronic disease is important to understand. To examine differences between public and private health insurance in perceptions of financial burden with managing asthma, outcomes, and factors that explain these perceptions. Secondary analysis was performed using baseline data from a randomized clinical trial that were collected through telephone interviews with 219 African American women seeking services for asthma and reporting perceptions of financial burden with asthma management. Path analysis with multigroup models and multiple variable regression analyses were used to examine associations. For public (P financial burden through different explanatory pathways. When adjusted for multiple morbidities, asthma control, income, and out-of-pocket expenses, those with private insurance used fewer inpatient (P financial burden was associated with more urgent office visits (P financial burden regardless of health insurance report more urgent health care visits and lower quality of life. Burden may be present despite having and being able to generate economic resources and health insurance. Further policy efforts are indicated and special attention should focus on type of coverage. Copyright © 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

The Precautionary Principle, Evidence-Based Medicine, and Decision Theory in Public Health Evaluation

Science.gov (United States)

Fischer, Alastair J.; Ghelardi, Gemma

2016-01-01

The precautionary principle (PP) has been used in the evaluation of the effectiveness and/or cost-effectiveness of interventions designed to prevent future harms in a range of activities, particularly in the area of the environment. Here, we provide details of circumstances under which the PP can be applied to the topic of harm reduction in Public Health. The definition of PP that we use says that the PP reverses the onus of proof of effectiveness between an intervention and its comparator when the intervention has been designed to reduce harm. We first describe the two frameworks used for health-care evaluation: evidence-based medicine (EBM) and decision theory (DT). EBM is usually used in treatment effectiveness evaluation, while either EBM or DT may be used in evaluating the effectiveness of the prevention of illness. For cost-effectiveness, DT is always used. The expectation in Public Health is that interventions employed to reduce harm will not actually increase harm, where “harm” in this context does not include opportunity cost. That implies that an intervention’s effectiveness can often be assumed. Attention should therefore focus on its cost-effectiveness. This view is consistent with the conclusions of DT. It is also very close to the PP notion of reversing the onus of proof, but is not consistent with EBM as normally practiced, where the onus is on showing a new practice to be superior to usual practice with a sufficiently high degree of certainty. Under our definitions, we show that where DT and the PP differ in their evaluation is in cost-effectiveness, but only for decisions that involve potential catastrophic circumstances, where the nation-state will act as if it is risk-averse. In those cases, it is likely that the state will pay more, and possibly much more, than DT would allow, in an attempt to mitigate impending disaster. That is, the rules that until now have governed all cost-effectiveness analyses are shown not to apply to catastrophic

[Collaboration between public health nurses and the private sector].

Science.gov (United States)

Marutani, Miki; Okada, Yumiko; Hasegawa, Takashi

2016-01-01

We clarified collaborations between public health nurses (PHNs) and the private sector, such as nonprofit organizations. Semi-structured interviews were conducted with 11 private sector organizations and 13 PHNs who collaborate with them between December 2012 to October 2013. Interview guides were: overall suicide preventive measurements, details of collaboration between private sector organizations and PHNs, and suicide prevention outcomes/issues. Data from private sector organizations and PHNs were separately analyzed and categories created using qualitative and inductive design. Private sector organizations' and PHNs' categories were compared and separated into core categories by similarities. Six categories were created: 1. establishing a base of mutual understanding; 2. raising public awareness of each aim/characteristic; 3. competently helping high suicidal risk persons detected during each activity; 4. guarding lives and rehabilitating livelihoods after intervention; 5. restoring suicide attempters/bereaved met in each activity; and 6. continuing/expanding activities with reciprocal cohesion/evaluation. PHNs are required to have the following suicide prevention tasks when collaborating with private sector organizations: understanding the private sector civilization, sharing PHN experiences, improving social determinants of health, meeting basic needs, supporting foundation/difficulties each other (Dear editor. Thank you for kind comments. I was going to explain that PHNs and NPOs support each other their foundation of activity and difficulties in their activities. The foundations include knowledge, information, budgets, manpower etc. The difficulties mean like suffering faced with suicide during activities.), and enhancing local governments' flexibilities/ promptness.

Private sector, human resources and health franchising in Africa.

Science.gov (United States)

Prata, Ndola; Montagu, Dominic; Jefferys, Emma

2005-04-01

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.

Private sector, human resources and health franchising in Africa.

Science.gov (United States)

Prata, Ndola; Montagu, Dominic; Jefferys, Emma

2005-01-01

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. PMID:15868018

A Review of State Public Health Emergency Declarations in Peru: 2014-2016.

Science.gov (United States)

Bambarén, Celso; Alatrista, Maria Del Socorro

2018-04-01

Peru has different legal mechanisms of emergency, one of which is the Public Health Emergency that is applicable when: there is high-risk for, or the existence of an outbreak, epidemic, or pandemic; the occurrence of cases of a disease classified as eliminated or eradicated; the occurrence of emerging or re-emerging infectious diseases with high epidemic potential; the occurrence of rapid disseminated epidemics that simultaneously affect more than one department; as well as the existence of an event that affects the continuity of health services. From July 2014 to December 2016, 23 Public Health Emergencies were declared, out of which 57% were in the high-risk or existence of epidemics, 30% were due to some natural or anthropic events that generate a sudden decrease in the operative capacity of health services, and 13% were due to the existence of a rapid spreading epidemic that could affect more than one department in the country. The risk or occurrence of epidemiological outbreaks, mainly of Dengue, was the main cause of emergency declaration. One-hundred and forty million US dollars were allocated to implement the action plans that were part of the declaration, of which 72% was used to keep the operational capacity of health services and 28% to vector and epidemiological control measures. Bambarén C , Alatrista MdS . A review of state public health emergency declarations in Peru: 2014-2016. Prehosp Disaster Med. 2018;33(2):197-200.

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

Directory of Open Access Journals (Sweden)

Dan CONSTANTINESCU

2012-10-01

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.

Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines.

Science.gov (United States)

Vieira Machado, Alessandra A; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

2014-09-01

Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.

Models of education in medicine, public health, and engineering.

Science.gov (United States)

Garcia, Patricia; Armstrong, Robert; Zaman, Muhammad H

2014-09-12

Discussion on global health in both the academic and the public domain has focused largely on research, capacity building, and service delivery. Although these efforts along with financial commitments from public and private partners have contributed to a broader appreciation and understanding of global health challenges, the reflection of global health in academic training has largely been lacking. However, integrative models are beginning to appear. Copyright © 2014, American Association for the Advancement of Science.

Public private partnerships

NARCIS (Netherlands)

Miranda Sarmento, J.J.

2014-01-01

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.

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

Directory of Open Access Journals (Sweden)

Okebe Joseph

2007-05-01

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.

Private vs. Public Higher Education Budgeting

Science.gov (United States)

Beamer, Sarah A.

