Treatment In Private Hospitals Research Articles

Aarogya Margdarsh- Medical Camp Related Mobile App

In few Rural Areas, people don’t have access to the better medical treatment for the diseases and most of the people can’t afford to get treatment in private hospitals. Even though several free Medical Camps are being conducted, most of the people are unaware of these Medical Camps’ Venues and timings. So, many people are ending up without utilizing the resources. To Overcome this problem, this EPICS Project proposes a novel, a Mobile Application called “Aarogya Margdarsh”, which provides an interface between patients and medical camp organizers and provides the information about the Free Medical Camps provided by Hospitals, Medical Colleges, NGOs etc. The project is divided into various modules like database collection, message alerts. The details of date, time and venues of free Medical Camps organized by all these Organizations is collected and it is provided to the users through the Mobile Application. The App satisfies the user in such a way that the user gets the detailed information about Medical Camps well in advance. This is also useful to Medical Camp organizers such that their humanitarian efforts will be well utilized by patients.

Myeloproliferative neoplasms – a global view

Myeloproliferative neoplasms – a global view

Exploring Unmet Needs from an Online Metastatic Breast Cancer Support Group: A Qualitative Study.

Background and Objective: Despite the increasing treatment options for patients with metastatic breast cancer (MBC), unmet needs remain common, especially in low and middle-income countries where resources are limited and MBC patients face many challenges. They often join support groups to cope with their unmet needs. Currently, many MBC patients connect with each other via online support group in view of the constant availability of support and rapid information exchange. The objective of this study is to determine the unmet needs of women with MBC from an online support group. Material and Methods: Messages in an online support group of twenty-two MBC patients over a period of three years from August 2016 till August 2019 were thematically analyzed. Results: Three themes were generated, (1) unmet information needs (2) unmet financial needs (3) unmet support needs. Women needed information on side effects of treatment, new treatment options and availability of clinical trials. Although Malaysia has universal health care coverage, access to treatment remains a major challenge. When treatment was not available in the public hospitals, or waiting lists were too long, women were forced to seek treatment in private hospitals, incurring financial catastrophe. Insufficient private insurance and inadequate social security payments force many women to consider stopping treatment. Women felt that they were not getting support from their clinicians in the public sector, who were quick to stop active treatment and advise palliation. On the other hand, clinicians in the private sector advise expensive treatment beyond the financial capability of the patients. Women with families also face the challenge of managing their family and household in addition to coping with their illness. Conclusions: There is a need for healthcare professionals, policy makers, and civil society to better address the needs of MBC patients through patient-centered, multidisciplinary and multi-organizational collaboration.

Insurance status and waiting times for hospital-based services in Ireland

In Ireland long waits for public hospital services are a feature of the healthcare system, with limited evidence that waits for private hospital services (delivered in both public and private hospitals) are shorter. In 2008, in an attempt to ensure more equitable access to hospital-based services, a ‘common waiting list’ for all patients within public hospitals was proposed. The aim of this paper is to analyse waiting times in Ireland for hospital services for patients with and without private health insurance (PHI) and to examine whether the 2008 reform reduced the differential in waiting. The analysis used data from the 2007 and 2010 health module of the Quarterly National Household survey (QNHS). The impact of insurance status on waiting times was analysed for the period before and after the reforms. A higher proportion of those without PHI were waiting more than three months for hospital services relative to those with PHI. There was no evidence that the 2008 reforms reduced the differential. Anecdotal evidence suggests that the proposals were not fully implemented, although expansion of capacity for private patients’ treatment in private hospitals is a possible confounding factor.

