Private Health Care Providers Research Articles

Trajectories of primary health care utilization: a 10-year follow-up after the Swedish Patient Choice Reform of primary health care

BackgroundIn January 2010, the choice reform was instituted in Swedish primary health care establishing free entry for private primary health care providers and enabling patients to choose freely among primary health care centers. The motivation behind the reform was to improve access to primary care and responsiveness to patient expectations. Reform effects on health care utilization have previously been investigated by using subgroup analyses assuming a pattern of homogeneous subgroups of the population. By using a different methodological approach, the aim of this study was to, from an equity perspective, investigate long term trends of primary health care utilization following the choice reform.MethodA closed cohort was created based on register data from Region Skåne, the third most populated region in Sweden, describing individuals’ health care utilization between 2007–2017. Using a novel approach, utilization data, measured as primary health care visits, was matched with socioeconomic and geographic determinants, and analyzed using logistic regression models.ResultsA total of 659,298 individuals were included in the cohort. Sex differences in utilization were recorded to decrease in the older age group and to increase in the younger age group. Multivariable logistic regression showed increasing utilization in older men to be associated with higher socioeconomic position, while in women it was associated with lower socioeconomic position. Furthermore, groups of becoming high utilizers were all associated with lower socioeconomic position and with residence in urban areas.ConclusionThe impact of demographic, socioeconomic and geographic determinants on primary health care utilization varies in magnitude and direction between groups of the population. As a result, the increase in utilization as observed in the general population following the choice reform is unevenly distributed between different population groups.

‘Accident and emergency’? Exploring the reasons for increased privatisation in England's NHS

England's NHS is experiencing rising privatisation as services are increasingly being delivered by private healthcare providers. This has led to concerns about the supposed benefit of this process on healthcare quality but the reasons for the increase – and whether processes prioritise quality – are not well understood. In-depth semi-structured interviews with 20 people involved in the commissioning process, sampled from 3 commissioning sites (regional health boards) are thematically analysed. Four key themes of reasons for outsourcing were identified: unmet need; the “choice agenda”; appetite for change amongst key individuals working at the commissioning body; and the impact of financial pressures. The study concludes that the experience of commissioners navigating the provision of healthcare with worsening social determinants of health and financial austerity means that decisions to use private providers based on anticipated quality are sometimes but not always possible - sometimes they constitute ‘accidents’, sometimes ‘emergencies’.

Is There a VA Advantage? Evidence from Dually Eligible Veterans

We study public versus private provision of health care for veterans aged 65 and older who may receive care provided by the US Department of Veterans Affairs (VA) and in private hospitals financed by Medicare. Utilizing the ambulance design of Doyle et al. (2015), we find that the VA reduces 28-day mortality by 46 percent (4.5 per centage points) and that these survival gains are persistent. The VA also reduces 28-day spending by 21 percent and delivers strikingly different reported services relative to private hospitals. We find suggestive evidence of complementarities between continuity of care, health IT, and integrated care. (JEL H51, I11, I12, I18, J14)

Assessing a digital technology-supported community child health programme in India using the Social Return on Investment framework.

An estimated 5.0 million children aged under 5 years died in 2020, with 82% of these deaths occurring in sub-Saharan Africa and southern Asia. Over one-third of Mumbai's population has limited access to healthcare, and child health outcomes are particularly grave among the urban poor. We describe the implementation of a digital technology-based child health programme in Mumbai and evaluate its holistic impact. Using an artificial intelligence (AI)-powered mobile health platform, we developed a programme for community-based management of child health. Leveraging an existing workforce, community health workers (CHW), the programme was designed to strengthen triage and referral, improve access to healthcare in the community, and reduce dependence on hospitals. A Social Return on Investment (SROI) framework is used to evaluate holistic impact. The programme increased the proportion of illness episodes treated in the community from 4% to 76%, subsequently reducing hospitalisations and out-of-pocket expenditure on private healthcare providers. For the total investment of Indian Rupee (INR) 2,632,271, the social return was INR 34,435,827, delivering an SROI ratio of 13. The annual cost of the programme per child was INR 625. Upskilling an existing workforce such as CHWs, with the help of AI-driven decision- support tools, has the potential to extend capacity for critical health services into community settings. This study provides a blueprint for evaluating the holistic impact of health technologies using evidence-based tools like SROI. These findings have applicability across income settings, offering clear rationale for the promotion of technology-supported interventions that strengthen healthcare delivery.

