Private Sector In Health Care Research Articles

The social, demographic and professional characteristics of general practitioners and district therapists of state and private sectors of health care

The article presents comparative analysis of demographic, social and professional characteristics of general practitioners and district therapists in state and private medical organizations. Sociological, statistical and analytical research methods were applied. The study was carried out on the basis of polyclinics of both Moscow Health Department and Moscow private health care sector. The sampling consisted of 399 questionnaires subjected to statistical processing. It is established that in state and private medical organizations, in this group of physicians prevail women 36-55 years old, born in the Russian Federation, in Moscow, married, having children and assessing one's income level as average. Most of them received their higher education in Moscow, graduated residency in therapy and have no medical category or academic degree. The professional experience consists 10 years or more. All physicians in state polyclinics hold more than one position and in private polyclinics 8.6% of physicians are underemployment. In the state sector, paternalistic model of communication with patient is preferable, in the private sector - a collegiate one. In the state sector, the collegiate management style of CEO is convenient and in the private sector - collegiate or dynamic one. In both sectors, adhocratic organizational culture is comfortable. Against the background of readiness to proceed working in current conditions, work in another sector is not excluded. The material factor is considered as main driver of professional motivation. The social, demographic and professional characteristics of general practitioners and district physicians in both sectors of health care in the main are similar, but have their own characteristics.

Accessibility of medical care in the public and private sectors of healthcare (based on the results of a sociological survey of the population of the Vologda region)

Introduction. In the Vologda region healthcare there are complex management and economic (acute shortage of doctors) and spatial (large territory, complex settlement system) restrictions on the availability of medical care. The private health sector is an alternative to the public sector, but it expands the burden of public spending. This actualizes research aimed at assessing the availability of medical care in both sectors of the industry.
 Purpose of the study. Assessment of the availability of medical care for the population of the Vologda region in the public and private sectors.
 Materials and methods. The toolkit is a questionnaire survey of the population (sample consisted of 1,500 people) conducted in the region in 2018 and 2020. The analysis is carried out by means of the distribution of respondents’ estimates, expressed in specific weights of the total amount of responses, in the comparative context of demographic and territorial groups, the public and commercial sectors of the industry. The integral index of accessibility of medical care is proposed and tested.
 Results. Respondents estimate the availability of medical care/services in private medical institutions higher than in public ones (the accessibility index (AI), in 2020 was 179.6 and 163.4, respectively). During the study period, the index increased, but the gap between sectors remained. The lowest subjective estimates of accessibility were received by medical care in rural areas (AI for the public sector — 167.8, private — 179.5) and in Cherepovets (AI accounted of, respectively, 148.1 and 151.4). The highest level of accessibility was found in small towns (AI was 177.6 and 194.8).
 Limitations. When studying the availability of medical care in the region, 1,500 questionnaires were evaluated, which represents a sufficient reference sample to solve the tasks set.
 Conclusion. The study allowed obtaining valuable results, which, along with the developed tools (in particular, the index of accessibility of medical care), are recommended to the authorities for monitoring the situation in the healthcare of the region.

Neoliberal Politikalar Bağlamında Özel Hastanelerin Sağlık Hizmetlerinin Değerlendirilmesi: Bir Alan Araştırması

The regulation of health policies within the scope of neoliberal policies caused the private sector in healthcare to be supported by the states and this led to a significant increase in the number of private hospitals. Increasing the role of private hospitals and the private sector in health services, has moved away from providing health services as a basic social policy and has transformed this area into a commercial area. By commercializing health services and transforming them into a tradable commodity that can be bought and sold, has caused many problems and causing service providers to evaluate health services through market dynamics and this brought the field away from its original purpose. The purpose of this research is to determine the changes in the service quality of health services and to reveal the reasons that transform this area into an area dominated by economic relations. The stage of the research consists of patients who were treated in private hospitals in Ağrı, Muş and Patnos and benefited from the health services of these hospitals. The patient groups who benefited health services from private hospitals in Muş, Ağrı and Patnos, which are believed to represent the stage; 10 from Ağrı, 15 from Muş and 10 from Patnos, were reached using the purposeful qualitative sampling technique. The patients who constitute the sample of the study, were asked conducted questions and interviews by using semi-structured in-depth interview technique according to the subject and purpose of the research. The findings were analyzed and interpreted according to the purpose and subject of the research by using the descriptive analysis method.