Exploring Patient Experiences of the Internal Market for Healthcare Provision in Turkey: Publicness under Pressure

Abstract The establishment of internal markets for healthcare provision in publicly-funded healthcare systems brings forth a number of new regulatory challenges. During the 2003 healthcare reform in Turkey, universal health coverage (UHC) was implemented concurrently with the establishment of an internal market for service provision, resulting in an increase in private sector activity. In this context, this paper explores how, in the Turkish case, the macro-level adoption of an internal market model for healthcare provision has shaped patient experiences at the micro-level in their ability to receive treatment in private hospitals offering publicly-funded services (PHOPS). It also examines the influence of the internal market on the realised publicness of healthcare services in Turkey. Data for the study were obtained from patient complaints that appeared on a private online platform and 20 patient interviews. These showed that patients sometimes face significant challenges, including pressure to make informal payments, when accessing their entitlements, which is evidence of the erosion of publicness in a hybrid healthcare system. These challenges emerge from information asymmetry between patients and providers; a large space for PHOPS to manoeuvre when deciding to register patients as insurance holders or private patients; and the ineffective public regulation of the internal market.

A two-tiered public-private health system: Who stays in (private) hospitals in Ireland?

Despite efforts to create a universal, single-tiered Irish health system, an unequal "two-tiered" system persists. The future blueprint for Irish health care, Sláintecare, recommends a separation of public and private hospital treatment. This study examines patterns of overall and private hospital utilisation in Ireland that could help identify some of the impacts of the proposed separation of public and private hospital treatment. Using data from EU-SILC (2016) (n = 10,131) the factors associated with inpatient hospitalisation and private inpatient hospitalisation are estimated using probit models.Unsurprisingly, those who are economically inactive are more likely to have had an inpatient stay. Furthermore, those aged over 65, with a chronic illness, with a medical/ GP visit card and private health insurance and those with only private health insurance are also more likely to have had an inpatient stay. Those with only primary education are less likely to report an inpatient stay in private hospital. Those aged over 25 and less than 65, those with a medical/ GP visit card and private health insurance and those with only private health insurance are significantly more likely to opt for a private hospital. Understanding overall and private hospital utilisation patterns is imperative for implementing universal health care and associated resource planning and fulfilling policy recommendations.

Clinical evaluation of some sofosbuvir-based regimens for the treatment of hepatitis c in private healthcare sector in Egypt

Hepatitis C Virus has been a universal rising problem and the leading cause of liver cirrhosis and its related complications principally hepatic decompensation and hepatocellular carcinoma. The annual prevalence is estimated at 3–4 million subjects. Egypt is considered among the highest endemic seropositive areas globally having more than 5% related to the adult inhabitants. In Egypt, hepatitis C virus, genotype 4 is responsible for about 90% of the cases. In addition to their efficacy, DAA therapies target to significantly cut the cumulative total economic burden of HCV. The previous established and published studies related to new treatment regimens for hepatitis C virus in Egypt focused mainly on governmental hospitals/institutes, and nearly none focused on the private sector. This is a retrospective observational study focused on efficacy and safety evaluation of sofosbuvir (SOF) + ribavirin (RBV), SOF + daclatasvir (DCV), and SOF + daclatasvir (DCV) + RBV compared with SOF + pegylated interferon alfa (pegIFN) + RBV in the treatment of naive non-cirrhotic patients infected with hepatitis C virus in Egypt. The population in this study were 200 Egyptian patients, diagnosed with chronic hepatitis C genotype 4 who were non-cirrhotic, not diagnosed with hepatocellular carcinoma (HCC), and didn't have a liver transplant or co-infections. Those patients received treatment in private hospitals and clinics between 2014 and 2017. Results of this study showed that treatment with DAAs was associated with dramatic increase in SVR12 rate. The achieved SVR12 rates in this study were 91.7% for SOF + pegIFN + RBV, 75% for SOF + RBV, 96% for SOF + RBV + DCV, and 94% for SOF + DCV. Among the studied baseline patient characteristics, the viral load was found to be a significant independent predictor of the expected SVR12 rate. Safety assessment revealed that the most common side effect in this study were anaemia and thrombocytopenia. Anaemia was found to be significantly associated with regimens containing RBV and the initial haemoglobin level, while thrombocytopenia was found to be associated with the initial patient platelets count and pegINF containing regimen.