2011-01-01

Private higher education institutions are those entities owned and operated by the private sector, while public institutions are those established, supported, and controlled by a governmental agency, most often a state. Key differences exist between private and public institutions that affect budgeting in critical ways. Such differences include…

Public and private sector interactions: an economic perspective.

Science.gov (United States)

Maynard, A

1986-01-01

The debate about the public-private mix for health care has been dominated by rhetoric and the failure to evaluate the characteristics of the outcomes of public and private health care systems and to relate these to policy targets. After a brief analysis of the competing, liberal (conservative) and collectivist (socialist), objectives, the nature of the private health care sector in Britain is described and it is shown that growth has faltered due to cost containment problems. This outcome is the product of characteristics of the private health care system, paralleled precisely in the NHS: asymmetry information, monopoly power, moral hazard and third party pays. The final section discusses briefly some remedies for the inefficient and inequitable outcomes which are seen in all health care markets and it is argued that competition within public and private health care systems may enable each system type to achieve its own particular objectives more efficiently.

A double-voiced reading of Romans 13:1–7 in light of the imperial cult

African Journals Online (AJOL)

Drawing on Mikhail Bakhtin's theory of double-voicedness and James Scott's theory of public and hidden transcripts, this essay investigates the colonial context of Romans 13:1–7 with particular attention to the Roman imperial cult. It is my contention that Paul attempts to persuade the audience to resist the imperial cult, ...

Public health, academic medicine, and the alcohol industry's corporate social responsibility activities.

Science.gov (United States)

Babor, Thomas F; Robaina, Katherine

2013-02-01

We explored the emerging relationships among the alcohol industry, academic medicine, and the public health community in the context of public health theory dealing with corporate social responsibility. We reviewed sponsorship of scientific research, efforts to influence public perceptions of research, dissemination of scientific information, and industry-funded policy initiatives. To the extent that the scientific evidence supports the reduction of alcohol consumption through regulatory and legal measures, the academic community has come into increasing conflict with the views of the alcohol industry. We concluded that the alcohol industry has intensified its scientific and policy-related activities under the general framework of corporate social responsibility initiatives, most of which can be described as instrumental to the industry's economic interests.

Socioeconomic patterns in use of private and public health services in Spain and Britain: implications for equity in health care.

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Lostao, Lourdes; Blane, David; Gimeno, David; Netuveli, Gopalakrishnan; Regidor, Enrique

2014-01-01

This paper estimates the pattern of private and public physician visits and hospitalisation by socioeconomic position in two countries in which private healthcare expenditure constitutes a different proportion of the total amount spent on health care: Britain and Spain. Private physician visits and private hospitalisations were quantitatively more important in Spain than in Britain. In both countries, the use of private services showed a direct socioeconomic gradient. In Spain, the use of public GPs and public specialists tends to favour the worst-off, but no significant differences were observed in public hospitalisation. In Britain, with some exceptions, no significant socioeconomic differences were observed in the use of public health care services. The different pattern observed in the use of public specialist services may be due to the high frequency of visits to private specialists in Spain. © 2013 Published by Elsevier Ltd.

[The contracting process and outsourcing in health: the scenario for dispute between public and private interests].

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Albuquerque, Maria do Socorro Veloso; Morais, Heloísa Maria Mendonça de; Lima, Luci Praciano

2015-06-01

This research analyzed the public-private composition in the municipal health network and aspects of the contracting/outsourcing process for services over the period from 2001 to 2008. The research method used was a case study with documentary research and interviews. The interviewees were former secretaries of health, directors of regulation and district managers. The categories of analysis used were public funds, care networks and public control. The results showed that the contracting was restricted to philanthropic units. With respect to the other private establishments linked to the public care network, non-compliance with programmatic aspects was detected, such as the lack of regulation of bidding processes required for contracting. Management authorities did not actively pursue building up state public services, or the formation of care networks. The contracted establishments conducted their activities without effective external and internal control mechanisms, which are paramount for the proper use of public resources. The authors conclude that the contracting process does not significantly alter the standard of buying and selling of services and indeed does not enhance the empowering process of the role of the public domain.

[Study on medical service supply public-private partnership mode: based on the view of public economics].

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Dai, Yue; Sun, Hong; Zhou, Li

2015-02-01

Due to the quasi-public attributes of medical service, the supply mode and system could influence equity and fairness of general people's health. Based on the view of public economics, the purpose of this paper was to explain the economic nature of medical service supply. By analyzing the practice of public-private partnership (PPP) mode in medical care supply and the related public economic issues, we summarized the feasibility and risks of PPP model in Chinese medical care supply market. Finally, we discussed the innovative medical service system provided by government, public hospitals, and social capitals together. Therefore, to guarantee further development of this new medical service supply--PPP mode, we should pay attention to some practical problems, such as the share of cooperation cost and the balance between the benefit and risk among all partners.

Public-private Partnership in the Context of Realisation of the State Financial Policy

Directory of Open Access Journals (Sweden)

Ostapenko Victoriia M.

2014-02-01

Full Text Available In the result of the study the article analyses modern tendencies of development of economy of Ukraine. It marks out problems connected with realisation of the state financial policy. It considers the essence of the state financial policy, its directions (such as budget-tax and monetary-credit, structural components and tasks. It emphasises the place of the public-private partnership as an instrument of realisation of the financial policy. It justifies tasks in the process of realisation of goals of the modern financial policy, which could be carried out with the help of the public-private partnership. The prospect of further studies in this direction is formation of practical recommendations on the use of the public-private partnership in the process of realisation of the state financial policy. Further improvement of the public-private partnership is connected with development of efficient mechanisms of its introduction and optimisation of its financial structure.

Public health ethics theory: review and path to convergence.

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Lee, Lisa M

2012-01-01

Public health ethics is a nascent field, emerging over the past decade as an applied field merging concepts of clinical and research ethics. Because the "patient" in public health is the population rather than the individual, existing principles might be weighted differently, or there might be different ethical principles to consider. This paper reviewed the evolution of public health ethics, the use of bioethics as its model, and the proposed frameworks for public health ethics through 2010. Review of 13 major public health ethics frameworks published over the past 15 years yields a wide variety of theoretical approaches, some similar foundational values, and a few similar operating principles. Coming to a consensus on the reach, purpose, and ends of public health is necessary if we are to agree on what ethical underpinnings drive us, what foundational values bring us to these underpinnings, and what operating principles practitioners must implement to make ethical decisions. If public health is distinct enough from clinical medicine to warrant its own set of ethical and philosophical underpinnings, then a decision must be made as to whether a single approach is warranted or we can tolerate a variety of equal but different perspectives. © 2012 American Society of Law, Medicine & Ethics, Inc.

The power of symbolic capital in patient and public involvement in health research.

