Private Healthcare Sector Research Articles

Politics of Evidence and Right to Health Care in India: The Challenges in Fixing Accountability of Medical Doctors in Patient Rights Violations in the Private Health Care Sector in India

Privatization oriented government health care policies have stimulated robust growth of private health care sector in India, without putting in place regulatory architecture that safeguards patients’ rights. The lack of adequate regulatory framework to govern them has put patients to undue disadvantage. This paper, based on primary investigation, analyses the ‘politics of evidence’ that patients are confronted with and are forced to navigate, in redressing ethical and patient rights violations against private medical establishments. The analysis of cases indicates that in the current medico-legal ecosystem is non-conducive to patients and impedes obtaining legally admissible evidence against medical professionals. The prevailing redressal avenues are significantly hostile to patients and unduly favour the private medical establishments who enjoy support and impunity from prosecution under the implicit state patronage. The paper makes a compelling case for a comprehensive regulatory architecture that simultaneously regulates the private medical establishments and safeguards the rights of patients.

Politics of Evidence and Right to Health Care in India: The Challenges in Fixing Accountability of Medical Doctors in Patient Rights Violations in the Private Health Care Sector in India.

Privatization oriented government health care policies have stimulated robust growth of private health care sector in India, without putting in place regulatory architecture that safeguards patients’ rights. The lack of adequate regulatory framework to govern them has put patients to undue disadvantage. This paper, based on primary investigation, analyses the ‘politics of evidence’ that patients are confronted with and are forced to navigate, in redressing ethical and patient rights violations against private medical establishments. The analysis of cases indicates that in the current medico-legal ecosystem is non-conducive to patients and impedes obtaining legally admissible evidence against medical professionals. The prevailing redressal avenues are significantly hostile to patients and unduly favour the private medical establishments who enjoy support and impunity from prosecution under the implicit state patronage. The paper makes a compelling case for a comprehensive regulatory architecture that simultaneously regulates the private medical establishments and safeguards the rights of patients.

Politics of Evidence and Right to Health Care in India: The Challenges in Fixing Accountability of Medical Doctors in Patient Rights Violations in the Private Health Care Sector in India

Privatization oriented government health care policies have stimulated robust growth of private health care sector in India, without putting in place regulatory architecture that safeguards patients’ rights. The lack of adequate regulatory framework to govern them has put patients to undue disadvantage. This paper, based on primary investigation, analyses the ‘politics of evidence’ that patients are confronted with and are forced to navigate, in redressing ethical and patient rights violations against private medical establishments. The analysis of cases indicates that in the current medico-legal ecosystem is non-conducive to patients and impedes obtaining legally admissible evidence against medical professionals. The prevailing redressal avenues are significantly hostile to patients and unduly favour the private medical establishments who enjoy support and impunity from prosecution under the implicit state patronage. The paper makes a compelling case for a comprehensive regulatory architecture that simultaneously regulates the private medical establishments and safeguards the rights of patients.

Colorectal cancer in South Africa: An assessment of disease presentation, treatment pathways and 5-year survival.

Colorectal cancer (CRC) is the fourth most common cancer in South Africa (SA), and the sixth most lethal. Approximately 25% of patients will have synchronous metastatic disease at the time of their primary CRC diagnosis. Although chemotherapy is used in most stages of the disease, surgical resection of the primary tumour and metastases remains the most successful treatment modality to achieve cure or prolong survival. To date, no data on CRC presentation and management have been published in SA. To determine CRC presentation, general management patterns and overall survival in the SA private healthcare sector. A retrospective review of a private healthcare funder's database from 1 January 2008 to 31 December 2015. International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) diagnosis codes were used to identify colorectal cancer and liver and/or pulmonary metastatic disease. Procedure codes assigned to hospital admissions were used to identify type of surgical treatment. Chemotherapy was identified by the World Health Organization Anatomical Therapeutic Chemical Classification System of medicines. Treatment patterns were determined and 5-year survival rates for these were calculated. Survival was estimated using the Kaplan-Meier method, and Cox proportional hazards regression was used for between-group comparisons of survival. Data analysis was carried out using SAS version 9.4 for Windows. A total of 3 412 patients were included in the study, 2 267 with CRC only and 1 145 with liver (LM) or pulmonary metastases (PM). The mean age was 64.1 years (range 21 - 97), and 54.6% were male; these did not differ statistically between the study groups. Twenty percent of patients with LM or PM underwent surgical resection of their metastases. Five-year survival rates following surgical resection of all disease for CRC only, CRCLM, CRCPM and CRCLMPM were 71.7%, 57.3%, 31.5% and 26.0%, respectively. SA CRC patients treated in the private healthcare sector have similar disease presentation to that in published international series, with similar outcomes following various treatment pathways; however, it seems that fewer resections of metastases are undertaken compared with international trends.