The role of magnetic resonance imaging and clinical assessments in predicting meniscal tear surgery.

This study aims to investigate the role of physical examination and magnetic resonance imaging (MRI) findings in predicting meniscal tear surgery. Medical records of a total of 997 patients (563 females, 434 males; mean age 40.53 years; range 18 to 66 years) who were recommended surgery for meniscal tear in an external center, but continued follow-up in our hospital between January 2012 and March 2018 were retrospectively analyzed. Data of the patients including demographic and clinical characteristics, physical examination findings, and MRI results were recorded. The visual analog scales (VAS) scores and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were evaluated. Of all the patients evaluated by MRI, 62.4% were recommended surgical treatment in private hospitals and 37.6% were recommended surgical intervention in state hospitals. Only 282 of them (28.3%) were treated surgically for meniscal tear after MRI evaluation and physical examination in our clinic. The median pre-treatment VAS score was 7.0 (range, 4 to 10) and 6.0 (range, 3 to 8) in the patients undergoing surgery and undergoing conservative treatment, respectively. The VAS and KOOS scores were similar between the groups at the postoperative sixth month and first year (p=0.940, p=0.203; p=116, p=0.057, respectively). Pain scores significantly decreased, while the KOOS scores significantly increased after the treatment in both groups (for all p=0.001). Decision for surgery should be solely based on physical examination and radiological findings in meniscal tears.

PS02.166: OESOPHAGO-GASTRIC CANCER PATIENTS OPERATED ON IN THE PRIVATE SECTOR SURVIVE LONGER THAN NHS PATIENTS

Abstract Background In the UK, national directives have resulted in centralisation of oesophago-gastric cancer in large National Health Service (NHS) centres. NHS cancer centres have treatment pathway targets of 30 and 60 days to complete staging and start treatment. We have treated patients with oesophago-gastric cancer both in the NHS and private sector. The purpose of this study was to assess whether the treatment and outcome was different for patients treated in the private sector. Methods Data was collected prospectively of consecutive oesophago-gastrectomies for OGJ cancer performed by a single surgeon from 2003–2013. After diagnosis all cases were discussed in a multi-disciplinary meeting. Neo-adjuvant chemotherapy was offered to all patients deemed to have N1 or T3 disease according to MAGIC and OEO5 study protocols. Patients in these stage groups who declined neo-adjuvant chemotherapy were offered adjuvant chemotherapy or chemo-radiation. During the first 2 years oesophago-gastrectomy was performed by open surgery, where-after laparoscopic and thoracoscopic techniques were introduced. Data analysis was by logistic regression using SPSS software. Results 204 resections for OGJ cancer were performed during. The average age was 63 years (range 41–82), 85% had adenocarcinoma, and 78% of patients received neo-adjuvant chemotherapy. The pathological staging was pN1 64%, pT0 5%, pT1 17%, pT2 32%, pT3 42%, pT4 3%. The median hospital stay was 14 days (range 6–210), and the in-hospital mortality was 2.5%. 40 patients had their treatment in private hospitals. There was no difference in the demographics, histology, tumour stage, percentage receiving chemotherapy, type of chemotherapy or surgery between private and NHS patients. Private patients completed their staging tests within 9 days (range 126) of endoscopy and started definitive treatment within 10 days (range 2–59) of the last staging test. 26 of the 40 patients (65%) operated on in the private sector survived 5 years which was more than the 39% of NHS patients who survived 5 years (P = 0.0084). Conclusion Treatment for oesophago-gastric cancer is evolving. Patients with oesophago-gastric cancer treated in the private sector have better long-term survival than NHS patients which might be related to their shorter treatment pathway. Further studies will elucidate the changes in treatment required to improve survival for all UK patients with oesophago-gastric cancer. Disclosure All authors have declared no conflicts of interest.