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Locock, Louise; Boylan, Anne-Marie; Snow, Rosamund; Staniszewska, Sophie

2017-10-01

Policy-makers and health research funders increasingly require researchers to demonstrate that they have involved patients in the design and conduct of research. However, the extent to which patients and public have the power to get involved on an equal footing is dependent on their economic, cultural, social and symbolic capital. To explore power relations in patient and public involvement (PPI) in research, particularly how patients may wield symbolic capital to develop a more equal relationship. Narrative interviews with a maximum variation sample of 38 people involved as patients, carers or public in health research, analysed thematically. Symbolic capital may be demonstrated in a range of ways (sometimes alongside or in the absence of other forms of capital): illness experience, technical illness knowledge and the challenging outsider. Symbolic capital is unstable and dependent on others for recognition and legitimacy. Nonetheless, participants identify a gradual shift in power relations over time. Research into PPI has been conceptually and theoretically poor, limiting our understanding of its mechanisms and wider contextual elements. Our findings demonstrate the importance of reflecting on the forms of power and capital wielded by the health research community, and of acknowledging the way in which PPI is challenging the status quo. As one of the first papers to conceptualize how different forms of symbolic capital operate and their critical role in challenging the balance of power, our findings may help researchers better plan their PPI activities and reflect on their own power. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Human and veterinary medicine: the priority for public health synergies

Directory of Open Access Journals (Sweden)

Adriano Mantovani

2008-12-01

Full Text Available The concepts of ‘one medicine’ and 'one ‘health’ are supported and visualised as a tree (medicine, placed on the fertile soil (basic sciences, which divides into the two major branches of human and veterinary medicine, connected by the large branch of public health; minor branches (specialisations depart from the three larger ones. The synergy between human and veterinary medicine is not only a must for public health, but also implies ethical considerations. The basic reasons requiring synergy are found in the common sharing of the environment, in the use of animal products by humans, in the common culture and in the many problems to be faced together. The long list of adversities requiring synergy is topped by zoonoses (intended both in the classic and in the extended sense and food safety that extends to many other items connected with nutrition, environment, human/animal coexistence and the management of public health; the entire quality of human life is affected. Human and veterinary medicine have a strong cultural background (many subject matters in common, but unfortunately the undergraduate and postgraduate education programme (with few important exceptions do not offer training in cooperation. The synergy between human and veterinary medicines is an indicator of 'good public health practice' and any obstacles to this collaboration should be identified and eliminated. The logo for a public health founded on synergy is drawn as an umbrella formed by the medical and veterinary activities, protecting the population (consumers and producers, the animals and their products and the environment from the possible adversities linked to health.

Celebrating Leadership in Public Health and Medicine

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... Navigation Bar Home Current Issue Past Issues Celebrating Leadership in Public Health and Medicine Friends of the ... a Distinguished Medical Science Award for his global leadership in cancer research and the development of combination ...

Organizational Citizenship Behavior and Work Motivation as Correlates of Psychological Capital among Public and Private School Teachers

OpenAIRE

Nazirul Hasnain; Zuby Hasan; Sehal Chorath

2017-01-01

Background: The components of Psychological capital as well as Organizational citizenship behavior and Work motivation are so influential for an individual especially for their performance in organizational setting. Aims: The main objectives of the study were: (1) to study the contributions of organizational citizenship behavior and work motivation in psycap of public school teachers; (2) to study the contributions of organizational citizenship behavior and work motivation in psycap of privat...

Public and private sector contributions to the discovery and development of "impact" drugs.

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Reichert, Janice M; Milne, Christopher-Paul

2002-01-01

Recently, well-publicized reports by Public Citizen and the Joint Economic Committee (JEC) of the US Congress questioned the role of the drug industry in the discovery and development of therapeutically important drugs. To gain a better understanding of the relative roles of the public and private sectors in pharmaceutic innovation, the Tufts Center for the Study of Drug Development evaluated the underlying National Institutes of Health (NIH) and academic research cited in the Public Citizen and JEC reports and performed its own assessment of the relationship between the private and public sectors in drug discovery and development of 21 "impact" drugs. We found that, ultimately, any attempt to measure the relative contribution of the public and private sectors to the research and development (R&D) of therapeutically important drugs by output alone, such as counting publications or even product approvals, is flawed. Several key factors (eg, degree of uncertainty, expected market value, potential social benefit) affect investment decisions and determine whether public or private sector funds, or both, are most appropriate. Because of the competitiveness and complexity of today's R&D environment, both sectors are increasingly challenged to show returns on their investment and the traditional boundaries separating the roles of the private and public research spheres have become increasingly blurred. What remains clear, however, is that the process still starts with good science and ends with good medicine.

[State Hygiene Institute, 1918-1954 organisational structure, objectives and tasks].

Science.gov (United States)

Wieckowska, E

2001-01-01

After Poland regained its independence in 1918, research units were set up to provide scientific assistance to the state health and epidemiological service then being created. Towards the end of 1918 The State Central Hygiene Institute was established and, following successive reorganisations, transformed into the State Hygiene Institute. It operated at Chocimska str. 24 throughout the entire pre-war period, adapting its organisational structure to current needs. As a state public-health institution, it tracked down sources of communicable diseases and the way they were spread, and conducted research to detect cases of Asian cholera and carriers of contagious diseases. It produced vaccinations of other biological products used in the treatment and prevention of epidemics and made a significant contribution to the war on communicable diseases. It also served as the central state institution in charge of inspecting the country's epidemiological condition as well as a scientific-research facility designed to maintain it at a suitable level in accordance with international norms. With various organisational modifications it survived World War Two, its continued existence being maintained by the German occupation authorities. Reactivated after the war it continues to function to this day at its old location - ulica Chocimska 24, where it serves as a scientific-research facility for health and epidemiological services transferred to a separate organisational structure after 1950. Health and sanitary stations became state institutions in charge of anti-epidemic campaigns and were responsible for the country's health and epidemiological situation. In 1954, the State Health Inspectorate co-operating with the Ministry of Health was set up. The State Hygiene Institute functions to this day and it is the supervisory, co-ordinating and scientific-research institution of the State Health and Epidemiological Service.

Genetic Testing between Private and Public Interests: Some Legal and Ethical Reflections.

Science.gov (United States)

Sándor, Judit

2018-01-01

In Europe, there is a wide variety of genetic tests that various private companies offer to patients or to consumers. More and more people have become curious about their genetic predisposition and susceptibility. Most public health-care systems, however, are not adequately prepared for responding to these new demands and to the results of these genetic tests as, quite often, there is no available therapy for the identified genetic condition. This discrepancy between the newly emerging expectations and the insufficient responses contributes to a further rift between the public and private sectors of health care. Individual genetic test results may also trigger the need for personalized medicine and may open up a competition between the two fields in offering further genetic tests and medical exams. Pro-active patients may need a different kind of information on genetic tests and their implications. In this context, how should the public health system deal with the challenges of private testing? Will private genetic testing transform health care from a solidarity-based system to an individualistic one? In this paper, I would like to explore the emerging legal and ethical issues related to genetic testing and the relevant legal framework that has developed so far. In the conclusion, I will examine the possibilities of further legal development.