Is health insurance really benefitting Indian population? Evidence from a nationally representative sample survey.

Universal health coverage (UHC) is the centrepiece of the sustainable development goals and aims to ensure access to essential and quality healthcare services to all without facing financial hardships. Several health insurance programmes have been launched in India to progress towards UHC. This study aims to assess the impact of health insurance (overall health insurance, government sponsored health insurance (GSHI), and private voluntary health insurance) on accessibility and utilization of inpatient care, out-of-pocket health expenditure (OOPE), catastrophic health expenditure (CHE), and impoverishment in India. The 75th round of National Sample Survey Office was used in the study, which covered 555,115 individuals, 113,823 households, and 91,445 hospitalization incidence all over India. Descriptive statistics, multivariable logistic regression, and propensity score matching (PSM) methods were employed. Enrolment under health insurance has impacted the accessibility and utilization pattern of hospitalization to some extent for the insured. PSM showed that enrolment under GSHI schemes reduced OOPE by INR 3314 (USD 49) and CHE incidence by 1%-4% at various thresholds. Among poor persons, there was a marginal but statistically significant reduction of OOPE among those enrolled under GSHI schemes (p<0.05). However, GSHI schemes did not statistically significantly reduce the CHE burden for poor persons enrolled (p>0.05). Furthermore, enrolment under private voluntary health insurance reduced OOPE by INR 13,511 (USD 198) and CHE by 13.47% at 10% threshold, 4.61% at 25% threshold, and 2.65% at 40% threshold. However, its uptake was primarily confined to richer economic quintiles and urban areas that exacerbates equity concerns. All the results were confirmed through robustness measures employed. There is a necessity to increase awareness and uptake of health insurance, along with introducing comprehensive insurance packages covering both inpatient and outpatient care. Also, increasing public health spending, strengthening public healthcare facilities, and improving regulatory implementation of private healthcare providers are imperative to augment financial protection.

Factors influencing public and private healthcare utilisation in Uganda.

In Uganda, health care utilisation remains very low despite a number of government reforms that have been implemented in the health sector since the 1990's such as decentralization and removal of user fees in public health facilities among others. To examine the factors influencing public and private health care utilisation in Uganda. The study used cross sectional data from the Uganda National Household Survey collected between July 2016 and June 2017. Anderson's conceptual framework was used to identify explanatory variables associated with choice of health care providers and a multinomial logistic regression model was estimated. Out of the 17,912 individuals who sought care, 36% used a government facility, 60% used private facility while 4% had self- care/treatment. The results show that out of pocket health expenditure, age, level of education, marital status, residence, and type of illness significantly influenced choice of public healthcare providers. Similarly, utilisation of private healthcare providers was associated with household welfare, level of education, residence, marital status, illness days, and type of illness. The findings highlight the need for a national health insurance scheme to reduce out of pocket payments for health care and enable the poor and vulnerable patients visit the modern health facilities.

Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey

AbstractBackgroundDiabetes mellitus (DM) is a major public health concern in India, and entails a severe burden in terms of disability, death, and economic cost. This study examined the out‐of‐pocket health expenditure (OOPE) and financial burden associated with DM care in India.MethodsThe study used data from the latest round of the National Sample Survey on health, which covered 555,115 individuals from 113,823 households in India. In the present study, data of 1216 individuals who sought inpatient treatment and 6527 individuals who sought outpatient care for DM were analysed.ResultsIn India, 10.04 per 1000 persons reported having DM during the last 15 days before the survey date, varying from 6.94/1000 in rural areas to 17.45/1000 in urban areas. Nearly 38% of Indian households with diabetic members experienced catastrophic health expenditure (at the 10% threshold) and approximately 10% of DM‐affected households were pushed below the poverty line because of OOPE, irrespective of the type of care sought. 48.5% of households used distressed sources to finance the inpatient costs of DM. Medicines constituted one of the largest proportion of total health expenditure, regardless of the type of care sought or type of healthcare facility visited. The average monthly OOPE was over 4.5‐fold and 2.5‐fold higher for households who sought inpatient and outpatient care, respectively, from private health facilities, compared with those treated at public facilities. Notably, the financial burden was more severe for households residing in rural areas, those in lower economic quintiles, those belonging to marginalised social groups, and those using private health facilities.ConclusionThe burden of DM and its associated financial ramifications necessitate policy measures, such as prioritising health promotion and disease prevention strategies, strengthening public healthcare facilities, improved regulation of private healthcare providers, and bringing outpatient services under the purview of health insurance, to manage the diabetes epidemic and mitigate its financial impact.