Is rising pharma market a new burden? Introspecting the implications of India’s healthcare journey from public to a private good

PurposeThe paper demonstrates prejudicial effects of the rising private participation and the lacuna of state in ensuring the accessibility and affordability of healthcare.Design/methodology/approachSecondary data analysis from national and international databases is employed to demonstrate the low government spending and the alternate healthcare financing mechanisms in the country. The company reports of six Indian pharma companies are examined to map the profits and revenues, and also taking into account the sales growth and return on investment.FindingsThe paper observes the pharmaceutical sector, via its spiralling drug prices, is the primary contributor to the huge out-of-pocket expenses borne by households. The study findings indicate that there is an increased divergence between the out-of-pocket expenses of households and exorbitant profits of the private drug companies in the country over the years.Research limitations/implicationsAmidst debates on the importance of public health in the aftermath of the pandemic, the paper examines the rising hands of private sector in healthcare, and implores – who benefits? The authors study the implications via looking into the rise in the wealth of pharma giants; at the time of crisis when the lives of common citizens in the country were at stake.Originality/valueThe paper emphasises the repercussions of the higher markup of the pharma industry in raising the healthcare costs of households. The authors emphasise that the nonregulation of the pharma sector leads to high medical debts/poverty, in the wake of growing out-of-pocket expenditures of the citizens.

Guest Editorial Data Science in Smart Healthcare: Challenges and Opportunities

The fifteen articles in this special section focus on data science used in smart healthcare applications. A shift toward a data-driven socio-economic health model is occurring. This is the result of the increased volume, velocity and variety of data collected from the public and private sector in healthcare, and biology in general. In the past five-years, there has been an impressive development of computational intelligence and informatics methods for application to health and biomedical science. However, the effective use of data to address the scale and scope of human health problems has yet to realize its full potential. The barriers limiting the impact of practical application of standard data mining and machine learning methods have been inherent to the characteristics of health data. Besides the volume of the data (‘big data’), these are challenging due to their heterogeneity, complexity, variability and dynamic nature. Finally, data management and interpretability of the results have been limited by practical challenges in implementing new and also existing standards across the different health providers and research institutions. The scope of this Special issue is to discuss some of these challenges and opportunities in health and biological data science, with particular focus on the infrastructure, software, methods and algorithms needed to analyze large datasets in biological and clinical research.

HEALTHCARE MARKET IN UKRAINE: THE MODERN CONDITIONS AND TRENDS OF ITS DEVELOPMENT

The state and trends of Ukrainian healthcare market development were analyzed in this research work. Its main characteristics were defined. The conditions of the state and private sectors of healthcare were researched. The market of medical tourism occupies a special place in the private healthcare sector. It is characterized by the positive trends as in Ukraine, as worldwide. Dynamics of Ukrainian household expenditures for healthcare are analyzed. Dynamics of a number of healthcare facilities and medical staff in Ukraine are researched. They are characterized by drop-down trends, which reveal general negative developments in the market.In the article the research of the national medical equipment market is provided. It is characterized by a high import content, which reflects undervelopment of the national production in this field.

Journey of Women: Puberty to Post-menopause

Women are facing several health hazards that have an adverse effect on them and their offspring. In this article, the potential health risk factors and repercussions in women are evaluated so that sustenance of well-being is maintained and appropriate strategic interventions are made at critical stages such as at childhood, adolescence and pregnancy. Weakened and restricted access to public health system for low socio-economic status women and unregulated growth of the private sector in healthcare is leading to a near-total eclipse of availability and accessibility of universal and comprehensive healthcare.