[Implementation of preventive measures recommended by the federal public health office and acceptance of advice by managers of commercial solaria--studies by the public health office of the Ammerland district].

Science.gov (United States)

Dahmen, H G

1990-06-01

Commercial solaria are not always up to the standards that would be desirable from a Public Health point of view in respect of protection of users against health hazards of exposure to UV radiation, and also with regard to supervision, qualified personal advice given to users by the staff, and qualification of the staff members to give such advice. Hygiene is definitely also a problem, as is evident from bacteriological swabs made from tanning beds. However, the talks conducted by a local Public Health board in Lower Saxony (North Germany) revealed considerable open-mindedness on the part of the entrepreneurs who were quite willing to follow expert health advice and to display a poster with recommendations regarding protective measures. This was combined with a questioning procedure that has proved successful with the proprietors.

Towards medicines regulatory authorities' quality performance improvement: value for public health.

Science.gov (United States)

Pejović, Gordana; Filipović, Jovan; Tasić, Ljiljana; Marinković, Valentina

2016-01-01

The purpose of this article is to explore the possibility of implementing total quality management (TQM) principles in national medicines regulatory authorities in Europe to achieve all public health objectives. Bearing in mind that medicines regulation is a governmental function that serves societal objectives to protect and promote public health, measuring the effective achievement of quality objectives related to public health is of utmost importance. A generic TQM model for meeting public health objectives was developed and was tested on 10 European national medicines regulatory authorities with different regulatory performances. Participating national medicines regulatory authorities recognised all TQM factors of the proposed model in implemented systems with different degrees of understanding. An analysis of responses was performed within the framework of two established criteria-the regulatory authority's category and size. The value of the paper is twofold. First, the new generic TQM model proposes to integrate four public health objectives with six TQM factors. Second, national medicines regulatory authorities were analysed as public organisations and health authorities to develop a proper tool for assessing their regulatory performance. The paper emphasises the importance of designing an adequate approach to performance measurement of quality management systems in medicines regulatory authorities that will support their public service missions. Copyright © 2014 John Wiley & Sons, Ltd.

Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis

Science.gov (United States)

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

2016-01-01

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

Understanding the complex relationships among actors involved in the implementation of public-private mix (PPM) for TB control in India, using social theory.

Science.gov (United States)

Salve, Solomon; Harris, Kristine; Sheikh, Kabir; Porter, John D H

2018-06-07

Public Private Partnerships (PPP) are increasingly utilized as a public health strategy for strengthening health systems and have become a core component for the delivery of TB control services in India, as promoted through national policy. However, partnerships are complex systems that rely on relationships between a myriad of different actors with divergent agendas and backgrounds. Relationship is a crucial element of governance, and relationship building an important aspect of partnerships. To understand PPPs a multi-disciplinary perspective that draws on insights from social theory is needed. This paper demonstrates how social theory can aid the understanding of the complex relationships of actors involved in implementation of Public-Private Mix (PPM)-TB policy in India. Ethnographic research was conducted within a district in a Southern state of India over a 14 month period, combining participant observations, informal interactions and in-depth interviews with a wide range of respondents across public, private and non-government organisation (NGO) sectors. Drawing on the theoretical insights from Bourdieu's "theory of practice" this study explores the relationships between the different actors. The study found that programme managers, frontline TB workers, NGOs, and private practitioners all had a crucial role to play in TB partnerships. They were widely regarded as valued contributors with distinct social skills and capabilities within their organizations and professions. However, their potential contributions towards programme implementation tended to be unrecognized both at the top and bottom of the policy implementation chain. These actors constantly struggled for recognition and used different mechanisms to position themselves alongside other actors within the programme that further complicated the relationships between different actors. This paper demonstrates that applying social theory can enable a better understanding of the complex relationship

Aspects regarding the hygienic-sanitary conditions at the level of certain dental medicine cabinets in Iasi County.

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Cernei, E R; Maxim, Dana Cristiana; Indrei, L L

2013-01-01

This baseline study aims to find out the evaluation of hygienic-sanitary conditions at the level of dental medicine cabinets through the verification of certain hygienic aspects. The study conducted consists in monitoring the hygienic/sanitary conditions at the level of 68 dental medicine cabinets (40 private cabinets and 28 school/university dental cabinets in Iasi county), using sheets for the assessment of the hygienic/sanitary conditions adapted from the control sheets of existing dental medicine cabinets at the level of DSP (Public Health Department) Iasi. The sheets for the assessment of the hygienic/sanitary conditions were evaluated by a specialized team and the results were i llustrated in the specific charts. At the level of all the dental cabinets the study revealed nonconformities regarding the means to carry out cleaning, disinfection operations, including the management of perilous waste, the control of medical personnel. An optimization of the hygienic-sanitary conditions at the level of dental medicine cabinets is still necessary, through participation to the activity of personnel training, who is directly involved in dental medical assistance.

Development of Systematic Knowledge Management for Public Health: A Public Health Law Ontology

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Keeling, Jonathan

2012-01-01

The Institute of Medicine has stated that legal structures and the authority vested in health agencies and other partners within the public health system are essential to improving the public's health. Variation between the laws of different jurisdictions within the United States allows for natural experimentation and research into their…

Assessing the impact of privatizing public hospitals in three American states: implications for universal health coverage.

Science.gov (United States)

Villa, Stefano; Kane, Nancy

2013-01-01

Many countries with universal health systems have relied primarily on publicly-owned hospitals to provide acute care services to covered populations; however, many policymakers have experimented with expansion of the private sector for what they hope will yield more cost-effective care. The study provides new insight into the effects of hospital privatization in three American states (California, Florida, and Massachusetts) in the period 1994 to 2003, focusing on three aspects: 1) profitability; 2) productivity and efficiency; and 3) benefits to the community (particularly, scope of services offered, price level, and impact on charity care). For each variable analyzed, we compared the 3-year mean values pre- and postconversion. Pre- and postconversion changes in hospitals' performance were then compared with a nonequivalent comparison group of American public hospitals. The results of our study indicate that following privatization, hospitals increased operating margins, reduced their length of stay, and enjoyed higher occupancy, but at some possible cost to access to care for their communities in terms of higher price markups and loss of beneficial but unprofitable services. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

[Autonomy for financial management in public and private healthcare facilities in Brazil].

