Private Delivery Research Articles

잠재계층로짓모형을 활용한 배달 앱 시장세분화

As the usage of domestic delivery apps skyrockets, the market sees a rapid expansion. Over the past five years, the transaction volume has amplified more than ninefold, predominantly propelled by private delivery apps. However, the rising service fees of these apps have sparked dissatisfaction among consumers and small business owners, drawing attention to the emergence of public delivery apps. These apps could potentially achieve numerous social objectives, such as broadening consumer choices and invigorating local markets. In this study, we aimed to understand consumers' preferences for delivery apps and explore ways to improve public delivery apps and revitalize local economies through them. To achieve this, we analyzed consumer preferences for market segmentation of delivery apps using latent class logt model. This study proposes marketing strategies to increase the usage of public delivery apps and revitalize local economies.

Advantages and disadvantages of digital mental health initiatives in Nigeria – a qualitative interview study

Background The impact of COVID-19 and its mitigation measures have exacerbated the global mental health crisis. Digital mental health interventions (DMHIs) may have the potential to address health system gaps and global health inequalities in low- and middle-income countries (LMICs). Aims This thesis aims to map the current state of DMHIs in Nigeria and illustrate their progress, limitations, and challenges. Methods Twenty interviews were conducted with researchers, healthcare providers, and digital health experts. Interviews were recorded and transcribed. Then data were coded and analyzed using thematic analysis. Results The majority of DMHIs in Nigeria are private mental health service delivery platforms that connect directly to mental health professionals. The target audience encompasses all mental health conditions and ages. Advantages of DMHIs include increasing efficiency, accessibility, addressing stigma, and filling the mental health service gap. Disadvantages include skepticism, limitations of applicability, lack of accessibility to internet and technology, lack of sustainability and infrastructure, and lack of funding and policies. Conclusion The lessons learned in the Nigerian context can inform the delivery of DMHIs in other low-resource settings. Future research should examine user and provider feedback of DMHIs to allow for comparative analysis, more conclusive and replicable results to inform DMHI design and implementation.

Trends in and Correlates of Short-Acting Contraceptive Stock-Outs: Multicountry Analysis of Performance Monitoring for Action Agile Platform Data.

Understanding trends in contraceptive stock-outs, as well as their structural and demand-side correlates, is critical for policymakers and program managers to identify strategies to further anticipate, reduce, and prevent stock-outs. We analyzed trends as well as supply- and demand-side correlates of short-acting contraceptive method stock-outs by using data from multiple rounds of Performance Monitoring for Action Agile surveys. These data longitudinally measured contraceptive availability over 2 years (between November 2017 and January 2020) across 2,134 public and private service delivery points (SDPs) from urban areas of 5 countries (Burkina Faso, Democratic Republic of the Congo [DRC], India, Kenya, and Nigeria). For each country, we analyzed the trends and used multilevel mixed-effect logistic regression to model the odds of short-acting contraceptive stock-outs, adjusting for key structural and demand-side factors of the SDPs. Stock-outs in short-acting contraceptive methods were common in health facilities and varied markedly, ranging from as low as 2.9% (95% confidence interval [CI]=1.7%, 5.1%) in India to 51.0% (95% CIs=46.8%, 56.0%) in Kenya. During the observation period, stock-out rates decreased by 28% in the SDP samples in India (aOR=0.72, P<.001) and 8% in Nigeria (aOR=0.92, P<.001) but increased by 15% in DRC (aOR=1.15; P=036) and 5% in Kenya (aOR=1.05, P=003) with each round of data collection. Correlates of stock-out rates included the facility managerial authority (private versus public), whether the facility was rated high quality, whether the facility was at an advanced tier, and whether there was high demand for short-acting contraceptives. In conclusion, stock-outs of short-acting contraceptives are still common in many settings. Measuring and monitoring contraceptive stock-outs is crucial for identifying and addressing issues related to the availability and supply of short-acting contraceptives.

Cocoa farmers' perspective on the quality of public and private agricultural extension delivery in Southern Ghana

While the theme of extension service quality has been extensively explored, we set out distinctly to compare farmers' perceptions of quality of public and private extension services. We adopted a survey method and collected data from 385 farmers. The private extension service received superior ratings as compared to the public services. Using multivariate probit model, we found gender, farm size, education, and access to hired labour as factors that affect extension service quality. Key challenges are wide agent-to-farmer ratio and high cost of services. We encourage collaborative efforts between government and private extension organisations to elevate extension delivery to farmers.