The COVID-19 Pandemic and the Private Health Sector: Profiting without Socially Contributing.

The COVID-19 pandemic necessitated the mobilization of all available health care resources, including private, for-profit ones. The aim of this multiple methods study (combination of document and secondary data analysis) was to assess government regulations facilitating the private health sector's participation in the COVID-19 response in Greece. During the pandemic, the government made three successive increases in private providers' reimbursement fees, provided additional financial incentives to private providers, and allocated €280 million of emergency funding for the private sector's involvement in the national COVID-19 response. In response, private hospitals made available on average 2.2% of their total bed capacity per epidemic wave for the treatment of COVID-19 patients and 1.7% of their total bed capacity for the treatment of non-COVID-19 patients transferred from National Health System (NHS) hospitals. In 2020 the five largest health care corporate groups maintained their revenues, while in 2021 they increased them by 18.7%-a striking comparison with the 9% recession experienced by the Greek economy in 2020 and its 8.4% recovery in 2021. In a time of an acute public health crisis, private health care providers responded to society's pressing health care needs by insulating their facilities from COVID-19 patients and NHS patient transfers, minimizing their social contribution and safeguarding their revenues and profits.

İnfantil Dermatolojik Hastalık ve Tedavilerin Sıklığı: Özel Hastane ve Özel Klinik Analizi

The aim of this study was to determine the prevalence and distribution of dermatologic diseases and treatments in pediatric patients between the ages of 0-2 and the relation between skin diseases and age, gender and application year in private healthcare providers. The study was retrospectively analysed and conducted at dermatology department in a private hospital and private dermatology clinics. A total of 482 patients aged 0-2 years of outpatient admissions from January 1, 2015, to December 1, 2022 were included the study. The most common diseases group were eczemas (53.6%), nevus and benign skin tumors (8.3%), viral diseases (6%), pigmentation disorders (5.7%), and parasitic infections (4%). The dermatitis group was statistically significantly higher in 0-1 age group than 1-2 age. Atopic dermatitis was the most common diagnosis. The viral infections, parasitic infections, nail diseases, and dermatoses due to physical factors were higher in 1-2 age group (p&amp;lt;0.05). Benign skin tumors were commonly observed in girls and 0-1 age group (p&amp;lt;0.05). The topical treatment were usually prescribed to the patients. Systemic treatment was commonly prescribed in 1-2 age (p=0.007) and follow-up decision was usually given to girls than boys (p=0.001). Viral and bacterial infections were observed in higher rates after coronavirus disease 2019 pandemic (p&amp;lt;0.05). New studies in specific pediatric age groups will help to better understand the frequency of dermatological diseases and treatments and also studies conducted at different levels of health care may contribute better to develop health care policies, designing preventive health services and education programmes.

Health Care Utilization in Russia: Public Health Survey Findings

Introduction: Different groups of population vary in whether and how often they seek help from health care providers. Determination of such intergroup differences in health care utilization contributes to identification of disparities in access to care. Andersen’s model of health care utilization (commonly used for exploring patients’ behaviors) was chosen as the theoretical basis for this study. Objective: To identify groups of individuals who are more likely to seek medical attention in Russia and to establish differences in their preference between public and private health care providers. Materials and methods: Statistical regression analysis was applied to public health survey data collected in 2022. The sample of 2,150 respondents was representative for the adult population of Russia. Results: Every four out of five respondents sought medical help (79.0 %) in the previous year. Two third of them reported going to a private provider at least once (65.3 %) over the previous year. Being female, younger, married, with higher education, employed, having monthly incomes over 20 thousand rubles, rating their own health as bad were associated with being more likely to seek medical assistance. The first four characteristics of the respondents listed above and belonging to the highest income group (earning more than 60 thousand rubles monthly) were also found to be associated with higher probability of utilizing paid services. Conclusions: This study revealed no differences in access to care between the respondents living in cities of different sizes; rather, such differences were associated with the employment status and income of the participants.