Science.gov (United States)

Santos, Maria Angelica Borges dos; Madeira, Fátima Carvalho; Passos, Sonia Regina Lambert; Bakr, Felipe; Oliveira, Klivia Brayner de; Andreazzi, Marco Antonio Ratzsch de

2014-01-01

Autonomy in financial management is an advantage in public administration. A 2009 National Healthcare Facility Survey showed that 3.9% of Brazil's 52,055 public healthcare facilities had some degree of financial autonomy. Such autonomy was more common in inpatient facilities (17.8%), those managed by State governments (26.3%), and in Southern Brazil (6.6%). Autonomy was mainly partial (for resources in specific areas, relating to small outlays, consumables and capital goods, and outsourced services or personnel). 74.3% of 2,264 public facilities with any financial autonomy were under direct government administration. Financial autonomy in public healthcare facilities appears to be linked to local political decisions and not necessarily to the facility's specific legal and administrative status. However, legal status displays distinct scopes of autonomy - those under direct government administration tend to be less autonomous, and those under private businesses more autonomous; 85.8% of the 45,394 private healthcare facilities reported that they were financially autonomous.

Socioeconomic patterns in the use of public and private health services and equity in health care

Directory of Open Access Journals (Sweden)

Ortega Paloma

2008-09-01

Full Text Available Abstract Background Several studies in wealthy countries suggest that utilization of GP and hospital services, after adjusting for health care need, is equitable or pro-poor, whereas specialist care tends to favour the better off. Horizontal equity in these studies has not been evaluated appropriately, since the use of healthcare services is analysed without distinguishing between public and private services. The purpose of this study is to estimate the relation between socioeconomic position and health services use to determine whether the findings are compatible with the attainment of horizontal equity: equal use of public healthcare services for equal need. Methods Data from a sample of 18,837 Spanish subjects were analysed to calculate the percentage of use of public and private general practitioner (GP, specialist and hospital care according to three indicators of socioeconomic position: educational level, social class and income. The percentage ratio was used to estimate the magnitude of the relation between each measure of socioeconomic position and the use of each health service. Results After adjusting for age, sex and number of chronic diseases, a gradient was observed in the magnitude of the percentage ratio for public GP visits and hospitalisation: persons in the lowest socioeconomic position were 61–88% more likely to visit public GPs and 39–57% more likely to use public hospitalisation than those in the highest socioeconomic position. In general, the percentage ratio did not show significant socioeconomic differences in the use of public sector specialists. The magnitude of the percentage ratio in the use of the three private services also showed a socioeconomic gradient, but in exactly the opposite direction of the gradient observed in the public services. Conclusion These findings show inequity in GP visits and hospitalisations, favouring the lower socioeconomic groups, and equity in the use of the specialist physician. These

Primary care careers among recent graduates of research-intensive private and public medical schools.

Science.gov (United States)

Choi, Phillip A; Xu, Shuai; Ayanian, John Z

2013-06-01

Despite a growing need for primary care physicians in the United States, the proportion of medical school graduates pursuing primary care careers has declined over the past decade. To assess the association of medical school research funding with graduates matching in family medicine residencies and practicing primary care. Observational study of United States medical schools. One hundred twenty-one allopathic medical schools. The primary outcomes included the proportion of each school's graduates from 1999 to 2001 who were primary care physicians in 2008, and the proportion of each school's graduates who entered family medicine residencies during 2007 through 2009. The 25 medical schools with the highest levels of research funding from the National Institutes of Health in 2010 were designated as "research-intensive." Among research-intensive medical schools, the 16 private medical schools produced significantly fewer practicing primary care physicians (median 24.1% vs. 33.4%, p schools. In contrast, the nine research-intensive public medical schools produced comparable proportions of graduates pursuing primary care careers (median 36.1% vs. 36.3%, p = 0.87) and matching in family medicine residencies (median 7.4% vs. 10.0%, p = 0.37) relative to the other 66 public medical schools. To meet the health care needs of the US population, research-intensive private medical schools should play a more active role in promoting primary care careers for their students and graduates.

Value-Based Health Care Delivery, Preventive Medicine and the Medicalization of Public Health

Science.gov (United States)

2017-01-01

The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a ‘value-based health care delivery’. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and ‘self-care’) that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity. PMID:28409064

Value-Based Health Care Delivery, Preventive Medicine and the Medicalization of Public Health.

Science.gov (United States)

Vilhelmsson, Andreas

2017-03-01

The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a 'value-based health care delivery'. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and 'self-care') that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity.

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

2016-09-01

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.

Constraints, challenges and prospects of public-private partnership in health-care delivery in a developing economy.

Science.gov (United States)

Anyaehie, Usb; Nwakoby, Ban; Chikwendu, C; Dim, Cc; Uguru, N; Oluka, Cpi; Ogugua, C

2014-01-01

In Nigeria, concerns on the quality and financing of health-care delivery especially in the public sector have initiated reforms including support for public-private partnerships (PPP) at the Federal Ministry of Health. Likewise, Enugu State has developed a draft policy on PPP since 2005. However, non-validation and non-implementation of this policy might have led to loss of interest in the partnership. The aim of this study was to provide evidence for planning the implementation of PPP in Enugu State health system via a multi-sectoral identification of challenges, constraints and prospects. Pre-tested questionnaires were administered to 466 respondents (251 health workers and 215 community members), selected by multi-stage sampling method from nine Local Government Areas of Enugu State, Nigeria, over a study period of April 2011 to September 2011. Data from the questionnaires were collated manually and quantitative data analyzed using SPSS version 15 (Chicago, IL, USA). Only 159 (34.1%, 159/466) of all respondents actually understood the meaning of PPP though 251 (53.9%) of them had claimed knowledge of the concept. This actual understanding was higher among health workers (57.8%, 145/251) when compared with the community members (6.5%, 14/215) (P < 0.001). Post-PPP enlightenment reviews showed a more desire for PPP implementation among private health-care workers (89.4%, 101/113) and community leaders/members (55.4%, 119/215). PPP in health-care delivery in Enugu State is feasible with massive awareness, elaborate stakeholder's engagements and well-structured policy before implementation. A critical challenge will be to convince the public sector workers who are the anticipated partners to accept and support private sector participation.

Public-private partnerships in practice: collaborating to improve health finance policy in Ghana and Kenya.

Science.gov (United States)

Suchman, Lauren; Hart, Elizabeth; Montagu, Dominic

2018-06-13

Social health insurance (SHI), one mechanism for achieving universal health coverage, has become increasingly important in low- and middle-income countries (LMICs) as they work to achieve this goal. Although small private providers supply a significant proportion of healthcare in LMICs, integrating these providers into SHI systems is often challenging. Public-private partnerships in health are one way to address these challenges, but we know little about how these collaborations work, how effectively, and why. Drawing on semi-structured interviews conducted with National Health Insurance (NHI) officials in Kenya and Ghana, as well as with staff from several international NGOs (INGOs) representing social franchise networks that are partnering to increase private provider accreditation into the NHIs, this article examines one example of public-private collaboration in practice. We found that interviewees initially had incomplete knowledge about the potential for cross-sector synergy, but both sides were motivated to work together around shared goals and the potential for mutual benefit. The public-private relationship then evolved over time through regular face-to-face interactions, reciprocal feedback, and iterative workplan development. This process led to a collegial relationship that also has given small private providers more voice in the health system. In order to sustain this relationship, we recommend that both public and private sector representatives develop formalized protocols for working together, as well as less formal open channels for communication. Models for aggregating small private providers and delivering them to government programmes as a package have potential to facilitate public-private partnerships as well, but there is little evidence on how these models work in LMICs thus far.