Mapping the Geographic Inequalities in Psychiatrist Distribution across Madhya Pradesh, India: An Exploratory Study

Objective: The National Mental Health Survey identified a vast treatment gap across India. This treatment gap is partly attributed to the availability and accessibility of mental health services in different states. Accessibility to a psychiatrist in Madhya Pradesh (MP) is essential due to the significant disparity among urban, rural, and tribal regions across the state. The study attempted to identify the geographical disparity of psychiatrists in MP to improve future mental health service delivery. Methods: An online survey of practicing psychiatrists was conducted in December 2022 in the settings of public and private healthcare service delivery systems through offline and online accessibility/availability of psychiatrists practicing in MP, and the data were mapped using geo-locations of psychiatrists and were analyzed using ArcMap 10.8.1. Results: In total, 152 psychiatrists were practicing in MP across 195 locations, which amounts to 0.21 psychiatrists per 100,000 population with a concentration around big cities. Out of 54 districts, 24 districts did not have any practicing psychiatrists. A total of 155 health facilities were identified across 30 (55.6%) districts where at least one psychiatrist provided mental health services. The nearest-neighbor index for 152 points was –13.69. Conclusions: Combining psychiatrist geo-mapping data with population data comprehensively explains the MP state’s mental health service delivery needs. It could be wise to improve the spatial distribution of psychiatrists in each district rather than achieving the recommended ratio of doctors to patients per state. These data need to be supplemented with qualitative inquiry to help policymakers and health planners generate effective public–private partnerships in mental health service delivery in the coming time.

IJCM_45A: Inter-district variation in preterm deaths identified by a perinatal death audit: a health system intervention research

Background: Analyzing preterm deaths is crucial due to the significant contribution of preterm babies to neonatal mortality rates. However, there is no universal perinatal death (PND) audit system in India Objective: To analyze the preterm deaths in two districts of Karnataka with study model of PND audit Methodology: Hospitals with maternal and child care facilities which met inclusion criteria in Dakshina Kannada (DK), high performing and Koppal (KPL),low performing districts were included after institutional ethics committee approval and permission from Mission Director, National Health Mission, Directorate of Heath and Family Welfare Services, Government of Karnataka. A PND audit system was designed. Personnel with training in medico-social history taking were utilized for data accumulation. Causal analysis of death as certified by independent expert panels and certifying physician was carried out and was compared for functionality. To determine optimality of care, facilities were categorized depending upon available levels of maternity and neonatal care. Preterm deaths during the one-year study period with complete data were analyzed. Results: 119 preterm deaths in DK and 97 preterm deaths in KPL were analyzed. In utero transfer was 81.5 % in DK and 11.3% in KPL. More preterm deliveries were documented in public hospitals in both districts. Deaths of preterm babies in private hospitals at KPLwas 41.2% against 27.8% private deliveries. In KPL 22.6% babies died at home despite delivering in hospitals. Risk factor documentation was poor in both districts. Expert committee review increased preventability assertion from 7.5 to 11.7% in DK, 2 to 62.8% in KPL. Conclusion: Auditing perinatal deaths and analysing preterm deaths resulted in identification of specific deficiencies in healthcare system. DK had reasonably good facilities but KPL had serious concerns. The study model enhanced the preventability assertion in preterm deaths

Threat Construction and Coercive Credibility

How do actors issue credible threats during international crises? While scholarship has traditionally focused on how the context of threats influences credibility, this paper considers how the construction of the threat itself affects credibility. More specifically, this paper introduces the concept of threat justification and theorize how the choice of explanation a leader uses in communicating her threats can influence her coercive credibility. This study employs a conjoint design survey experiment to identify the influence of threat specificity and severity, public versus private threats, and threat justification on perceptions of credibility. This paper finds that more precise threats are perceived as more credible, while threats employing reputational justifications are less credible. There is a minimal amount of evidence that the public versus private delivery of a threat influences credibility. This paper also finds that perceptions of credibility are influenced by whether the audience is domestic versus international and by the severity of the instigating crisis trigger. This study furthers our understanding of the factors shaping coercive credibility and how policymakers can most effectively convey their commitments during international crises.

Managed competition in Colombia: convergence of public and private insurance and delivery.

