Private Bed Research Articles

Regspraak: Onderhoudskostes vir koekoekskuikens – wie moet vir die gelag betaal, of rus die skade maar waar dit val?

Regspraak: Onderhoudskostes vir koekoekskuikens – wie moet vir die gelag betaal, of rus die skade maar waar dit val?

Specialised psychiatric beds and 24-hour residential care in Australia 2018-2019 - Comparative analysis and commentary according to international benchmarking.

A commentary on Australian specialised private and public psychiatric acute and non-acute inpatient care, and 24-hour-staffed community residential care with regard to international benchmarks. Descriptive analysis of specialised psychiatric beds from the Australian Institute of Health and Welfare (AIHW) with the WHO Mental Health Atlas 2020, and an international Delphi consensus on optimal and minimal psychiatric beds per capita. Australian private sector beds have shown a 3.8% annual growth rate from 2014-15 to 2018-19, in contrast to relatively static public sector bed numbers. Australia's national combined public and private psychiatric bed number (hospital acute and non-acute, and 24-hour-staffed community residential) of 48.8 per 100,000 population is lower than the WHO European (100.6) and World Bank High Income (69.2) medians, due to fewer community residential and non-acute beds. Australia's 40.9 general and stand-alone psychiatric beds per 100,000 are below the Delphi consensus optimal level of 60 beds per 100,000, but above the bed shortage threshold (30 per 100,000). Rising bed numbers in private hospitals have contributed to Australian psychiatric inpatient capacity, although the level remains below comparable international medians. Recent initiatives to increase psychiatric bed numbers may signal a policy shift in the public sector, complementary to private and community care.

From ‘‘container’’ to ‘‘lifestyle:’’ Kazuyo Sejima, Sou Fujimoto and the destruction of the nuclear family box

After the Second World War, Japan fell under the spell of a post-war ideology that popularized an ideal middle-class nuclear family. Mainstream housing options responded to this ideology with the introduction of a typical floorplan that contained a hierarchy akin to the nuclear family and stressed the need for individuality with multiple private (bed)rooms. By the mid-1960s, this nLDK-model — a layout system in which n came to indicate the number of rooms in addition to the Living room and the Dining-Kitchen space, had become a national code, not only creating homogeneity in the type of houses but also pushing one specific type of family. This study focuses on the two case-study houses of Kazuyo Sejima’s Bairin no Ie (2003) and Sou Fujimoto’s T-House (2005) to highlight a recent transformation in the conception of a house from a standard ‘container’ for the nuclear family into a particular house for a tangible lifestyle. By situating the two case studies in a socio-historical context, this paper aims to identify a redefinition of house-family relations that no longer relied on established notions of “wall” and “room,” but supported the free movement of people and the spontaneous formation of new relationships between rooms and functions.

Duygusal Emek Davranışı ve Tükenmişlik Arasındaki İlişki: Örgütsel Özdeşleşmenin Aracılık Etkisi (The Relationship Between Emotional Labor Behavior and Burnout: The Mediating Effect of Organizational Identification)

Purpose – In this study, it is aimed to determine the relationship between emotional labor behavior and burnout of health personnel and the mediating effect of organizational identification in this relationship. Design/methodology/approach – Relational screening model was used in the research. The sample of the study consists of 784 healthcare professionals working in private bed hospitals affiliated to Istanbul Provincial Health Directorate Health Research Branch Directorate Private Bed Health Services Branch Directorate. SPSS package program was used for descriptive statistics, correlation analysis (s), validity and reliability tests and exploratory factor analysis. For confirmatory factor analysis, path analysis and mediating effect analysis, the SEM (AMOS) package program was used. Results – According to the structural equation modeling results; It is seen that the dimensions of superficial behavior, deep behavior and natural behavior of emotional labor have an effect on the decrease in personal accomplishment, emotional exhaustion and depersonalization. On the other hand, it is seen that emotional labor has a profound effect on behavioral and natural behavior dimensions on organizational identification. It is seen that organizational identification has an effect on the decrease in personal accomplishment, depersonalization and emotional exhaustion. Since the effect of superficial behavior on organizational identification was not detected, the mediating effect of organizational identification on the effect of burnout on decreased personal accomplishment, emotional exhaustion and depersonalization could not be tested. Organizational identification plays a full mediating role in the effect of deep behavior on the effect of burnout on a decrease in personal accomplishment, emotional exhaustion and depersonalization. Organizational identification plays a partial mediating role in the effect of natural behavior on the effect of burnout on a decrease in personal accomplishment and depersonalization, and a full mediating role in its effect on emotional exhaustion. Discussion – The importance and value of the job and employees in the health sector should be taken into account. Because, healthcare personnel do not only work with physical and mental labor. In addition to these, they include their emotions as a labor factor in the process. Employees who are identified with their organizations are valuable for organizations. For this reason, the management should pay attention to the emotions and feelings of each healthcare provider as much as possible. In order for health personnel to be integrated with their organization, the management should clearly demonstrate its understanding and support for them. Thus, the responses of healthcare personnel (s) to various events and situations encountered in the work environment can be directly observed. Measures can be taken to identify the factors that cause healthcare personnel to experience burnout and to eliminate the problem in the first place.

