scholarly journals Surgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness study

2020 ◽  
Vol 162 (3) ◽  
pp. 703-711
Author(s):  
Mattis A. Madsbu ◽  
Øyvind Salvesen ◽  
Sven M. Carlsen ◽  
Steinar Westin ◽  
Kristian Onarheim ◽  
...  

Abstract Background There is limited evidence on the comparative performance of private and public healthcare. Our aim was to compare outcomes following surgery for lumbar disc herniation (LDH) in private versus public hospitals. Methods Data were obtained from the Norwegian registry for spine surgery. Primary outcome was change in Oswestry disability index (ODI) 1 year after surgery. Secondary endpoints were quality of life (EuroQol EQ-5D), back and leg pain, complications, and duration of surgery and hospital stays. Results Among 5221 patients, 1728 in the private group and 3493 in the public group, 3624 (69.4%) completed 1-year follow-up. In the private group, mean improvement in ODI was 28.8 points vs 32.3 points in the public group (mean difference − 3.5, 95% CI − 5.0 to − 1.9; P for equivalence < 0.001). Equivalence was confirmed in a propensity-matched cohort and following mixed linear model analyses. There were differences in mean change between the groups for EQ-5D (mean difference − 0.05, 95% CI − 0.08 to − 0.02; P = 0.002) and back pain (mean difference − 0.2, 95% CI − 0.2, − 0.4 to − 0.004; P = 0.046), but after propensity matching, the groups did not differ. No difference was found between the two groups for leg pain. Complication rates was lower in the private group (4.5% vs 7.2%; P < 0.001), but after propensity matching, there was no difference. Patients operated in private clinics had shorter duration of surgery (48.4 vs 61.8 min) and hospital stay (0.7 vs 2.2 days). Conclusion At 1 year, the effectiveness of surgery for LDH was equivalent in private and public hospitals.

2020 ◽  
Author(s):  
Abolhasan Afkar ◽  
Habib Jalilian ◽  
Abolghasem Pourreza ◽  
Habibeh Mir ◽  
Abdolhosein Emami Sigaroudi ◽  
...  

Abstract Backgrounds Breast cancer is the most prevalent cancer among women. Breast cancer imposes a considerable economic burden on the health system. This study aimed to compare the cost of breast cancer among patients who referred to private and public hospitals in Iran (2017). Methods This was a prevalence-based cost of illness study. A total of 179 patients were selected from private and public hospitals using the census method. The researcher-constructed checklist was used for data collection. Data were analyzed using SPSS software version 22. Results The estimated total mean (SD) direct cost of patients who referred to the private hospital and the public hospital was $10050 (19480) and $3960 (6780), respectively. Further, the total mean indirect cost of patients who referred to the private hospital was lower than those referring to the public hospital at $1870 (%15 of total costs) and $22350 (%85 of total costs), respectively. These differences were statistically significant (P<0.05). Conclusion Breast cancer imposes a substantial cost on patients, health insurance organizations and the whole society in Iran. Therefore, the adoption of effective measures for the prevention and early diagnosis of breast cancer is urgently needed.


2020 ◽  
Author(s):  
Abolhasan Afkar ◽  
Habib Jalilian ◽  
Abolghasem Pourreza ◽  
Habibeh Mir ◽  
Abdolhosein Emami Sigaroudi ◽  
...  

Abstract Backgrounds Breast cancer is the most prevalent cancer among women. Breast cancer imposes a considerable economic burden on the health system. This study aimed to compare the cost of breast cancer among patients who referred to private and public hospitals in Iran (2017).Methods This was a prevalence-based cost of illness study. A total of 179 patients were selected from private and public hospitals using the census method. The researcher-constructed checklist was used for data collection. Data were analyzed using SPSS software version 22.Results The estimated total mean ± SD direct cost of patients who referred to the private hospital and the public hospital was $10051.78 ± 19484.61 and $3956.33 ± 6783.02, respectively. Further, the total mean indirect cost of patients who referred to the private hospital was lower than those referring to the public hospital at $1870.89 (%15.69 of total costs) and $22348.5 (%84.95 of total costs), respectively. These differences were statistically significant (P < 0.05).Conclusion Breast cancer imposes a substantial cost on patients, health insurance organizations and the whole society in Iran. Therefore, the adoption of effective measures for the prevention and early diagnosis of breast cancer is urgently needed.