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

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

The Role of Government in Health Care Reform in the United States and England

The Role of Government in Health Care Reform in the United States and England

Reflexiones sobre la participación pública y privada en la asistencia a la salud

Health care is one of the major issues in social policy, affected by multiple factors, such as the increase in health costs, crisis, and the degree of private participation in the financing of services. In this essay we reflect on this participation of the private sector in health care, with Brazil as a reference country and taking into account member states of the Union of South American Nations. Based on a qualitative study using data from national and international organizations, we found significant private participation in health care of countries in various continents, with an increase of public and private spending between 2000 and 2010. Regardless of the adopted health system, there was an increase of private spending in most countries analyzed, which emphasizes the need to further evaluate the performance of public and private sectors, as well as the regulatory frameworks for their participation in health care, thus enabling policies that promote quality improvement and the expansion of coverage.

Preferences on Policy Options for Ensuring the Financial Sustainability of Health Care Services in the Future: Results of a Stakeholder Survey

Universal access to health care in most western European countries has been a given for many decades; however, macroeconomic developments and increased pressure on health care budgets could mean the status quo cannot be maintained. As populations age, a declining proportion of economically active citizens are being required to support a larger burden of health and social care, while increasing availability of novel technologies for extending and improving life continues to push health care costs upwards. With health expenditure continuing to rise as a proportion of national income, concerns are raised about the current and future financial sustainability of Organisation for Economic Co-Operation and Development (OECD) health care systems. Against this backdrop, a discussion about options to fund health care in the future, including whether to raise additional health care finance (and the ways to do so), reallocate resources and/or ration services becomes very pertinent. This study elicits preferences among a group of key stakeholders (payers, providers, government, academia and health-related industry) on the issue of health care financial sustainability and the future funding of health care services, with a view to understanding the different degrees of acceptability between policy interventions and future funding options as well as their feasibility. We invited 842 individuals from academia, other research organisations (eg. think tanks), national health services, providers, health insurance organisations, government representatives and health-related industry and related advisory stakeholders to participate in an online survey collecting preferences on a variety of revenue-generating mechanisms and cost/demand reducing policies. Respondents represented the 28 EU member states as well as Norway, Iceland, Switzerland, Australia, Russian Federation, Canada and New Zealand. We received 494 responses to our survey from all stakeholder groups. Across all groups, the highest preference was for policies to modify lifestyle and implement more extensive screening within risk groups for high burden illnesses. There was a broad consensus not to reallocate resources from social security/education. Between stakeholders, there were differences of opinion between industry/advisory and a range of other groups, with industry being generally more in favour of market-based interventions and an increased role for the private sector in health care financing/delivery. Conversely, stakeholders from academia, government, national health services and insurance were relatively more in favour of more restrictive purchasing of new and expensive technologies, and (to varying extent) of higher income/corporate taxes. Taxes on cigarettes/alcohol were by far considered the most politically feasible option. According to this study, policy options that are broadly acceptable across stakeholder groups with different inherent interests exist but are limited to lifestyle modification, screening interventions and excise taxes on harmful products. Representatives from the private sector tend to view solutions rooted in the private sector as both effective and politically feasible options, while stakeholders from academia and the public sector seem to place more emphasis on solutions that do not disproportionately impact certain population groups.

Private sector contributions and their effect on physician emigration in the developing world

The contribution made by the private sector to health care in a low- or middle-income country may affect levels of physician emigration from that country. The increasing importance of the private sector in health care in the developing world has resulted in newfound academic interest in that sector's influences on many aspects of national health systems. The growth in physician emigration from the developing world has led to several attempts to identify both the factors that cause physicians to emigrate and the effects of physician emigration on primary care and population health in the countries that the physicians leave. When the relevant data on the emerging economies of Ghana, India and Peru were investigated, it appeared that the proportion of physicians participating in private health-care delivery, the percentage of health-care costs financed publicly and the amount of private health-care financing per capita were each inversely related to the level of physician expatriation. It therefore appears that private health-care delivery and financing may decrease physician emigration. There is clearly a need for similar research in other low- and middle-income countries, and for studies to see if, at the country level, temporal trends in the contribution made to health care by the private sector can be related to the corresponding trends in physician emigration. The ways in which private health care may be associated with access problems for the poor and therefore reduced equity also merit further investigation. The results should be of interest to policy-makers who aim to improve health systems worldwide.