Development Strategies for Taking Thailand’s Health Healing Tourism Business into the Global Market

As a business, medical tourism seems to offer a wide range of products/services to potential customers, especially those from overseas. In this regard, the Thai government has adopted a policy to promote Thailand, as the medical hub of Asia, capable of providing world-class health care. The purpose of this study, therefore, is to analyze the development strategy of the medical tourism business using a combination of methods, both qualitative and quantitative in nature, to achieve this objective. The sample for this study consisted of 310 foreigners undergoing medical treatment in private hospitals in Bangkok, and the data collected from these respondents is presented in statistical form through the use of Path Analysis. The strategies pertaining to the development of medical tourism consist of demand strategies, supply strategies, research framework strategies (such as the perceived potential of the medical tourism industry for providing quality service), appeal, management of relevant public services, and service quality strategies, including those relating to strong and weak points. Furthermore, using path analysis to determine the relationship between public management, the quality of the hospital’s service, and the appeal of the country’s amenities that affects foreigners’ perception of the country’s potential regarding health facilities. It was found that the most important factor was the quality of the service provided, while the second most influential variable was appeal.

Dialysis practice from the English NHS to the orient.

The dialysis modality mix in China is quite different from Hong Kong (HK). A recent article [1] about global differences in dialysis modality mix showed interesting differences in peritoneal dialysis (PD) prevalence in 36 countries (reported 2003–05) but omitted China and HK in its report. The Gross Domestic Product (GDP) per capita on healthcare and the reimbursement rate of renal services were regarded as the main determinants of the dialysis modality mix, although diabetes was associated with significantly less use of PD at Day 91. Diabetes is a common cause of end-stage kidney disease (ESKD) in the Orient. It is interesting that HK has a ‘PD first’ policy, where 90% of patients are on PD. Yet, in China, with a population of 1.3 billion, there are approximately 260 000 people currently on haemodialysis (HD), and only 40 000 people on PD. It is estimated that currently, another one to two million people in China with ESKD are not receiving dialysis therapy. HK and China are only separated by a short distance; but how different is the dialysis provision! Can this be explained by different macroeconomics and/or renal service indicators? HK spent ∼5% of its GDP on health compared with 10% in the UK, and 18% in the USA. In HK, PD is mainly provided by the public health authority for a nominal charge. The cost of PD was 40% of HD, but only the basic or glucose-based solution is used. Government funding for HD slots is limited. Patients who do not have medical contraindications for PD but choose HD treatment, need to pay for the HD treatment in private hospitals or charity-subsidized HD units. What about China? Even though most hospitals are public hospitals, they receive no subsidy from the government, so the focus of any hospital is revenue generation. In most Chinese cities, the charges of HD are covered by ‘social insurance’ which the patients have paid into, but there is a co-payment payable by the patient. The minimum co-payment is 10%, but is variable depending on the employment of the individual and the place of residence; some people in the rural areas might have no coverage and need to pay the full treatment cost. The low PD percentage is largely due to the perceived disadvantage related to the reimbursement for PD compared with HD, and the inexpensive cost of nursing for HD.

Risk factors associated with death among influenza A (H1N1) patients, Tamil Nadu, India, 2010

Limited information is available about the risk factors associated with death among patients of influenza A (H1N1) in India. To describe the epidemiology of laboratory-confirmed influenza A (H1N1) patients and identify risk factors associated with death. We reviewed the surveillance data of laboratory-confirmed patients in Tamil Nadu, India, for the year 2010. We conducted a case-control study by comparing 70 laboratory-confirmed A (H1N1) patients who died (cases) with 210 A (H1N1) patients who recovered (controls) to identify the risk factors for deaths. We interviewed the controls and immediate care-takers of the influenza patients who died to collect information about socio-demographic details and co-morbid conditions. We used an abstraction form to collect the information about the clinical details from the case records of the hospitals where the cases and controls received treatment. We analysed the surveillance data by time, place and person. We conducted univariate and multivariate logistic regression analysis for identifying factors associated death. During 2010, 1302 laboratory-confirmed cases were reported to the Tamil Nadu surveillance unit. Of these, 72 patients died (case fatality=5.5%). About 2/3 of the cases and 40% of the deaths were from three districts. On multivariate analysis, past history of diabetes, treatment in private hospitals, treatment with corticosteroids during illness, visit to >1 healthcare facility before laboratory confirmation and delay of >48 h in starting antivirals were found to be independently associated with the deaths. Influenza patients with previous history of diabetes, who had treatment with corticosteroids during illness, and started with antivirals after 48 h of onset of symptoms, were at higher risk of adverse outcome. In order to reduce the risk of death during future waves of influenza in Tamil Nadu, the physicians need to be sensitised regarding (1) higher risk of adverse outcomes among A (H1N1) patients with diabetes; (2) adherence to the national protocol for categorisation of cases; (3) prompt initiation of antivirals for severe cases; and (4) avoidance of systemic corticosteroids during management.