Colorectal cancer in South Africa: An assessment of disease presentation, treatment pathways and 5-year survival

Background. Colorectal cancer (CRC) is the fourth most common cancer in South Africa (SA), and the sixth most lethal. Approximately 25% of patients will have synchronous metastatic disease at the time of their primary CRC diagnosis. Although chemotherapy is used in most stages of the disease, surgical resection of the primary tumour and metastases remains the most successful treatment modality to achieve cure or prolong survival. To date, no data on CRC presentation and management have been published in SA.Objectives. To determine CRC presentation, general management patterns and overall survival in the SA private healthcare sector.Methods. A retrospective review of a private healthcare funder’s database from 1 January 2008 to 31 December 2015. International Statistical Classification of Diseases and Related Health Problems (10th revision) (ICD-10) diagnosis codes were used to identify colorectal cancer and liver and/or pulmonary metastatic disease. Procedure codes assigned to hospital admissions were used to identify type of surgical treatment. Chemotherapy was identified by the World Health Organization Anatomical Therapeutic Chemical Classification System of medicines. Treatment patterns were determined and 5-year survival rates for these were calculated. Survival was estimated using the Kaplan-Meier method, and Cox proportional hazards regression was used for between-group comparisons of survival. Data analysis was carried out using SAS version 9.4 for Windows.Results. A total of 3 412 patients were included in the study, 2 267 with CRC only and 1 145 with liver (LM) or pulmonary metastases (PM). The mean age was 64.1 years (range 21 - 97), and 54.6% were male; these did not differ statistically between the study groups. Twenty percent of patients with LM or PM underwent surgical resection of their metastases. Five-year survival rates following surgical resection of all disease for CRC only, CRCLM, CRCPM and CRCLMPM were 71.7%, 57.3%, 31.5% and 26.0%, respectively.Conclusions. SA CRC patients treated in the private healthcare sector have similar disease presentation to that in published international series, with similar outcomes following various treatment pathways; however, it seems that fewer resections of metastases are undertaken compared with international trends.

Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey

ObjectiveThe purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic (DCs) working in private sector health care settings in the United States. MethodsWe conducted an online, cross-sectional survey using a purposive sample of DCs (n = 50) working in integrated health care facilities. The 36-item survey collected demographic, facility, chiropractic, and interdisciplinary practice characteristics, which were analyzed with descriptive statistics. ResultsThe response rate was 76% (n = 38). Most respondents were men and mid-career professionals with a mean 21 years of experience in chiropractic. Doctors of chiropractic reported working in hospitals (40%), multispecialty offices (21%), ambulatory clinics (16%), or other (21%) health care settings. Most (68%) were employees and received salary compensation (59%). The median number of DCs per setting was 2 (range 1-8). Most DCs used the same health record as medical staff and worked in the same clinical setting. More than 60% reported co-management of patients with medical professionals. Integrated DCs most often received and made referrals to primary care, physical medicine, pain medicine, orthopedics, and physical or occupational therapy. Although in many facilities the DCs were exclusive providers of spinal manipulation (43%), in most, manipulative therapies also were delivered by physical therapists and osteopathic or medical physicians. Informal face-to-face consultations and shared health records were the most common communication methods. ConclusionsDoctors of chiropractic are working in diverse medical settings within the private sector, in close proximity and collaboration with many provider types, suggesting a diverse role for chiropractors within conventional health care facilities.

Perceptions of and support for national health insurance in South Africa's public and private healthcare sectors.

IntroductionFor the purpose of effective implementation of a National Health Insurance (NHI) policy it is necessary to have an understanding of the awareness and perceptions of and support for such policy among clients using the healthcare system.MethodsThe South African National Health and Nutrition Examination Survey asked household heads a series of questions on healthcare utilisation and access and collected information on knowledge and perceptions of and support for national health insurance. Comparisons are drawn between private sector healthcare users with medical aid and public sector healthcare users without medical aid, using descriptive and regression analysis.ResultsInequalities in access to quality healthcare remain stark. Only 8.5% of private users had postponed seeking healthcare compared to 23.9% of public users (p < 0.001). Only 11.9% of public users were very satisfied with the quality of healthcare services compared to 50.2% of private users (p < 0.001). More than eighty percent of healthcare users however were of the opinion that NHI is a top priority. However, for healthcare users to sacrifice choice required a national health insurance that provides better quality healthcare, increasing the probability of support for an NHI with lower cost and full coverage by 10.1%.ConclusionIt is imperative to provide better quality healthcare services in the public sector for private sector users to be supportive of national health insurance. Concerted efforts are also required to develop a proper communication strategy to disseminate information on and garner support for national health insurance, both in the public and private healthcare sectors.