Moving towards in-depth knowledge on the private health sector in low- and middle-income countries

The past two decades have seen a steady growth in attention to the private sector role within the overall health systems of lowand middle-income countries. Since the 1990s researchers have worked to call attention to the previously unrecognized scale of private medical services in the developing world (Berman and Rose 1996; Brugha and Zwi 1998; Hanson and Berman 1998; Preker et al. 2000; Uplekar 2000; Berman 2001; Mills et al. 2002; Harding and Preker 2003). As cross-country datasets have become available, the evidence has become increasingly clear that the private sector plays a major role in financing and provision of care in lowand middle-income countries (LMICs) (Zwi et al. 2001; Ha et al. 2002; Liu et al. 2006; Konde-Lule et al. 2010). In parallel, a half-dozen multi-centre projects supporting research on the private sector in LMICs have been implemented (De Costa and Diwan 2007; Access Health International, n.d.; PSP, n.d.; PSP-One, n.d.; Results for Development Institute, n.d.). Evidence and analysis has also pointed to the challenges and opportunities that the private sector poses to health and health sector development (Lonnroth et al. 1998; Lonnroth et al. 2001; Travis and Cassels 2006). The result of this growth in evidence is a general acknowledgement of the private sector and acceptance of its existence and important role in health care for many people in lowand middle-income countries. Consequently, the focus in research and policy development has moved from measurement to nuanced assessment of policy options and interventions for engagement of the private sector in public policy goal attainment (Montagu 2002; De Costa et al. 2008; Dimovska 2009; Lagomarsino 2009; Kangwana et al. 2011). As a result, in 2010 the World Health Assembly passed a resolution calling on countries to ‘constructively engage the private sector in providing essential health-care services’ (WHO 2010). The British development agency, DFID (Department for International Development), has supported a series of recent systematic reviews addressing voucher-based payments for care, the quality of private provision, and health outcomes in public vs private facilities in LMICs (Madhavan 2010; Montagu 2010; Meyer 2011). Health system thinking is increasingly acknowledging, and measuring, the scale of private provision. While documentation and guidance on policies and analysis are still in limited supply, the field is expanding. A further indication of this is the growing body of researchers addressing issues of private health care in LMICs and sharing their evidence in public fora and in peer-reviewed journals. In 2007 an informal gathering of researchers on the private sector met for lunch at the VIth World Congress of the International Health Economics Association (iHEA) in Copenhagen. From this group a small committee was formed to organize a symposium on the Role of the Private Sector in Health Care in conjunction with the 2009 VIIth iHEA congress. Around 100 participants attended the symposium. The papers in this supplement were presented at that 2009 Symposium. They are indicative of the growing sophistication and depth of research being conducted on issues of private health care provision in LMICs. Ann Levin and Miloud Kaddar have conducted a literature review on the role of the private sector in lowto middle-income countries in the delivery of immunization services. Overall, there are few studies of the subject but the authors find that the private sector is contributing to immunization service delivery and helping to improve access to basic vaccines in some low-income countries. They find that not-for-profit facilities are more likely to be coordinated with public services than the private for-profit sector. The contribution of this sector is poorly documented, leading to a lack of recognition of its role at national and global levels. The study Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine The Author 2011; all rights reserved. Health Policy and Planning 2011;26:i1–i3 doi:10.1093/heapol/czr050

The role of the private sector in health financing and service delivery

When we debate the appropriate role of the private sector in health care, we often tend to stray from the evidence base and become ideological. To focus the debate it is imperative to use a clear definition of what we mean by a private sector role in health financing or service delivery. An easy to understand taxonomy, which is rooted in the real world also helps. Alone the word: ‘privatization’ immediately triggers an emotional response when it comes to health care. The appropriate role of the private sector in health care should be seen as a continuum, ranging from private financing and provision in one extreme, to full public financing and provision in the other extreme—and anything in between. The paper by Albreht cites a taxonomy used by Saltman, which largely focuses on care provision. However, in the real world, service delivery is much more complex: for example, in almost any country in Europe we see vibrant private markets in the health sector, irrespective of the general orientation of the health system. Usually such markets …