Challenges in engaging the private sector for tuberculosis prevention and care in Nigeria: a mixed methods study

ObjectivesThis study aimed to assess the practices of private practitioners regarding tuberculosis (TB), and to ascertain factors related to the low contribution of private healthcare providers to TB prevention and...

Exploring the determinants of private healthcare providers' market power: A performance-based perspective.

This research focuses on market power in the private healthcare sector. This topic has been poorly explored by the extant literature and the reasons mainly rely on the peculiarities of the sector and the specific market. In fact, health providers' market power is influenced by multiple factors and by the fact that prices are often regulated by national or regional public authorities. To fill this gap, the article explores the relationship between performance characteristics and health providers' market power, measured through the Lerner index. The research is based on the analysis of panel data for 437 Italian private healthcare providers over the period 2012-2020. To explore the determinants of health providers' market power, this research employs System-generalized method of moments (SYS-GMM) estimation models. The results highlight a significant and non-linear relationship between market power and process performance, as well as with gender diversity. Intangible assets are another input variable that has a significant and positive relationship with market power. The study contributes to the identification of the performance characteristics driving health providers' market power.

A comprehensive examination ofthe economic impact ofout-of-pocket health expenditures inIndia.

More than 50% of health expenditure is financed through out-of-pocket payments in India, imposing a colossal financial burden on households. Amidst the rising incidence of non-communicable diseases, injuries, and an unfinished agenda of infectious diseases, this study examines comprehensively the economic impact of out-of-pocket health expenditure (OOPE) across 17 disease categories in India. Data from the latest round of the National Sample Survey (2017-18), titled 'Household Social Consumption: Health', were employed. Outcomes, namely, catastrophic health expenditure (CHE), poverty headcount ratio, distressed financing, foregone care, and loss of household earnings, were estimated. Results showed that 49% of households that sought hospitalization and/or outpatient care experienced CHE and 15% of households fell below the poverty line due to OOPE. Notably, outpatient care was more burdensome (CHE: 47.8% and impoverishment: 15.0%) than hospitalization (CHE: 43.1% and impoverishment: 10.7%). Nearly 16% of households used distressed sources to finance hospitalization-related OOPE. Cancer, genitourinary disorders, psychiatric and neurological disorders, obstetric conditions, and injuries imposed a substantial economic burden on households. OOPE and associated financial burden were higher among households where members sought care in private healthcare facilities compared with those treated in public facilities across most disease categories. The high burden of OOPE necessitates the need to increase health insurance uptake and consider outpatient services under the purview of health insurance. Concerted efforts to strengthen the public health sector, improved regulation of private healthcare providers, and prioritizing health promotion and disease prevention strategies are crucial to augment financial risk protection.

Impact of COVID-19 on healthcare system in India: A systematic review.

Despite an extensive healthcare system in India, the COVID-19 Pandemic created havoc upon the existing Indian healthcare system by disrupting the supply of essential healthcare services to patients. It has also highlighted the significant-quality discrepancies of healthcare facilities between the rural-urban areas and between public and private healthcare providers. The not so advanced healthcare system of India was exposed through the lack of oxygen and essential drugs required for the treatment of COVID-19. Additionally, during the pandemic period there was a drastic decline in seeking non-COVID-19 disease related healthcare services. The objective of this systematic review is to determine whether COVID-19 has impacted the healthcare system in India.

Utilization of public and private healthcare facilities: patient choice

Healthcare system in Russia lets patients choose where they want to get medical services: at public or private healthcare facilities. This choice may depend on several factors. According to Andersen’s healthcare utilization model, these factors can be divided into three groups: predisposing, enabling and need factors. The purpose of this study is to identify factors determining patient choice between public and private healthcare providers in Russia. Statistical and regression analysis was carried out using 2019 Rosstat data. We found that men and people from older age groups were more likely to attend public facilities, while people with higher education, employed and living in larger cities were more likely to attend private clinics. Higher income, having supplemental health insurance, and receiving medical services outside one’s city were associated with an increase in probability of using private healthcare providers. Analysis of need factors showed that worse health in individuals was associated with increased probability of choosing private medical organizations, whereas disability was associated with decreased probability of making the same choice.