MEDICATION ADHERENCE BEHAVIOUR OF PRIVATE SECTOR PATIENTS AFFLICTED WITH CERTAIN COMMUNICABLE AND/OR NON-COMMUNICABLE DISEASES

Ponte Academic JournalJul 2018, Volume 74, Issue 7 MEDICATION ADHERENCE BEHAVIOUR OF PRIVATE SECTOR PATIENTS AFFLICTED WITH CERTAIN COMMUNICABLE AND/OR NON-COMMUNICABLE DISEASESAuthor(s): Suklal K. BPharm ,Naidoo P. BPharmJ. Ponte - Jul 2018 - Volume 74 - Issue 7 doi: 10.21506/j.ponte.2018.7.6 Abstract:Medication adherence is a significant factor contributing towards the achievement of treatment goals. This study was conducted to provide insight into the medication adherence behaviour of private sector patients afflicted with communicable and non-communicable chronic diseases.\r\nObjectives\r\nTo investigate the medication adherence behaviour of patients suffering from Non-Communicable diseases and Communicable diseases in the private health care sector of the eThekwini Metropolitan of KwaZulu-Natal. \r\nMethods \r\nA self-reported medication adherence questionnaire was used to obtain data, from 233 patients afflicted with Human Immunodeficiency Virus, Type 2 Diabetes Mellitus, Hypertension and Dyslipidaemia. The questionnaire focused on factors that influence medication adherence as well as the number of days of medication missed during the last 30 days. Data was collected and analysed using SPSS .\r\nResults \r\nMajority of participants were aged between 41-60 years (49.8%), and were of male gender (52.8%). An almost equal number of participants were afflicted with single disease (n=116) or multiple diseases (117). Hypertension was the most prevalent ailment (n=167), followed by Type 2 Diabetes (n=113), Dyslipidaemia (n=94) and HIV (n= 26). Over 62% of participants reported not missing any medication during the last 30 days. More than 21% had stated missing 1-2 days of their medication and 15.9% reported missing 3 or more days of medication during the last 30 days. With regards to single diagnosis, the highest percentage of adherence was reported in participants afflicted with Hypertension (60.6%), and Type 2 diabetes (58.3%). HIV and Dyslipidaemia had the lowest rates of adherence as 45% (n=9) of HIV only afflicted participants and 57.1% (n=4) of Dyslipidaemia only afflicted participants reported missing 1 or more days of their medication. The highest rate of non-adherence was found in the age group of participants 51-60 years old, while the highest rate of adherence was found in the group aged 70 years+. Reasons for non-adherence included cost, forgetting to take medication, running out of medication, stopping medication because it made them feel worse or gave a side effect and having difficulty with time schedules or having medication with/without food. \r\nConclusion\r\nParticipants afflicted with communicable and non-communicable diseases in the private health care sector have sub-optimal medication adherence. No significant correlations were found between having a particular disease and the rate of adherence, but participants afflicted with HIV only and Dyslipidaemia only where the least adherent. Reasons for non-adherence were the similar to other studies. Download full text:Check if you have access through your login credentials or your institution Username Password

The Private Healthcare Sector in Johor: Trends and Prospects by Meghann Ormond, Lim Chee Han

The Private Healthcare Sector in Johor: Trends and Prospects by Meghann Ormond, Lim Chee Han

Inequalities in health in a municipality of Serbia

Background/Aim. A consistent association between socioeconomic determinants and health related variables has been found in many European countries. The aims of this study were: to analyze the association of socioeconomic factors with self-perceived health and utilization of health services as well as to suggest some interventions to overcome the existing problems. Methods. Hybrid study was pefrormed. The two cross-sectional studies were conducted on quota samples (1999 and 2015) in Krusevac Municipality. The questionnaire was used as the investigation instrument for 196 interviewees in 1999 and 226 interviewees in 2015. Results. In the reporting period, there were the following results: a significant increase in people who did not have a steady income (?2 = 22.800; df = 4; ? &lt; 0.01), a decrease in the number of people who perceived their own health as ?well? and ?very well?, a significant increase (6.1%) in people who did not visit anyone when disease occurred, a decrease of 13.2% in number of people who, at least once, visited the general practitioner and an increase in the number of people who visited private health care sector. The findings revealed inequalities in self-perceived health depending on socioeconomic position, in particular educational and employment status (?2 = 11.293; df = 4; p &lt; 0.05). There are two major ways in which unemployment affects health: lack of income and ability to meet daily needs and emotional stress related to the meaning of the work, uncertain future, loss of self-esteem, and identity. Conclusion. Equality is a key value in the assessment of the effects on health. It is necessary to conduct effective interventions for overcoming the consequences in society that would be focused on a specific target group in one territory.