UTILIZATION OF SKILLED BIRTH ATTENDANTS IN PUBLIC AND PRIVATE SECTORS IN VIETNAM

The private sector in health care in Vietnam has been increasingly competing with the government in primary health care services. However, little is known about the use of skilled birth attendance or about choice of public and private sectors among those who opt for skilled attendants. Using data from the Vietnam 2002 Demographic and Health Survey, this study examines factors related to women's decision-making of whether to have a skilled birth attendant at a recent childbirth, and if they did, whether it was a public or private sector provider. The study indicates that the use of the private sector for delivery services was significant. Women's household wealth, education, antenatal care and community's wealth were positively related to skilled birth attendance, while ethnicity and order of childbirth were negatively related. Order of childbirth was positively associated with skilled birth attendance in the private sector. Among service environment factors, increased access to public sector health centres was associated with an increased likelihood of skilled birth attendance in general, but a lowered chance of that in the private sector. Further studies are needed to assess the current situation in the private sector, the demand for delivery services in the private sector, and its readiness to provide quality services.

The private sector in healthcare: contributing to service but not to research

Public and private medicine has lived cheek by jowl in Ireland for many years. In Graves's time, Lyons recounts how "the vacancy at the Meath Hospital filled by the celebrated J Graves in 1821 occurred after an interchange of money" [Lyons JB (1991) 1834-1844. In: The quality of Mercer's-The story of Mercer's Hospital, 1734-1991, Glendale, Dublin, p 70]. Indeed Graves retired from the Meath Hospital aged 47 years to concentrate on his private practice. He continued to work as a consultant to the Adelaide, the Coombe and to Peter's Parish Dispensary, which was an example of how the philanthropic and the private sector worked together in the 1800s.

Romanow and Kirby on the public/private divide in healthcare: demystifying the debate.

In this paper, we review recent developments in the debate over the role of the private sector in healthcare in Canada, with a particular focus on the two major federal reports that were released in the autumn of 2002, the final report of the Senate Committee on Social Affairs (the Kirby report ) and the Romanow Commission report. It is possible to see these reports as representing two polarized positions in the public versus private debate. Kirby has often been portrayed as an advocate of privatization whereas Romanow has been given the role of champion of the public system. However, both conceptualizations are simplistic and inaccurate. We argue that rather than cast these two reports as proxies in an ideological dispute, it is more helpful to try to glean from them workable and flexible solutions to this immensely complex and divisive debate. More specifically, using the similarities and the differences manifest in these reports as a key reference point, we clarify the extent to which the terms used in the public policy debate have accurately represented the reality of the funding and delivery mechanisms that actually characterize the Canadian healthcare system. This allows us to draw some provisional conclusions on the degree of consensus that prevails in the healthcare debate, and on the sources of pressure for change. Given the universal emphasis currently placed on the need to base policy conclusions on "evidence," we also look at some recent academic contributions to the debate, notably by Raisa Deber and Devereaux et al., in order to better understand what the best available evidence indicates about the merit of the various forms of healthcare delivery. As well, we examine examples of private delivery of health services, including the Morgentaler clinics, that point to the importance of retaining the space for experimentation with forms of delivery that currently exists within the Canadian healthcare system.

Private health care

During the last decade there has been considerable international mobilisation around shrinking the role of States in health care. The World Bank reports that, in many low and middle-income countries, private sources of finance comprise the largest share of total national health expenditures. Private sector health care is ubiquitous, reaches throughout the population, preferred by the people and is significant from both economic as well as health perspective. Resources are limited, governments are weak, and a new approach is needed. This paper provides a broad overview and raises key issues with regard to private health care. The focus is on provision of health care by private medical providers. On the background of the world’s common health problems and interventions available to tackle them, the place of private health care in the overall context is first discussed. The concept of privatisation within the various forms of health care systems is then explained. The paper then describes the genesis and key elements of rapidly enhancing role of the private sector in health care and points to the paucity of literature from low and middle-income countries. Common concerns about private health care are outlined. Two illustrative examples — tuberculosis, the top infectious killer among the poor and coronary heart disease, the top non-infectious killer among the rich — are presented to understand the current and possible role of private sector in provision of health care. Highlighting the need to distinguish between health care as a public good or a market commodity, the paper leaves it to the reader to draw conclusions.