Imperial Medicine in a Changing World: The Fourth International Congresses on Tropical Medicine and Malaria, 1948.

Science.gov (United States)

Wells, Julia

2016-01-01

The close connections between colonialism and tropical medicine have been widely discussed by historians over the last fifty years. However, few authors consider the relationship between tropical medicine and European and North American imperialism in the immediate post-World War II period. This article examines the Fourth International Congresses on Tropical Medicine and Malaria, held jointly in Washington in 1948. Using the research presented during the conference, it questions to what degree the specialisation had changed in the postwar period. It argues that although some changes are discernable, imperial traditions and relationships remained firmly embedded within the tropical medicine of the congress.

Public Sector Unions and Privatization

DEFF Research Database (Denmark)

Foged, Søren Kjær; Aaskoven, Lasse

2016-01-01

Privatization varies considerably among local governments. One of the oft-listed explanations is the ability of public employees to block privatization. However, many studies on the influence of public employees on privatization do not use very precise measures of the influence of public employees...... Danish municipalities in 2012, we are able to measure the strength of the public eldercare union as well as the number of the public eldercare workers relative to the number of local voters. We find that the increased union strength measured in terms of union density at the municipal level leads...... to substantially and significantly less privatization through the voucher market. By comparison, the estimated relationship between the relative number of public workers and privatization does not reach statistical significance. Features of the voucher market and qualitative evidence suggest that the union...

Annual report of the regional public health authorities in the Slovak Republic. Year 2011

International Nuclear Information System (INIS)

2011-07-01

A brief account of activities carried out by the regional public health authorities of the Public Health Authority of the Slovak Republic (UVZ SR) in 2011 is presented. These activities are reported under the headings: (1) The environment; (2) Preventive occupational medicine; (3)Hygiene of nutrition, food safety and cosmetic products; (4) Hygiene of children and youth; (5) Epidemiology; (6) Objectivization of factors of living conditions; (7) Medical microbiology; (8) Health promotion; (9) Health protection against radiation; (10) Complaints and petitions; (11) Medical informatics and biostatistics; (12) Lectures and publications.

Annual report of the regional public health authorities in the Slovak Republic. Year 2012

International Nuclear Information System (INIS)

2013-02-01

A brief account of activities carried out by the regional public health authorities of the Public Health Authority of the Slovak Republic (UVZ SR) in 2012 is presented. These activities are reported under the headings: (1) The environment; (2) Preventive occupational medicine; (3) Hygiene of nutrition, food safety and cosmetic products; (4) Hygiene of children and youth; (5) Epidemiology; (6) Objectivization of factors of living conditions; (7) Medical microbiology; (8) Health promotion; (9) Health protection against radiation; (10) Complaints and petitions; (11) Medical informatics and biostatistics; (12) Lectures and publications.

Public health interventions for epidemics: implications for multiple infection waves.

Science.gov (United States)

Wessel, Lindsay; Hua, Yi; Wu, Jianhong; Moghadas, Seyed M

2011-02-25

Epidemics with multiple infection waves have been documented for some human diseases, most notably during past influenza pandemics. While pathogen evolution, co-infection, and behavioural changes have been proposed as possible mechanisms for the occurrence of subsequent outbreaks, the effect of public health interventions remains undetermined. We develop mean-field and stochastic epidemiological models for disease transmission, and perform simulations to show how control measures, such as drug treatment and isolation of ill individuals, can influence the epidemic profile and generate sequences of infection waves with different characteristics. We demonstrate the impact of parameters representing the effectiveness and adverse consequences of intervention measures, such as treatment and emergence of drug resistance, on the spread of a pathogen in the population. If pathogen resistant strains evolve under drug pressure, multiple outbreaks are possible with variability in their characteristics, magnitude, and timing. In this context, the level of drug use and isolation capacity play an important role in the occurrence of subsequent outbreaks. Our simulations for influenza infection as a case study indicate that the intensive use of these interventions during the early stages of the epidemic could delay the spread of disease, but it may also result in later infection waves with possibly larger magnitudes. The findings highlight the importance of intervention parameters in the process of public health decision-making, and in evaluating control measures when facing substantial uncertainty regarding the epidemiological characteristics of an emerging infectious pathogen. Critical factors that influence population health including evolutionary responses of the pathogen under the pressure of different intervention measures during an epidemic should be considered for the design of effective strategies that address short-term targets compatible with long-term disease outcomes.

Overdependence on For-Profit Pharmacies: A Descriptive Survey of User Evaluation of Medicines Availability in Public Hospitals in Selected Nigerian States.

Science.gov (United States)

Ushie, Boniface Ayanbekongshie; Ugal, David Betelwhobel; Ingwu, Justin Agorye

2016-01-01

Lower availability of medicines in Nigerian public health facilities-the most affordable option for the masses-undermines global health reforms to improve access to health for all, especially the chronically ill and poor. Thus, a sizeable proportion of healthcare users, irrespective of purchasing power, buy medicines at higher costs from for-profit pharmacies. We examined user evaluation of medicine availability in public facilities and how this influences their choice of where to buy medicines in selected states-Cross River, Enugu and Oyo-in Nigeria. We approached and interviewed 1711 healthcare users using a semi-structured, interviewer-administered questionnaire as they exited for-profit pharmacies after purchasing medicines. This ensured that both clients who had presented at health facilities (private/public) and those who did not were included. Information was collected on why respondents could not buy medicines at the hospitals they attended, their views of medicine availability and whether their choice of where to buy medicines is influenced by non-availability. Respondents' mean age was 37.7±14.4 years; 52% were males, 59% were married, 82% earned ≥NGN18, 000 (US$57.19) per month, and 72% were not insured. Majority (66%) had prescriptions; of this, 70% were from public facilities. Eighteen percent of all respondents indicated that all their medicines were usually available at the public facilities, most (29%), some (44%) and not always available (10%). Reasons for using for-profit pharmacies included: health workers attitudes (43%), referral by providers (43%); inadequate money to purchase all prescribed drugs (42%) and cumbersome processes for obtaining medicines. Lower availability of medicines has serious implications for healthcare behavior, especially because of poverty. It is crucial for government to fulfill its mandate of equitable access to care for all by making medicines available and cheap through reviving and sustaining the drug revolving

Psychosocial Work Hazards, Self-Rated Health and Burnout: A Comparison Study of Public and Private Sector Employees.