Average out-of-pocket healthcare and work-loss costs of traffic injuries in Karachi, Pakistan

The objective of this study was to assess the average out-of-pocket healthcare and work-loss costs of road traffic injuries (RTI) in Karachi. In this cross-sectional study, RTI patients presenting to the five trauma centres in Karachi were contacted using stratified sampling to report their inpatient and outpatient expenses, the time spent in hospital and their average monthly income. These costs were compared among different categories of patient-related variables using analysis of variance test. Out of 341 RTI victims, two wheelers accounted for the majority of injuries (77.2%, N = 256) followed by pedestrians (14.2%, N = 48). Almost half of the sample patients were breadwinners (N = 135, 45.2%), with 87.4% (N = 118) earning less than US$ 248. Average out-of-pocket healthcare costs were US$ 271 (SD = 440.9), which were significantly higher (P ≤ 0.026) for pedestrians (US$ 442), moderate (US$ 341.7) or severe (US$ 553.8) injury, and treatment in private hospitals (US$ 451.7). Similarly, average work loss was US$ 67.1 (SD = 132.1), which were significantly higher (P = 0.001) for breadwinners (US$ 99.1), moderate (US$ 130.0) or severe (US$ 157.1) injury, and treatment in private hospitals (US$ 150.0). Study results clearly showed the need to advocate RTI prevention measures in Pakistan as any such event could lead to a difficult economic situation for those involved and their family.

Cardiovascular and women’s health in the Indian subcontinent

> “Woman, I hold, is the personification of self-sacrifice, but unfortunately today she does not realize what tremendous advantage she has over man” Gandhi Five years ago, I was an...

Readers panel perpetuated independent sector myths

Last week your reader’s panel (reflections January 21) answered the question: ‘Thousands of patients are being offered NHS-funded treatment in private hospitals. Is this a threat to NHS services?’

Patient characteristics and clinical caseload of short stay independent hospitals in England and Wales, 1992-3.

To describe and quantify the patients and clinical activities of independent short stay hospitals. Retrospective survey of hospital records for sampled periods of one financial year and comparison with data from 1981 to 1986. 217 independent hospitals in England and Wales, 1992-3. Distributions of sex, age groups, and areas of residence of patients, clinical procedures, financial provision. Data were obtained from 201 (93%) hospitals. An estimated 429,172 inpatients (7% more than 1986) and 249,531 day cases (an increase of 154%) from 1986 were treated in the year. The number of overseas patients was half that in 1986. Clinical case mix remained similar to 1986. Abortion remained the commonest procedure (13% v 19% in 1986). Lens operations, heart operations, endoscopies, and non-surgical cases showed the largest increases from 1986. Proportionately more overseas patients had abortions (30% v 12% for England and Wales residents) and they received 41% of coronary artery bypass grafting. Three quarters of the patients were aged 15-64. The proportion of patients aged over 65 had changed little (19% v 17% in 1986). Estimated average bed occupancy was only 48%. Only one in 20 patients was treated under NHS contract; 90% of episodes were funded through private health insurance. The demand for treatment in private hospitals continues to increase despite additional investment in the NHS, but the overseas market is falling. Overall, the range of clinical activity has changed little.