The Colombian health system has made a deep transition into managed competition since a major reform in 1993. A market for insurers was created, the consumer has free choice of insurer and a national-level equalisation fund distributes revenues via a per-capita payment. Fully subsidised insurance for the poor and informal, and a comprehensive standardised benefit package for subsidised and contributory schemes (both schemes covering 98 per cent of the population), has led to a low level of out-of-pocket expenses and high financial protection, as well as to reduced gaps in equity in access. The preconditions for managed competition are largely met, but improving health care providers' organisation towards integrated care, to enable them to deliver more value, is a necessary step to achieve the expected results of managed competition in terms of efficiency and quality. Although the current system is likely to be reformed in the coming months, the nature and extent of those reforms are not defined yet, so our analysis is based on the current system.

Effect of COVID-19 pandemic on utilization of maternal healthcare services in a rural area of Haryana - A record-based comparative study.

The COVID-19 pandemic posed a challenge for the public health system, as all the health facilities and manpower were diverted for the delivery of COVID-19-related services. This affected the provision of routine health services, including maternal healthcare services. There is a paucity of data from rural and primary healthcare settings, as the earlier studies were either modelling-based or from tertiary care centres. This record-based study was conducted in 12 subcentres in the district Faridabad of Haryana. Data of pregnant women registered during 1 April to 30 September in the years 2017-2020 were retrieved. The utilization of maternal healthcare services among women registered during 1 April 2020 to 30 September 2020 was compared with those registered in the same period during the preceding 3 years (2017-2019). There was a significant decline in utilization of maternal healthcare services. Services like minimum four antenatal visits declined from 67.8% to 48.3% (P < 0.0001), at least 100 iron-folic acid tablets (45.4-20.9%; P < 0.001), and examination at each visit (90.8-72.3%; P < 0.001). The proportion of pregnant women who received full antenatal care decreased from 26.0% to 10.7% (P < 0.001). There was a significant increase in delivery in private health facilities (40.9-49.9%) and delivery by caesarean section (21.6-27.3%; P = 0.002). COVID-19 pandemic had an adverse effect on utilization of maternal healthcare services. Effective planning and coordination between different levels of government health facilities and primary care providers, including family physicians, can ensure uninterrupted provision of essential services during similar emergencies in future.

Large investors’ involvement in Ireland's primary care centres

Abstract Background In 2001, Ireland announced a Primary Care Strategy that has led to the implementation of primary care centres (PCCs) throughout the country. This presentation examines the nature and extent of private sector involvement in establishing the PCC network since 2001, focusing on large global investors. Methods A dataset on all primary care centres in Ireland was constructed, comprising information on geographical location, the year that it became operational, and its delivery mode (public procurement, lease, or public-private partnership). A survey of large investment patterns was also conducted through the grey literature and news reports. Results By 2023, 172 PCCs are planned to be operational, developed through public, leased or public-private partnerships arrangements. Before 2009, PCCs were delivered by traditional public procurement, but since 2009, private delivery methods have been prioritized. Leased primary care centres have been attractive for large institutional investors attracted by stable rental income. This paper surveys the patterns and trends involved. Conclusions Trends in large multinational and domestic investments in the primary care market should be documented systematically because they have the potential to transform the existing PCC network and primary care system.

Extremal graph theory and generation of quadratic multivariate transformations of Algebraic Post-Quantum Cryptography

We introduce large groups of quadratic transformations of a vector space over the finite fields defined via symbolic computations with the usage of algebraic constructions of Extremal Graph Theory. They can serve as platforms for the protocols of Noncommutative Cryptography. The modifications of these symbolic computations in the case of large fields of characteristic two allow us to define quadratic bijective multivariate public keys such that the inverses of public maps has a large polynomial degree. We suggest the usage of constructed protocols for the private delivery of quadratic encryption maps instead of the public usage of these transformations.

Double burden of vulnerability for refugees: conceptualization and policy solutions for financial protection in Iran using systems thinking approach