Science.gov (United States)

Liu, Hsi-Chen; Cheng, Yawen

2018-04-01

To compare psychosocial work conditions and health status between public and private sector employees and to examine if psychosocial work conditions explained the health differences. Two thousand four hundred fourty one public and 15,589 private sector employees participated in a cross-sectional survey. Psychosocial work hazards, self-rated health (SRH), and burnout status were assessed by questionnaire. As compared with private sector employees, public sector employees reported better psychosocial work conditions and better SRH, but higher risk of workplace violence (WPV) and higher levels of client-related burnout. Regression analyses indicated that higher psychosocial job demands, lower workplace justice, and WPV experience were associated with poor SRH and higher burnout. The public-private difference in client-related burnout remained even with adjustment of psychosocial work factors. Greater risks of WPV and client-related burnout observed in public sector employees warrant further investigation.

Public Private Partnerships in Water and Electricity in Africa

International Nuclear Information System (INIS)

Auriol, Emmanuelle; Blanc, Aymeric

2007-01-01

The paper analyzes the costs and benefits of private participation in the electricity and water industries in Sub- Saharan Africa. Contrary to conventional wisdom, the participation of private unregulated firms in the supply of services for the middle class and poor is fairly common in the region. This private involvement reflects the extreme weakness of African governments. By contrast, service to the rich is provided by public utilities. Theory then suggests that prices should be high, so that the public firms make a profit. Yet piped water, and to a lesser extent electricity, are heavily subsidized. This signals a problem of capture by the ruling elite. It is a matter of justice and efficiency to increase public utilities revenues to subsidize investment and fiscal relief. This is especially relevant in electricity, where the economies of scale are much larger than in water. Electrification is the biggest challenge to the African economy because it requires huge investment. Local and regional private investors can play a non-negligible role in reducing penury. However, their involvement is conditional on the financial health of the sector and on strong government commitment. (authors)

Ethics in public health research: masters of marketing: bringing private sector skills to public health partnerships.

Science.gov (United States)

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

2007-04-01

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.

Public and private sector in the health care system of the Federation bosnia and herzegovina: policy and strategy.

Science.gov (United States)

Slipicevic, Osman; Malicbegovic, Adisa

2012-01-01

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.

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

Science.gov (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

2016-01-01

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.

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.

Privatization in economic theory

Directory of Open Access Journals (Sweden)

Drakić Maja

2007-01-01

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.

Postneoliberal Public Health Care Reforms: Neoliberalism, Social Medicine, and Persistent Health Inequalities in Latin America.

Science.gov (United States)

Hartmann, Christopher

2016-12-01

Several Latin American countries are implementing a suite of so-called "postneoliberal" social and political economic policies to counter neoliberal models that emerged in the 1980s. This article considers the influence of postneoliberalism on public health discourses, policies, institutions, and practices in Bolivia, Ecuador, and Venezuela. Social medicine and neoliberal public health models are antecedents of postneoliberal public health care models. Postneoliberal public health governance models neither fully incorporate social medicine nor completely reject neoliberal models. Postneoliberal reforms may provide an alternative means of reducing health inequalities and improving population health.

[Global public health: international health is tested to its limits by the human influenza A epidemic].

Science.gov (United States)

Franco-Giraldo, Alvaro; Alvarez-Dardet, Carlos

2009-06-01

This article comes from the intense international pressure that follows a near-catastrophy, such as the human influenza A H1N1 epidemic, and the limited resources for confronting such events. The analysis covers prevailing 20th century trends in the international public health arena and the change-induced challenges brought on by globalization, the transition set in motion by what has been deemed the "new" international public health and an ever-increasing focus on global health, in the context of an international scenario of shifting risks and opportunities and a growing number of multinational players. Global public health is defined as a public right, based on a new appreciation of the public, a new paradigm centered on human rights, and altruistic philosophy, politics, and ethics that undergird the changes in international public health on at least three fronts: redefining its theoretical foundation, improving world health, and renewing the international public health system, all of which is the byproduct of a new form of governance. A new world health system, directed by new global public institutions, would aim to make public health a global public right and face a variety of staggering challenges, such as working on public policy management on a global scale, renewing and democratizing the current global governing structure, and conquering the limits and weaknesses witnessed by international health.

Valuing public sector risk exposure in transportation public-private partnerships.

Science.gov (United States)

2010-10-01

This report presents a methodological framework to evaluate public sector financial risk exposure when : delivering transportation infrastructure through public-private partnership (PPP) agreements in the United : States (U.S.). The framework is base...

National Center for Disaster Medicine and Public Health

Data.gov (United States)

Federal Laboratory Consortium — The National Center for Disaster Medicine and Public Health (NCDMPH) is an academic center tasked with leading federal, and coordinating national, efforts to develop...

Medicines and vaccines for the world's poorest: Is there any prospect for public-private cooperation?

OpenAIRE

Scheffler, Richard M; Pathania, Vikram

2005-01-01

Abstract This paper reviews the current status of the global pharmaceutical industry and its research and development focus in the context of the health care needs of the developing world. It will consider the attempts to improve access to critical drugs and vaccines, and increase the research effort directed at key public health priorities in the developing world. In particular, it will consider prospects for public-private collaboration. The challenges and opportunities in such public-priva...

Genetic Testing between Private and Public Interests: Some Legal and Ethical Reflections

Directory of Open Access Journals (Sweden)

Judit Sándor

2018-01-01

Full Text Available In Europe, there is a wide variety of genetic tests that various private companies offer to patients or to consumers. More and more people have become curious about their genetic predisposition and susceptibility. Most public health-care systems, however, are not adequately prepared for responding to these new demands and to the results of these genetic tests as, quite often, there is no available therapy for the identified genetic condition. This discrepancy between the newly emerging expectations and the insufficient responses contributes to a further rift between the public and private sectors of health care. Individual genetic test results may also trigger the need for personalized medicine and may open up a competition between the two fields in offering further genetic tests and medical exams. Pro-active patients may need a different kind of information on genetic tests and their implications. In this context, how should the public health system deal with the challenges of private testing? Will private genetic testing transform health care from a solidarity-based system to an individualistic one? In this paper, I would like to explore the emerging legal and ethical issues related to genetic testing and the relevant legal framework that has developed so far. In the conclusion, I will examine the possibilities of further legal development.

Pharmaceutical Public-Private Partnerships

DEFF Research Database (Denmark)

Bagley, Constance; Tvarnø, Christina D.

2014-01-01

This article provides a game theory and law-and-management analysis of for- profit pharmaceutical public-private partnerships, a complex type of legal arrangement in the highly regulated pharmaceutical industry. A pharmaceutical public-private partnership (PPPP) agreement is a legally binding...... and a practical perspective on how properly crafted PPPP arrangements can promote innovation more efficiently than traditional self-optimizing contracts. In particular, a properly framed binding contract, coupled with respect for positive incentives, can move the parties away from an inefficient prisoners...... systems to build and share innovation. When coupled with appropriate attention to the difficult task of coordinating the actions of interdependent actors, a PPPP arrangement can enhance the likelihood of successful commercialization of pharmacological discoveries by flipping the par- ties’ incentives...