CMR access for patients with chest pain, raised troponins and unobstructed coronary arteries. A retrospective real world analysis from a large UK district general hospital

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The differential diagnosis in patients with chest pain, a dynamic troponin rise and unobstructed coronary arteries is broad. Cardiac magnetic resonance (CMR) imaging can differentiate between the aetiologies of myocardial injury The UK has a low number of MR scanners/million people compared to Germany (8.6 v 34.4) resulting in poor equity in access to CMR (1). Our hospital relies on an off-site private health care provider for the CMR service. Background The 2020 ESC Taskforce guidelines recommend the use CMR in all myocardial infarction with normal coronary artery (MINOCA ) patients ideally within 2 weeks. Purpose There were three objectives: 1. To identify what proportion of these patients had a CMR scan 2. To determine the mean CMR waiting time 3. To establish in how many cases CMR changed the diagnosis and patient management. Methods We retrospectively collected the data from January - December 2021 of all patients admitted to our hospital with chest pain, a dynamic troponin rise and unobstructed coronary arteries on coronary angiography. Patient demographics, troponin levels, the discharge diagnosis, timing and details of CMR study and changes in diagnosis and management post CMR scan were recorded. Results 81 patients fit inclusion criteria (49% male, mean 61.2±14.8 years). Mean troponin rise 271±403 ng/L. 45% underwent CMR imaging. Mean waiting time for CMR 35 ± 26.9 days. 21% had CMR in &amp;lt; 14 days. CMR scan led to a change in diagnosis in 40% and changed management in 29.7%. In 37.5 % of patients with a pre-scan diagnosis of myocarditis were found to have myocardial infarction post CMR scan. Conclusion The majority (55%) of our MINOCA patients did not have CMR imaging and the minority had it in &amp;lt; 2 weeks. As CMR led to a management change in almost one third of patients there is no doubt that our patients are getting suboptimal care due to lack of timely access to CMR. This study shows the difficulties of implementing guidelines in the real world particularly in a UK hospital where resources are strained and rapid expansion of urgent CMR slots is not possible.

"Together against Tuberculosis": Cascade of Care of Patients Referred by the Private Health Care Providers in the Kyrgyz Republic.

Until 2021, in the Kyrgyz Republic, tuberculosis (TB) was diagnosed and treated only in the public sector. With funding support of the STOP-TB partnership, the private providers in four regions of the country and Bishkek city were mapped, trained and incentivized to screen for and identify presumptive TB patients and refer them to the public facilities for diagnosis and treatment. In this study, we describe the cascade of care of such patients. This was a cohort study involving secondary analysis of routine data. Of 79,352 patients screened during February 2021-March 2022, 2511 (3%) had presumptive TB, of whom 903 (36%) were not tested for TB [pre-diagnostic loss to follow-up]. A total of 323 (13%) patients were diagnosed with TB, of whom, 42 (13%) were not started on treatment [pre-treatment loss to follow-up]. Among 257 patients eligible for outcome assessment, 197 (77%) had treatment success, 29 (11%) were lost-to-follow-up, 13 (5%) died, 4 (2%) had treatment failure and 14 (5%) were not evaluated. While this donor-funded, pioneering initiative was successful in engaging the private sector, we recommend that the national TB programme scales up the initiative nationally with dedicated budgets, activities and plans to monitor progress. Qualitative research is urgently needed to understand the reasons for the gaps in the care cascade.

Overall survival in treated ovarian cancer patients in Argentina: OCEANIA study.