IntroductionIran is host to one of the world’s largest and longest-standing refugee populations. Although Iran has initiated a basic health insurance scheme for refugees throughout the country since September 2015, the population coverage of this scheme is very low, and various factors have caused a significant percentage of refugees to still lack insurance coverage and often face financial hardships when receiving health services. In response, this study aimed to understand barriers to insurance coverage among refugees in Iran and propose effective policies that can address persistent gaps in financial protection.MethodsThis qualitative study was conducted in two phases. First, a review of policy documents and interviews with participants were conducted to investigate the common barriers and facilitators of effective insurance coverage for refugees in Iran. Then, a systems thinking approach was applied to visualize the common variables and interactions on the path to achieving financial protection for refugees.ResultsFindings showed that various factors, such as (1) household-based premium for refugees, (2) considering a waiting time to be eligible for insurance benefits, (3) determining high premiums for non-vulnerable groups and (4) a deep difference between the health services tariffs of the public and private service delivery sectors in Iran, have caused the coverage of health insurance for non-vulnerable refugees to be challenging. Furthermore, some policy solutions were found to improve the health insurance coverage of refugees in Iran. These included removing household size from premium calculations, lowering current premium rates and getting monthly premiums from non-vulnerable refugees.ConclusionsA number of factors have caused health insurance coverage to be inaccessible for refugees, especially non-vulnerable refugees in Iran. Therefore, it is necessary to adopt effective policies to improve the health financing for the refugee with the aim of ensuring financial protection, taking into account the different actors and the interactions between them.

Understanding Afghan Refugee Experiences With Obstetrical Care: A Qualitative Study [ID: 1381425

INTRODUCTION: Providing equitable maternal care to refugees is a challenging task for hosting countries because of differences in personal experiences and health care systems. It is important to understand these unique needs because of the increased risk of poor pregnancy and birth outcomes for refugee patients. The aim of this study was to explore the experiences of obstetrical care among Afghan refugees in their native countries to mitigate that risk. METHODS: A qualitative study was conducted of 10 Afghan women. Institutional review board approval was obtained (UMKC #2092624). Face-to-face, semistructured, and in-depth interviews were conducted with certified interpreters. Interviews were analyzed using a thematic analytical method. RESULTS: All study participants were recent migrants within the past 6 months with no prior care within the U.S. health care system. Patients were pregnant in their second (n=8) or third trimester (n=2). Two were nulliparous. Three major themes were identified: insufficient prenatal and postpartum care, inadequate information, and decreased social support. None of the participants had regular prenatal care, ultrasounds, or labs. Most of the women (n=8) had previously delivered in a hospital, although they noted several differences: lack of private delivery rooms, fetal monitoring, and support during the process. There was no consent process, and the women were unaware of indications for delivery or cesarean delivery. CONCLUSION: With better understanding of the background and experiences of Afghan refugee patients, we can develop strategies to improve obstetric care and outcomes. This includes educational efforts geared towards introducing these women to a new health care model that closes the gaps they previously experienced.

Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa

BackgroundWhile South Africa’s national HIV program is the largest in the world, it has yet to reach the UNAIDS 95–95-95 targets. To reach these targets, the expansion of the HIV treatment program may be accelerated through the use private sector delivery models. This study identified three innovative non-governmental primary health care models (private sector) providing HIV treatment, as well as two government primary health clinics (public sector) that served similar populations. We estimated the resources used, and costs and outcomes of HIV treatment across these models to provide inputs to inform decisions around how these services might best be provided through National Health Insurance (NHI).MethodsA review of potential private sector models for HIV treatment in a primary health care setting was conducted. Models actively offering HIV treatment (i.e. in 2019) were considered for inclusion in the evaluation, subject to data availability and location. These models were augmented by government primary health clinics offering HIV services in similar locations. We conducted a cost-outcomes analysis by collecting patient-level resource usage and treatment outcomes through retrospective medical record reviews and a bottom-up micro-costing from the provider perspective (public or private payer). Patient outcomes were based on whether the patient was still in care at the end of the follow up period and viral load (VL) status, to create the following outcome categories: in care and responding (VL suppressed), in care and not responding (VL unsuppressed), in care (VL unknown) and not in care (LTFU or deceased). Data collection was conducted in 2019 and reflects services provided during the 4 years prior to that (2016–2019).ResultsThree hundred seventy-six patients were included across the five HIV treatment models. Across the three private sector models there were differences in the costs and outcomes of HIV treatment delivery, two of the models had results similar to the public sector primary health clinics. The nurse-led model appears to have a cost-outcome profile distinct from the others.ConclusionThe results show that across the private sector models studied the costs and outcomes of HIV treatment delivery vary, yet there were models that provided costs and outcomes similar to those found with public sector delivery. Offering HIV treatment under NHI through private delivery models could therefore be an option to increase access beyond the current public sector capacity.