Jurisdictional Competition Between Private and Public Sector Auditors

DEFF Research Database (Denmark)

Klarskov Jeppesen, Kim

2012-01-01

This paper explores the apparent paradox that while public sector auditors have become more powerful by claiming performance auditing expertise and linking this to New Public Management reforms, the same reforms have provided an opening for competition between private and public sector auditors....... In Denmark, the competitive relation has led to a jurisdictional dispute between public and private sector auditors in which the former have developed a special qualification for public sector auditors. The paper analyses the development of this qualification using Abbott's (1988) theory of the system...... of professions, thus focusing on how the involved groups have attempted to build networks of support for their competing jurisdictional claims of expertise. The case contributes to knowledge about the potential for development of a distinct public sector auditor identity. The case suggests that to develop...

Public-Private partnership procurement: Game-theoretic studies of the tender process.

OpenAIRE

De Clerck, Dennis

2015-01-01

A Public-private partnership (PPP) is a settlement between a public party and a contractor or private sector consortium to engage in a long-term contractual agreement for designing, building, operating and/or maintaining capital intensive projects, while trying to attain value for money. PPPs are globally gaining importance in the construction industry. The risk transfer from the contracting government towards the private entity has important repercussions on the tender. Contractors need to c...

[Economics, politics, and public health in Porfirian Mexico (1876-1910)].

Science.gov (United States)

Carrillo, Ana María

2002-01-01

The article examines the scientific, political, and economic elements that permitted the birth of modern public health in Mexico under the Porfirio Díaz administration (1876-1910). Firstly, a portion of Mexican physicians were open to the discoveries of microbiology, immunology, and epidemiology. Secondly, the State's growing concentration of power in public health matters ran parallel to its concentration of disciplinary political power and enabled this new knowledge to be placed at the service of collective health problem prevention. Lastly, both imperialism and the Porfirian elite needed to protect their business interests. The article evaluates public health achievements and limitations during the Porfirian period, abruptly interrupted by the revolution begun in 1910.

[Public health competencies and contents in Spanish university degree programmes of Veterinary Medicine].

Science.gov (United States)

Davó-Blanes, María Del Carmen; Vives-Cases, Carmen; Huerta, Belén

2017-04-19

To reach a consensus among public health faculty from various Spanish universities about the core public health competencies that should be integrated into the Veterinary Medicine degree training. The 3rd Forum of University Professors of Public Health was held at the School of Veterinary Medicine of the University of Cordoba (12-13 January 2016). Forty-two university professors and lecturers from nine Spanish universities with veterinary degrees participated in the forum. They were divided into five working groups during three working sessions to identify and classify core public health competencies for the Veterinary Medicine degree, propose public health contents for the identified competencies and organize such contents in thematic blocks. The results were discussed in different plenary sessions. The highest number of core competencies was identified in the activities related to the following public health functions: «Assessment of the population's health needs» and «Developing health policies». The final programme included basic contents organized into five units: 1) Fundamentals of public health; 2) Study and research in public health; 3) Production, animal health and environment; 4) Food security; and 5) Health education. The public health core competencies and contents identified in this Forum may be considered as a starting point to update public health training programmes for future veterinary professionals. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Policy Pathways: Joint Public-Private Approaches for Energy Efficiency Finance

Energy Technology Data Exchange (ETDEWEB)

NONE

2012-09-06

This Policy Pathway outlines, through the experiences and lessons learned from country examples, the critical elements to put in place a public-private partnership to finance energy efficiency. It focuses on three mechanisms - dedicated credit lines, risk guarantees, and energy performance service contracts and presents the planning, implementing, monitoring, and evaluating phases of implemention. Accelerating and scaling up private investment in energy efficiency is crucial to exploit the potential of energy efficiency. However many barriers remain to private investment such as access to capital, uncertainty of future energy prices, transaction costs, perceived higher risk, and lack of knowledge. As part of the IEA 25 Energy Efficiency Policy Recommendations, the IEA recommends that governments support private investment in energy efficiency. A joint public-private approach can use public finance and regulatory policy to support the scaling up of private investment in energy efficiency.

Rising Inequality and Intergenerational Mobility: The Role of Public Investments in Human Capital.

Science.gov (United States)

Aizer, Anna

2014-06-01

One consequence of the rise in inequality witnessed over the past 40 years is its potentially negative impact on intergenerational mobility if parents at the bottom of the income distribution invest significantly less in their children's human capital. I consider whether public investments in children can potentially offset the inequality of private investments. Specifically, examining changes in public spending in 25 Organization for Economic Co-operation and Development countries over the period 2000-2009, I find that increases in spending on health are most strongly associated with reductions in the importance of family background and declines in inequality in the production of child human capital as measured by the Program for International Student Assessment test scores among 15-year-olds. Public spending on family support, housing, and education are also moderately related. In contrast, increased spending on the elderly is associated with increases in the importance of parental background and inequality of child test scores. These results suggest that public investments in child human capital have the potential to offset the potentially negative impact of increasing income inequality on intergenerational mobility and inequality of the next generation. Further research firmly establishing a causal relationship is needed.

Rising Inequality and Intergenerational Mobility: The Role of Public Investments in Human Capital

Science.gov (United States)

Aizer, Anna

2014-01-01

One consequence of the rise in inequality witnessed over the past 40 years is its potentially negative impact on intergenerational mobility if parents at the bottom of the income distribution invest significantly less in their children's human capital. I consider whether public investments in children can potentially offset the inequality of private investments. Specifically, examining changes in public spending in 25 Organization for Economic Co-operation and Development countries over the period 2000–2009, I find that increases in spending on health are most strongly associated with reductions in the importance of family background and declines in inequality in the production of child human capital as measured by the Program for International Student Assessment test scores among 15-year-olds. Public spending on family support, housing, and education are also moderately related. In contrast, increased spending on the elderly is associated with increases in the importance of parental background and inequality of child test scores. These results suggest that public investments in child human capital have the potential to offset the potentially negative impact of increasing income inequality on intergenerational mobility and inequality of the next generation. Further research firmly establishing a causal relationship is needed. PMID:25419203

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

2013-10-01

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

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

Science.gov (United States)

van de Vijver, Steven; Oti, Samuel; Tervaert, Thijs Cohen; Hankins, Catherine; Kyobutungi, Catherine; Gomez, Gabriela B; Brewster, Lizzy; Agyemang, Charles; Lange, Joep

2013-10-21

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. To develop and introduce a model of cardiovascular prevention in the slums of Nairobi by integrating public health and private sector approaches. 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. 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). 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 relevant policymakers and NGOs.

Public values in public-private partnerships

NARCIS (Netherlands)

Reynaers, A.; de Graaf, G.

2014-01-01

Although public-private partnerships (PPPs) are often evaluated in terms of efficiency, their impact on public values is often neglected. In order to find out what we know about the public values-PPPs relation, this article reviews public administration literature and describes two opposite

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