Service quality in private hospitals of Jammu and Kashmir - an empirical assessment from District Srinagar

The growing middle class, increased health consciousness and inadequate public health facilities have led to an enormous growth of the private healthcare sector in India. The aim of the present study is to evaluate the service quality of private hospitals in Srinagar District of India from the perspective of outpatients. The study used SERVQUAL model to determine the overall service quality and gaps between perceptions and expectations of outpatients regarding service quality attributes in sample private hospitals. The results revealed that there existed a statistically significant difference between total mean perceptions and total mean expectations of patients across all the dimensions and variables of healthcare service quality (p < 0.05) except for three variables (hospital being visually appealing; floor being clean; and, hospital having regular water supply). The overall service quality of −1.22 implies that the private hospitals in Srinagar District are far from meeting the expectations of patients.

Does Cash Incentive Effect TB Case Notification by Public Private Mix-General Practitioners Model in Pakistan?

Setting: Private healthcare providers including solo practitioners and laboratories enrolled with Public Private Mix General Practitioners model in Pakistan who were enrolled with the program and maintained participation during 2014 to 2016. Objective: To assess the change in case notification by private healthcare providers as well as effect on sputum smear positivity rate at private laboratories after introduction of incentives. Design: A comparative cross-sectional study based on routinely maintained National TB Control Program data collected before and after the introduction of incentives (2014 and 2016). Results: In 2016, TB case notification increased by 71% after cash incentives was introduced. Among the 618 private healthcare providers who enrolled and maintained participation in the Public Private Mix program, only 1% of the GPs contributed to 19% increase in case notification, whereas 27% GPs had reported a reduced number of cases compared to the pre-intervention period. After incentives, slide positivity rate for diagnostic declined by 1.9% and follow-up increased by 0.6%. Number of slides for diagnostic and follow-up testing increased by 82% and 72% respectively. Conclusion: Engaging the private healthcare sector, by providing cash incentives to private health care Provider’s is an effective strategy for providing a substantial increase in National TB case notification.

Bias in Contraceptive Provision to Young Women Among Private Health Care Providers in South West Nigeria.

Health care providers' biases regarding the provision of contraceptives to adolescent and young adult women may restrict women's access to contraceptive methods. Two mystery client visits were made to each of 52 private-sector health care facilities and individual providers in South West Nigeria in June 2016. In one visit, the mystery client portrayed an unmarried, nulliparous adolescent, and in the other, the client portrayed a married adult woman with two children. During subsequent in-depth interviews, providers were read vignettes describing hypothetical clients with these same profiles, and were asked how they would interact with each. Descriptive analyses of mystery client interactions were combined with thematic analyses of the interview data. In greater proportions of married-profile visits than of unmarried-profile visits, mystery clients reported that providers had asked about past contraceptive use and method preference; the opposite was true in regard to providers' using side effects to dissuade clients from practicing contraception. In in-depth interviews, providers expressed concerns about fertility loss among unmarried women who used hormonal contraceptives. Providers more commonly recommended condoms, emergency contraception and the pill for unmarried clients, and longer-acting methods for married clients. The restriction of methods was typically explained by providers of various backgrounds in terms of protecting younger, unmarried clients from damaging their fertility. Provider bias in the provision of contraceptives to adolescent and young adult women in South West Nigeria may affect quality of care and method choice. Interventions to reduce provider bias should go beyond technical training to address the underlying sociocultural beliefs that lead providers to impose restrictions that are not based on evidence.

State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis.

Most Veterans who use the Veterans Health Administration (VHA) also utilize private-sector health care providers. To better inform local and regional health care planning, we assessed the association between reliance on VHA ambulatory care and total and system-specific preventable hospitalization rates (PHRs) at the state level. We conducted a retrospective dynamic cohort study using Veterans with diabetes mellitus, aged 66 years or older, and dually enrolled in VHA and Medicare parts A and B from 2004 to 2010. While controlling for median age and proportion of males, we measured the association between reliance on VHA ambulatory care and PHRs at the state level using multivariable ordinary least square regression, geographically weighted regression, and generalized additive models. We measured geospatial patterns in PHRs using global Moran’s I and univariate local indicator spatial analysis. Approximately 30% of hospitalized Veterans experienced a preventable hospitalization. Reliance on VHA ambulatory care at the state level ranged from 13.92% to 67.78% and was generally not associated with PHRs. Geospatial analysis consistently identified a cluster of western states with low PHRs from 2006 to 2010. Given the generally low reliance on VHA ambulatory care and lack of association between this reliance and PHRs, policy changes to improve Veterans’ health care outcomes should address private-sector care in addition to VHA care.