The Vital Role of a Full Continuum of Psychiatric Care Beyond Beds.

The authors make the case for expanding the national discussion of inpatient psychiatric beds to recognize and incorporate other vital components of the continuum of care in order to improve outcomes for individuals with serious mental illness. They review the varied terminology applied to psychiatric beds and describe how the location of these beds has changed from primarily state hospitals to the criminal justice system, emergency departments, inpatient units, and the community. The authors propose 10 recommendations related to beds or to contextual issues regarding them. The recommendations address issues of mental illness terminology, criminal and juvenile justice diversion, the Emergency Medical Treatment and Labor Act, mental health technology, and the mental health workforce, among others. Each recommendation is based on findings from publicly available data and clinical observation and is intended to reduce the human and economic costs associated with severe mental illness by promoting a robust, interconnected, and evidence-based system of care that goes beyond beds.

How many beds? Capacity implications of hospital care demand projections in the Irish hospital system, 2015-2030.

Existing Irish hospital bed capacity is low by international standards while Ireland also reports the highest inpatient bed occupancy rate across OECD countries. Moreover, strong projected population growth and ageing is expected to increase demand for hospital care substantially by 2030. Reform proposals have suggested that increased investment and access to nonacute care may mitigate some increased demand for hospital care over the next number of years, and it is in this context that the Irish government has committed to increase the supply of public hospital beds by 2600 by 2027. Incorporating assumptions on the rebalancing of care to nonhospital settings, this paper analyses the capacity implications of projected demand for hospital care in Ireland to 2030. This analysis employs the HIPPOCRATES macrosimulation projection model of health care demand and expenditure developed in the ESRI to project public and private hospital bed capacity requirements in Ireland to 2030. We examine 6 alternative projection scenarios that vary assumptions related to population growth and ageing, healthy ageing, unmet demand, hospital occupancy, hospital length of stay, and avoidable hospitalisations. We project an increased need for between 4000 and 6300 beds across public and private hospitals (an increase of between 26.1% and 41.1%), of which 3200 to 5600 will be required in public hospitals. These findings suggest that government plans to increase public hospital capacity over the 10years to 2027 by 2600 may not be sufficient to meet demand requirements to 2030, even when models of care changes are accounted for.

Modelling the substitutability of community, long-term, and hospital care and their impact on acute hospital length of stay in Ireland

Background: Within the context of reduced health expenditure and Government policy of transferring of care out of acute hospitals, this study models the supply of acute, community, and long-term care on acute hospital length of stay in Ireland. This study examines how different forms of acute and non-acute care often operate as substitutes for each other and that investment or changes in one area will have spillover effects on others. Understanding these substitution effects is vital in order reduce the demands on the expensive, strained acute hospital sector, and to provide a better model of integrated care within a healthcare system. Methods: This study uses data from the large administrative Hospital Inpatient Enquiry (HIPE) database (2010-2014), and other administrative databases to model the role acute and non-acute supply of care have on acute inpatient length of stay in Ireland. Longitudinal methods using both linear and count data models as well as multilevel modelling techniques are incorporated. Analyses were undertaken on both elective and emergency admissions, as well as specific populations where non-acute services may be most important, i.e. patients requiring rehabilitation. Results: This study finds that both the supply of acute hospital beds and staffing, and the non-acute supply of care impact acute hospital length of stay. Results from the hospital-level model found that a 10% of reduction in acute hospital beds led to a 5.6% reduction in average length of stay for inpatients in public hospital, with a larger reduction seen for emergency admissions (6.2%). Inequities also emerged; those with public insurance (a medical card) or not in a private bed being most sensitive to the reduction in acute bed supply. Considerable geographical differences in the supply of community care and long-term care were also observed. There was substantial evidence that poorer provision of non-acute services resulted in longer length of stay. These results highlight that non-acute and acute health services are often substitutable. Conclusion and discussion: The reduction in the supply of many healthcare services during a period of reduced healthcare expenditure impacted patient outcomes, including acute hospital length of stay. Both acute and non-acute healthcare supply impacted length of stay, with community services found to be substitutable for more expensive acute care. Greater awareness that changing the provision of both acute and non-acute care will impact patient outcomes will aid better models of integrated care. Better integration of acute and non-acute health may have highly beneficial effects on both patient outcomes and sustainability of services.