Learning Hybridization in Montessori School during Pandemic

This study describes learning strategies and the stages of their implementation in Islamic Montessori schools during the pandemic. Conditions during the pandemic require teachers to be adept at using IT to innovate in their learning. This research was a case study. Subjects are teachers whose taught used the Montessori approach for at least 2 years. Data were collected using interviews, documentation, and observation. The data was analyzed using the Spradley technique. Triangulation techniques and thick descriptions are used for the validity of the data. The main findings from Montessori learning at Budi Mulia Dua Islamic schools during the pandemic were carried out using three strategies, namely, Save Distancing Private Class (SDPC), Online Class (OC), and delivery of lesson kits. The use of the results of this research is especially for teachers in Montessori to be able to conduct activities during a pandemic using the original Montessori learning stages through the three strategies. SDPC is most likely to apply the complete Montessori learning stages from greeting to closing. Modification of the Montessori stages was carried out when the OC strategy was implemented. Meanwhile, the Montessori stages cannot be applied to the lesson kit delivery strategy because children study at home under parental guidance. The novelty in this research is that the COVID-19 pandemic has made the implementation of learning require various innovations so that it can be carried out in a quality manner and still pay attention to the needs of children. The strategy is adjusted to government policies that follow developments in cases that occur in the country in general. This variation in strategy also determines the continuity of education services in schools, including this Budi Mulia Dua (BMD). Keywords: learning strategies, Montessori, pandemic. DOI: https://doi.org/10.55463/hkjss.issn.1021-3619.60.70

Privacy-preserving targeted mobile advertising: A Blockchain-based framework for mobile ads

The targeted advertising is based on preference profiles inferred via relationships among individuals, their monitored responses to previous advertising and temporal activity over the Internet, which has raised critical privacy concerns. In this paper, we present a novel proposal for a Blockchain-based advertising platform that provides: a system for privacy preserving user profiling, privately requesting ads from the advertising system, the billing mechanisms for presented and clicked ads, the advertising system that uploads ads to the cloud according to profiling interests, various types of transactions to enable advertising operations in Blockchain-based network, and the method that allows a cloud system to privately compute the access policies for various resources (such as ads, mobile user profiles). Our main goal is to design a decentralised framework for targeted ads, which enables private delivery of ads to users whose behavioural profiles accurately match the presented ads, defined by the ad system. We implement a POC of our proposed framework i.e. a Bespoke Miner and experimentally evaluate various components of Blockchain-based in-app advertising system, implementing various critical components; such as, evaluating user profiles, implementing access policies, encryption and decryption of users’ profiles. We observe that the processing delay for traversing policies of various tree sizes, the encryption/decryption time of user profiling with various key-sizes and user profiles of various interests evaluates to an acceptable amount of processing time as that of the currently implemented ad systems.

Differences in contraceptive prices between and within family planning outlets in urban and semiurban Nigeria: a prospective cohort study

BACKGROUNDThere is a lack of comprehensive evidence assessing variability and volatility in contraceptive prices. Improved understanding of contraceptive pricing, both between and within public and private service delivery points situated within complex, mixed health systems, may improve understanding of contraceptive access from the perspective of the consumer. OBJECTIVETo describe variability and volatility in contraceptive method prices within localized urban and semiurban markets in Nigeria. STUDY DESIGNWe used product audit data from a complete census and longitudinal cohort of family planning vendors within 4 urban and semiurban study sites in Nigeria. Differences in outlet-level minimum prices by outlet type were assessed using generalized estimating equations. We presented descriptive summaries of within-outlet changes in minimum price over time. RESULTSAmong 672 family planning vendors, outlet-level minimum prices were significantly higher in private facilities/outlets than in public facilities. The outlet-level minimum price was $9.4 (95% confidence interval, $5.7–$13.2) higher for implants in private vs public facilities. We observed high availability of free contraceptive products in the public sector (79%–100%), moderate levels for specific contraceptive product types among community health workers and private facilities (28%–62% for male condoms), and low prevalence among private nonfacility outlets (0%–3%). Variability in contraceptive prices was high within private facilities and nonfacility outlets: standard deviations in the distribution of long-acting reversible contraceptive products ranged from $9.7 for implants to $13.1 for intrauterine devices in the private sector. Changes in minimum prices by contraceptive method type were common within the same outlets over time in the private sector. CONCLUSIONWe observed high variability between and within contraceptive vendors in selected Nigerian family planning markets. Further research assessing the impact of price variability is critical for understanding contraceptive access and decision-making from the consumer's perspective.