e17595 Background: OCEANIA is a retrospective, real-world database study that evaluated treatment patterns and outcomes in a cohort of patients diagnosed with ovarian cancer (OC) in private healthcare settings in Latin America. The present analysis focused on evaluating up to five-year overall survival (OS) in a cohort of treated patients with OC in Argentina. Methods: Patients with an OC code diagnosed from 2010 to 2019 and with a cancer-related treatment claim (antineoplastics, surgery, and/or radiotherapy) were selected from a private healthcare provider’s database (Hospital Italiano de Buenos Aires) in Argentina. Patients were followed from diagnosis until the end of observation period or death. Frequency of OC patients by FIGO (International Federation of Gynecology and Obstetrics) stage was described. Cumulative treatment type was described through the whole follow-up period. One- to five-year survival Kaplan–Meier curves were built; patients who were lost to follow-up were censored. Results: 741 patients with OC were identified in the database with a mean (standard deviation) follow-up time of 31.7 (30.6) months; 539 (72.7%) were treated during this period. Among this population, 76.3% had information about FIGO staging: 73 (17.8%) were stage 1; 36 (8.8%) stage 2; 259 (63.0%) stage 3; and 43 (10.5%) stage 4. Cumulative distribution across treatment types revealed 355 (65.9%) patients received antineoplastics (321 [90.4%] received platinum-based treatment), 496 (92.0%) surgery and 18 (3.3%) radiotherapy. During a five-year observation window, 111 patients died (more than one half within two years of diagnosis). The adjusted cumulative OS for all treated patients in years 1–5 was 93.2%, 87.2%, 80.9%, 74.1%, and 69.0%, respectively (Table). Conclusions: OS is a key outcome in assessing the impact of current standards of care. Based on the results, although most (69.0%) of the patients survived after 5 years of follow-up, further improvement in OS presents a challenge. However, recent drug releases for OC management in Latin America may change this scenario. [Table: see text]

Progression-free survival in patients receiving first-line platinum-based therapy in Argentina: OCEANIA study.

e17593 Background: OCEANIA is a retrospective database study that evaluated treatment patterns and outcomes in a cohort of patients diagnosed with all ovarian cancer (OC) types in private healthcare settings in Brazil and Argentina. The present analysis described up to 5-year real-world (RW) outcomes in an OC cohort of patients who received first-line platinum-based treatment (PBT) in Argentina. Methods: Patients with an OC code diagnosed from 2010 to 2019 who received a PBT alone or in combination with other therapeutic modalities (other antineoplastics, surgery, and/or radiotherapy) were selected from a private healthcare provider’s database (Hospital Italiano de Buenos Aires) in Argentina. Frequency of PBT patients by FIGO (International Federation of Gynecology and Obstetrics) stage was described. Cumulative risk of progression to subsequent treatment or death was calculated for one year up to five years after the end of first PBT from the survival analysis (using Kaplan–Meier analyses). RW progression-free survival (RW-PFS) was defined as the time between the end of first PBT and the beginning of subsequent treatment or death; patients who were lost to follow-up were censored at the end of the study period. Results: From 741 OC patients in the database, 321 (43.3%) were exposed to a PBT. Among this population, 89.4% had information about FIGO staging: 39 (13.6%) were stage 1; 23 (8.0%) stage 2; 195 (67.9%) stage 3; and 30 (10.5%) stage 4. During the follow-up period, 209 events were recorded, including 181 progressions to subsequent treatments and 28 deaths. The unadjusted mean (standard deviation) and median RW-PFS were 16 (22.3) months and 6 months, respectively. The adjusted cumulative risks of progression or death for years 1–5 were 53.8%, 67.6%, 71.2%, 74.4%, and 76.1%, respectively. Conclusions: Almost two thirds (65.1%) of patients with OC exposed to PBT progressed to subsequent treatment or death during follow-up. The greatest risk of progression was observed within the first year after end of PBT, likely because almost 80% of patients were at stages 3 and 4 and the therapeutic options available during the study period were limited. Funding: GSK213815.

On the bright side of market concentration in a mixed-oligopoly healthcare industry

We describe the healthcare industry as a mixed oligopoly, where a public and two private providers compete, and examine the effects of a merger between the two private healthcare providers on prices, quality, and welfare. When the price and (eventually) quality of the public provider are regulated, the cost synergies required for the merger to increase consumer welfare are less significant than in a setting with only profit-maximizing providers. When, instead, the public provider can adjust its policy to the rivals’ behavior and maximizes a weighted sum of profits and consumer surplus (i.e., it has ‘semi-altruistic’ preferences), the merger is consumer surplus increasing if the public provider is sufficiently altruist, in some cases even absent efficiencies. These results suggest that ignoring the role and objectives of the public sector in the healthcare industry may lead agencies to reject mergers that, while would decrease consumer welfare in fully privatized industries, would increase it in mixed oligopolies.