The policy of free healthcare for children under the age of 6 years in Vietnam: assessment of the uptake for children hospitalised with acute diarrhoea in Ho Chi Minh City

ObjectiveTo assess the proportion of, and reasons for, households not utilising the policy of free healthcare for children under 6 years of age (FCCU6) for hospitalisation with diarrhoea, and assess the risk of catastrophic expenditure for households that forgo FCCU6 and pay out of pocket.MethodsInvoices detailing insurance information and charges incurred from 472 hospitalised diarrhoeal cases in one paediatric hospital in Ho Chi Minh City were retrieved. Hospital charges and the utilisation of elective services were analysed for patients utilising and not utilising FCCU6. Associations between socio-economic factors with non-utilisation of FCCU6 were evaluated.ResultsOverall, 29% of patients were FCCU6 non-users. The FCCU6 non-users paid a median hospital charge of $29.13 (interquartile range, IQR: $18.57–46.24), consuming no more than 1.4% of a medium-income household's annual income. Seventy per cent of low-income FCCU6 non-users utilised less-expensive elective services, whereas only 43% of medium income patients and 21% of high-income patients did (P = 0.036). Patients from larger households and those with a parent working in government were more likely to use FCCU6.ConclusionsThe rate of FCCU6 non-usage in this study population was 29%. A significant proportion of those that did not use FCCU6 was from lower income households and may perceive a justifiable cost–benefit ratio when forgoing FCCU6. Although a single diarrhoeal hospitalisation is unlikely to induce a catastrophic expenditure, FCCU6 non-usage may disproportionately increase the risk of catastrophic expenditure for lower income households over multiple illnesses.

노인장기요양보험 시설서비스 이용자의 비급여 본인부담 크기 및 영향요인

The purpose of this study is to understand magnitude and its related factors of user's cost-sharing for non-covered services in long-term care facilities. We corrected data for 1,016 subjects, based on the long-term care benefits cost specification. Eighteen subjects were excluded from the data analysis due to missing data on family care-givers characteristics. Finally, 998 subjects were included in the study. The average cost of non-covered services per month was 209,093 won and distributed from 0 to 1,011,490 won. There was a significant difference by the characteristics of family care-givers and long-term care facilities. The monthly average cost for meal materials per person was 199,181 won(0~558,000), average cost of additional charge caused by using private bed was 232,992 won (50,000~600,000), and costs for haircut and cosmetics were 8,599 won. For the rest, there were various programs costs(93,328 won), diaper and its disposal cost(109,628 won), purchase cost for daily necessaries(24,435 won) and etc. The related factors for the magnitude of non-covered services expenditures were education level of family care-givers, occupancy rate and location of LTC facilities, and the costs of using private bed, haircut and cosmetics, and various programs among non-covered services. These findings suggest that present level range of LTC facilities users' cost-sharing is wide and it is urgent to prepare the standard guideline for cost and level in non-covered services.

The Influence of Primary Care and Hospital Supply on Ambulatory Care–Sensitive Hospitalizations Among Adults in Brazil, 1999–2007

We assessed the influence of changes in primary care and hospital supply on rates of ambulatory care-sensitive (ACS) hospitalizations among adults in Brazil. We aggregated data on nearly 60 million public sector hospitalizations between 1999 and 2007 to Brazil's 558 microregions. We modeled adult ACS hospitalization rates as a function of area-level socioeconomic factors, health services supply, Family Health Program (FHP) availability, and health needs by using dynamic panel estimation techniques to control for endogenous explanatory variables. The ACS hospitalization rates declined by more than 5% annually. When we controlled for other factors, FHP availability was associated with lower ACS hospitalization rates, whereas private or nonprofit hospital beds were associated with higher rates. Areas with highest predicted ACS hospitalization rates were those with the highest private or nonprofit hospital bed supply and with low (< 25%) FHP coverage. The lowest predicted rates were seen for areas with high (> 75%) FHP coverage and very few private or nonprofit hospital beds. These results highlight the contribution of the FHP to improved health system performance and reflect the complexity of the health reform processes under way in Brazil.