Comparative performance of public and private primary care service delivery in Malaysia: An analysis of findings from QUALICOPC

Primary care services are essential in achieving universal health coverage and Malaysia is looking into public-private partnership to overcome resource constraints. The study aims to compare the performance of primary care service delivery dimensions between public and private sector. This cross-sectional study used the data from the Malaysian International Quality and Costs of Primary Care (QUALICOPC) study conducted in 2015-2016. The relative performance of each sector in four dimensions was compared using multi-level linear regression by incorporating a dummy variable indicating public sector in the model. The public sector was shown to have higher performance in comprehensiveness and coordination, while the private sector was better in continuity. There was no significant difference in accessibility. The public primary care services were better in serving primary care sensitive conditions, better informational continuity, and with better skill-mix and inter- and intra- professional relationship. Meanwhile, the private sector was stronger in referral decision making process, specialist feedback and greater out of hours facilities access. The public and private sectors differ in their strengths, which the government may tap into to strengthen primary care services. Other areas for improvement include seamless care strategies that promote good referral, feedback, and information continuity.

The Neoliberal State and Management of the Covid-19 Pandemic in Nigeria

Abstract This study examines how neoliberalism affected the management of Covid-19 in Nigeria. As a result of its emphasis on privatisation and austerity, neoliberalism discouraged social investment programmes and provisioning. The privatisation of Nigeria’s health sector severely stifled health financing, which led to the collapse of public health institutions and the proliferation of private and informal health delivery systems. It limited universal access to quality healthcare, worsened the health conditions of poor Nigerians and rendered the health sector incapable of managing emergency health situations, such as Covid-19. The absence of well-coordinated social investment programmes to cushion the effects of lockdown widened social inequality and misery, making it impossible for citizens in the informal economy to adhere to the Covid-19 guidelines. The state responded with repression to enforce the rules. This study recommends overhauling the Nigerian state and its political economy as a condition for reducing citizen’s vulnerability to a pandemic.

Assessment of Healthcare Delivery Systems in Orthopaedic Surgery: A Large Retrospective Cohort Evaluation.

The purpose of this study was to assess how quality and volume of common orthopaedic care varies across private, municipal, and federal healthcare delivery systems (HDSs). Hip and knee arthroplasty, knee and shoulder arthroscopy, and hip fracture repair were audited over a two-year period. Electronic medical records were reviewed for demographics, diagnosis, lengths of stay (LoSs), surgical wait times, inpatient complication, readmission, and revision surgery rates. Multivariate regression controlled for differences in age, sex, diagnosis, and Charlson Comorbidity Index to determine how HDS correlated with surgical wait time, length of stay, complication rates, readmission, and revision surgery. The 5,696 included patients comprise 87.4% private, 8.6% municipal, and 4.0% federal HDSs. Compared with private HDS for arthroplasty, federal surgical wait times were 18 days shorter (95% CI = 9 to 26 days, P < 0.001); federal LoS was 4 days longer (95% CI = 3.6 to 4.3 days, P < 0.001); municipal LoS was 1 day longer (95% CI = 0.8 to 1.4, P < 0.001); municipal 1-year revision surgery odds were increased (odds ratio [OR] = 2.8, 95% CI = 1.3 to 5.4, P = 0.045); and complication odds increased for municipal (OR = 12.2, 95% CI = 5.2 to 27.4, P < 0.001) and federal (OR = 12.0, 95% CI = 4.5 to 30.8, P < 0.001) HDSs. Compared with private HDS for arthroscopy, municipal wait times were 57 days longer (95% CI = 48 to 66 days, P < 0.001) and federal wait times were 34 days longer (95% CI = 21 to 47 days, P < 0.001). Compared with private HDS for fracture repair, municipal wait times were 0.6 days longer (95% CI = 0.2 to 1.0, P = 0.02); federal LoS was 7 days longer (95% CI = 3.6 to 9.4 days, P < 0.001); and municipal LoS was 4 days longer (95% CI = 2.4 to 4.8, P < 0.001). Only private HDS fracture repair patients received bone health consultations. The private HDS provided care for a markedly larger volume of patients seeking orthopaedic care. In addition, private HDS patients experienced reduced surgical wait times, LoSs, and complication odds for inpatient elective cases, with better referral patterns for nonsurgical orthopaedic care after hip fractures within the private HDS. These results may guide improvements for federal and municipal HDSs.