Chronic disease list conditions in patients with rheumatoid arthritis in the private healthcare sector of South Africa.

Little is known about the burden of rheumatoid arthritis (RA) in South Africa. The aim of this study was to establish the prevalence of RA and coexisting chronic disease list (CDL) conditions in the private health sector of South Africa. A retrospective, cross-sectional analysis was performed on medicine claims data from 1 January 2014 to 31 December 2014 to establish the prevalence of RA. The cohort of RA patients was then divided into those with and those without CDL conditions, to determine the number and type of CDL conditions per patient, stratified by age group and gender. A total 4352 (0.5%) patients had RA, of whom 69.3% (3016) presented with CDL conditions. Patients had a median age of 61.31years (3.38; 98.51), and 74.8% were female. Patients with CDL conditions were older than those patients without (p < 0.001; Cohen's d = 0.674). Gender had no influence on the presence of CDL conditions (p = 0.456). Men had relatively higher odds for hyperlipidemia (OR 1.83; CI 1.33-2.51; p < 0.001) and lower odds for asthma (OR 0.83; CI 0.48-1.42; p = 0.490) than women. In combination with hyperlipidemia, the odds for asthma were reversed and strongly increased (OR 6.74; CI 2.07-21.93; p = 0.002). The odds for men having concomitant hyperlipidemia, hypertension, type 2 diabetes mellitus and hypothyroidism were insignificant and low (OR 0.40; CI 0.16-1.02; p = 0.055); however, in the absence of hypothyroidism, the odds increased to 3.26 (CI 2.25-4.71; p < 0.001). Hypothyroidism was an important discriminating factor for comorbidity in men with RA. This study may contribute to the body of evidence about the burden of RA and coexisting chronic conditions in South Africa.

The market dynamics of selective serotonin re-uptake inhibitors: a private sector study in South Africa.

The objective of this study was to analyse the market share of generic vs originator selective serotonin re-uptake inhibitors (SSRIs), and also compare market share of different SSRIs in the private health care sector in South Africa, over a period of 4 years. This was a retrospective, descriptive study that measured generic market volume as a percentage of the total private SSRI market volume. Retail private sector sales data for six SSRIs available in the private sector in South Africa was evaluated. Sales data were obtained from various stages in the pharmaceutical supply chain, June 2009 - May 2013. Generics constituted 86% and originators 14% of the private sector market volume of SSRIs. The share of the market volume of generic medicines increased by 29.93% over this 4-year period, while an overall increase of 27.86% in the ratio of generics to originators was observed. In line with policies, generic SSRIs hold a larger volume of the market in the private sector in South Africa.

Perceptions and Uses of Public and Private Health Care in a Brazilian Favela

Since 1988, Brazil has reorganized and expanded its public health care system, defining access to health care as a right of every citizen. In parallel, the private health care sector grew rapidly to become one of the largest in the world. We explore the use of public and private health care by a low-income population living in a favela, Rio das Pedras, in Rio de Janeiro. At the time of data collection, only part of the community was covered by the primary health care program. We conducted semistructured interviews with 14 adults, both with and without access to the public primary care program. Regardless of program coverage, participants noted barriers and negative experiences while accessing public health care. The perceived inability of health professionals to deal compassionately with a low-income population was prominent in their narratives, and in the expressed motivation for pursuing private sector health care alternatives. We explore the tension arising from the more recent rights-based health care provision and historic social control and assistentialist framing of state intervention in Brazilian favelas.

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

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 < 0.01; 95% CI - 0.77, -0.39) on a normalized scale. Despite relatively higher level of responsiveness of 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.

Surgical care in the public health agenda.

The current article examines surgical care as a public health issue and a challenge for health systems organization. When surgery fails to take place in timely fashion, treatable clinical conditions can evolve to disability and death. The Lancet Commission on Global Surgery defined indicators for monitoring sustainable universal access to surgical care. Applied to Brazil, the global indicators are satisfactory, but the supply of surgeries in the country is marked by regional and socioeconomic inequalities, as well as between the public and private healthcare sectors.

Medscheme Mental Health Programme

Medscheme Mental Health Programme