Who's that sleeping in my bed? Potential and actual utilization of public and private in-patient beds in Irish acute public hospitals

To examine the impact of the unusual public/private mix on public and private in-patient bed utilization within Irish acute public hospitals. Data from the Department of Health and Children and the Hospital In-Patient Enquiry were used to estimate and compare potential and actual utilization of public and private designated in-patient beds in 54 acute public hospitals from 2000 to 2004. Private in-patients used more bed days than were potentially available to them in 14.1% of hospital-year observations. The equivalent figure for public in-patients was 12.6%. Although the prevalence of excess utilization of private beds was relatively small, it did increase over the study period. Hospitals with excess private utilization were characterized by a relatively low proportion of private- or non-designated beds despite their patient profile being broadly similar to that of hospitals where there was no excess private utilization. Despite policies designed to limit private practice in Irish acute public hospitals, some hospitals have apparently been able to overcome these restrictions. In a system where financial incentives to treat private patients exist both for consultants and hospitals, it is not clear whether this excess private practice in public hospitals reflects a more efficient utilization of resources (when demand from public patients is low) or the displacement of public patients in favour of private patients. However, that a smaller number on hospital waiting lists possess private health insurance provides some support for the displacement hypothesis. Thus, it appears that policy-makers may need to reconsider attempts to ensure an appropriate division of acute public hospital resources between public and private patients.

The relationship between advertising, price, and nursing home quality

Theoretically, nursing homes should engage in advertising for the following two reasons: (a) to improve awareness of the services offered in a particular market and (b) to signal high-quality services. In this study, we build upon results from prior studies of nursing home advertising activity, market competition, and quality. The purpose of this study was to examine the association between advertising expenses, price, and quality. We focused on answering the question: Do nursing homes use advertising and price to signal superior quality? The Texas Nursing Facilities Medicaid Cost Report, the Texas Quality Reporting System, and the Area Resource File were merged for the year 2003. We used three alternative measures of quality to improve the robustness of this exploratory analysis. Quality measures were examined using Bonferroni correlation coefficient analysis. Associations between advertising expenses and quality were evaluated using three regression models predicting quality. We also examined the association of the price of a private bed per day with quality. Advertising expenses were not associated with better nursing home quality as measured by three quality scales. The average price customers pay for one private bed per day was associated with better quality only in one of the three quality regression models. The price of nursing home care might be a better indicator of quality and necessary to increase as quality of care is improved in the nursing homes sector. Because more advertising expenditures are not necessarily associated with better quality, consumers could be mislead by advertisements and choose poor quality nursing homes. Nursing home administrators should focus on customer relationship management tools instead of expensive advertising. Relationship management tools are proven marketing techniques for the health services sector, usually less expensive than advertising, and help with staff retention and quality outcomes.

Outpatient care utilization in urban Kerala, India

Kerala is characterized by a high density of public and private health infrastructure. While less inequality in access has been reported in this Indian state, few studies have looked at problems found within cities. Escalation of costs of private services and reduced public investments could generate some inequalities in access for the poor. To assess factors associated with utilization and source of outpatient care in urban Kerala, and to discuss policy implications with regards to access to care. A multilevel analysis of individual and urban characteristics associated with utilization and source of outpatient care was conducted using data from a 1995-96 survey by the National Sample Survey Organisation on health care in urban Kerala. There is a high level of utilization (83.6%) of allopathic medical services. Controlling for illness severity and age, utilization thereof was lower for the very poor (OR 0.13 [0.03; 0.49]), inhabitants of medium towns (OR 0.20 [0.05; 0.70]), and inhabitants of cities with a lower proportion of permanent material (pucca) houses (0.21 [0.06; 0.72]). Among all users, 77% resorted to a private source of care. Utilization of a private provider was less likely for the very poor (OR 0.13 [0.03; 0.51]) and individuals from casual worker households (OR 0.54 [0.30; 0.97]), while it was more likely for inhabitants of cities from both low public bed density districts (OR 4.08 [1.05; 15.95]) and high private bed density districts (OR 5.83 [2.34; 14.53]). Problems of quality and accessibility of the public sector were invoked to justify utilization of private clinics. A marked heterogeneity in utilization of outpatient care was found between cities of various sizes and characteristics. This study confirms high utilization of private outpatient care in Kerala and suggests problems of access for the poorest. Even in a context of high public availability and considering the health transition factor, relying on the development of the private sector to respond to increasing health care needs could create inequalities in access. Investing in the public urban primary care system and ensuring access to quality health care for the poorest is warranted.

Predicting state vs. private hospital referral in psychiatric emergencies

Using data from a two-month observation of referrals (N=320) to state hospitals and private facilities from five prescreening sites in Massachusetts, the authors discuss a number of factors predictive of referral destination. Overall, the probability of referral to a state hospital was approximately 60% greater than to a privately owned facility. Patients who were married, non-threatening to self or others, and privately insured were more likely to be referred to private settings. In addition, a significant positive effect of regional private bed supply was identified.

Storm in a Private Bed

Storm in a Private Bed