Status of a health care quality review programme in South Africa.

This paper provides an overview of an accreditation programme for health care facilities in South Africa. It traces the origin of COHSASA (The Council for Health Service Accreditation of Southern Africa) which began as a pilot programme in 1992, to its current status as the only accreditation body in the country. There are brief descriptions of its structure, how it is governed, and how standards were developed and organized. The authors sketch a background of the unique sociopolitical context and legal developments within which the programme operates in South Africa and how the programme is contributing towards the new government's intention to provide equitable and quality health care to all its citizens. There is an outline of the principles on which the COHSASA programme is based and the structure and process of the programme. The programme incorporates an integrated, multi-disciplinary, continuous quality improvement approach with special emphasis on capacity building of hospital staff when necessary. The paper refers to groundbreaking research in Kwa-Zulu Natal where the impact of accreditation is being measured in a randomized control trial. It points to the benefits of accreditation being perceived in both public and private sectors of health care in South Africa and outlines some of the results of the program's implementation.

India: Advertising of infant foods to be restricted

[The Indian] parliament has passed the Infant Milk Substitutes Feeding Bottles and Infant Foods (Regulation of Production Supply and Distribution) Bill which when it comes into force will severely restrict the advertising and promotion of these baby products. Essentially the bill incorporates the contents of the International Baby Food code adopted by the World Health Assembly in 1981 but expands its scope to include infant foods--i.e. foods being marketed a complement to mothers milk to meet the growing nutritional needs of the infant after the age of 4 months. Apart from disallowing the advertising of these products the bill prohibits the distribution of free samples and the offer of other inducements for promoting them. Donations of infant-milk substitutes and bottles may be made only to orphanages. The law also lays down stringent conditions for the labeling of baby foods and categorically bans the use of pictures of an infant or a woman or both or the use of words such as humanized or maternalized in the information printed on the containers. All information material on the product must promote breastfeeding and stress the financial and social implications of using infant formulas and baby bottles. Further manufacturers are forbidden from offering inducements to or fixing salaries of employees on the basis of volume of sales. Offenses under this act may be punishable by imprisonment for up to 3 years or a fine of up to Rs 500. Not surprisingly baby-food manufacturers opposed the bill tooth and nail and succeeded in stalling it for a considerable time. There is after all a huge and growing market at stake. According to a Voluntary Health Association of India estimate the market for baby foods worth nearly Rs 7200 million (approximately 180 million pounds)--almost entirely shared between Amul the manufacturing unit of a highly successful and pathbreaking Indian milk cooperative venture and Nestle--is growing at 6%/year. The bill has had a long and interrupted passage. A diluted version was 1st introduced in Parliament in 1986 when it was passed by the Upper House but lapsed with the dissolution of the Lower House. The current version of the bill was introduced in January; again it lapsed with the dissolution of the House and was reintroduced in May. Institutions such as the Indian Academy of Pediatrics the Consumer Guidance Society of India and the Voluntary Health Association of India have endorsed the bill and have played a leading role in having it enacted in parliament. The question now is whether the law can be implemented successfully. The problems are many. For one the law makes food inspectors appointed under the food Adulteration Act responsible for taking cognizance of any offenses under it. The already overworked and often corrupt inspection staff is hardly likely to take the new task seriously. Secondly the bill makes illegal the use of the health system or its employees for the promotion or advertising of these baby products which implies the existence of an agency that will monitor or at least keep watch over the functioning of the health system. There is no such agency and the proliferating private sector in health care is largely unregulated. And thirdly there is the other side of the coin--restricting the promotion of baby food must be accompanied by creation of conditions that enable the vast majority of poor women to breastfeed. Such a task in a country where most women are forced to work in the unorganized sector would be colossal. (full text)