2018 ◽  
Vol 31 (7) ◽  
pp. 755-774 ◽  
Author(s):  
Rocio Rodriguez ◽  
Göran Svensson ◽  
David Eriksson

Purpose The purpose of this paper is to examine the logic and differentiators of organizational positioning and planning of sustainability initiatives between private and public organizations in the healthcare industry. Sustainability initiatives refer to organizations’ economic, social and environmental actions. Design/methodology/approach This study is based on an inductive approach judgmental sampling and in-depth interviews of executives at private and public hospitals in Spain have been used. Data were collected from the directors of communication at private hospitals, and from the executive in charge of corporate social responsibility in public hospitals. An empirical discourse analysis is used. Findings The positioning and planning of sustainability initiatives differs between private and public hospitals. The former consider sustainability as an option that is required mainly for social reasons, a bottom-up positioning and planning. It emerges merely spontaneously within the organization, while the sustainability initiatives in public hospitals are compulsory. They are imposed by the healthcare system within which the public hospital, operates and constitutes a top-down positioning and planning that is structured to accomplish set sustainability goals. Research limitations/implications A limitation of this study is that it is undertaken exclusively in Spanish organizations from one industry. This study differs from previous ones in terms of exploring the positioning and planning of the sustainability initiatives, which focus on the organizational logic of such sustainability initiatives. There are both common denominators and differentiators between private and public hospitals. Practical implications The logic of determining the positioning and planning of the sustainability initiatives is mainly about satisfying organizational needs and societal demands. Nowadays, organizations tend to engage in sustainability initiatives, so it is essential to understand the logic of how organizations position and plan such efforts. Originality/value This study investigates the path that follows sustainability initiatives in public and private organizations. It reports mainly differentiators between private and public organizations. It also contributes to explaining the organizational reasoning as to why companies make decisions about sustainability initiatives, an issue which has not been addressed sufficiently in existing theory studies.


PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250626
Author(s):  
Aviad Tur-Sinai ◽  
Royi Barnea ◽  
Orna Tal

Trust is an essential element in patient-physician relationships, yet trust is perceived differently among providers and customers exist. During January-February 2020 we examined the standpoints of medical managers and administrative directors from the private and public health hospitals on patient-physician trust, using a structured questionnaire. Thirty-six managers in public and private hospitals (24 from the public sector and 12 from the private sector) responded to the survey. Managers in the private sector rated trust higher in comparison to managers in the public sector, including trust related to patient satisfaction, professionalism and accountability. Managers from public hospitals gave higher scores to the need for patient education and shared responsibility prior to medical procedures. Administrative directors gave higher scores to various dimensions of trust and autonomy while medical managers gave higher scores to economic considerations. Trust is a fundamental component of the healthcare system and may be used to improve the provision and quality of care by analyzing standpoints and comparable continuous monitoring. Differences in position, education and training influence the perception of trust among managers in the health system. This survey may allow policy makers and opinion leaders to continue building and maintaining trust between patients and care providers.


2000 ◽  
Vol 23 (3) ◽  
pp. 162 ◽  
Author(s):  
Jennifer Badham ◽  
Jason Brandrup

This analysis uses average length of stay as a proxy for efficiency, to compare the Australian private and public hospitalsectors. We conclude that private hospitals are more efficient than public hospitals in providing the range of care providedby private hospitals. However, public hospitals are more efficient in handling the casemix of the public hospital sector.The picture is more complicated when particular types of care (such as obstetric and psychiatric) are excluded.


Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2244-2244
Author(s):  
Eloisa Riva ◽  
Natalia Paola Schutz ◽  
Camila Peña ◽  
Fiorella Villano ◽  
Guillermo J. Ruiz-Argüelles ◽  
...  

Abstract Introduction Compliance with Multiple Myeloma (MM) recommendations regarding diagnosis and treatment is highly variable worldwide, outside clinical trials. This survey among hematologists from Latin America (LA) aims to describe real access to diagnostic and prognostic analyses and first line treatment for newly diagnosed MM (NDMM). Objectives To describe the access to diagnostic and prognostic tests and first line treatment options for MM in LA. To compare public versus private access to tests and therapies. Methods This is a multicenter cross-sectional study. A 16-question survey focusing on demographic characteristics of physicians, centers, and standard of care practices for NDMM was emailed to 182 hematologists from 11 LA countries. (Fig 1) The survey was open from Dec/17-Feb/18. Results We received 103 completed questionnaires (56.6%) from 8 countries: Argentina (45), Uruguay (28), Chile (15), Paraguay (6), Peru (3), Costa Rica (2), Mexico (2), Venezuela (2). Most physicians (85/103) work in private and public institutions; the majority (64.7%) treat benign and malignant diseases, 30% mainly malignant diseases, and 4.9% mainly plasma cell disorders. Access to diagnostic tests is shown in Table 1. In > 20% of public hospitals there is no access to serum protein electrophoresis (SPEP), serum immunofixation (IFX) or serum immunoglobulins quantification (Igs); in 57.3% serum Free Light Chain (sFLC) assay is not done. Lack of access to Fluorescent in situ hybridization (FISH) is 67%, Computed Tomography (CT) scan 23.5%, Magnetic Resonance Imaging (MRI) 45% and Positron Emission Tomography (PET/CT) 66.5%. In private centers, lack of access to SPEP is <5%, IFX 10%, Igs 15%, sFLC 16.5%, FISH 33%, CT scan 5%; MRI 7.3% and PET/CT 20%. Thalidomide, Bortezomib and autologous stem cell transplant (ASCT) are available in all reporting countries, in public and private institutions. Lenalidomide is reported commercially available by 97.9% of physicians, Melphalan 92.7%, Daratumumab 68%, Pomalidomide 67%, Carfilzomib 60%, Ixazomib 18%. (Table 2) Nevertheless, due to reimbursement policies not all patients have access to these drugs, as reflected in treatment choices. In private institutions, 86.5% report treating ASCT-eligible patients upfront with Bortezomib-based triplets versus 51.6% in public hospitals [OR 5.72 (IC95% 2.32-14.7) p <0.001). Cyclophosphamide-Thalidomide-Dexamethasone (CTD) is used in the public setting by 40.3% (Table 3). Firstline choice for high risk MM (HRMM) is Bortezomib combinations in all private centers but in only 74.4% of public institutions (p<0.001). ASCT ineligible patients: the most used upfront regimen is Cyclophosphamide-Bortezomib-Dexamethasone (CyBorD) in private centers and CTD in public hospitals (Table 4). For HRMM, Bortezomib-based triplets is the first choice in 88.57% and 65.51% in private and public settings, respectively [OR 4.09 (CI95% 1.57-11.16) p=0.0011). Most physicians indicate maintenance treatment, mainly until progression/intolerance.(Table 5) Lenalidomide or Bortezomib are used in private centers in all countries, but for Venezuela. Only Thalidomide and Dexamethasone are available in public hospitals from 6/8 countries. Lenalidomide or Bortezomib maintenance approval require special authorization in most countries, delaying its initiation. Discussion This study shows real word data regarding the challenges LA faces in the care of MM patients. Access to recommended diagnostic and prognostic tests is deficient, particularly in the public setting. Diagnosis, risk assessment and response evaluation are, therefore, inaccurate. In public hospitals, >50% of patients have no access to adequate imaging evaluation, being screened by X-rays. Regardless of commercial availability, real access to novel drugs is limited, particularly in the public setting. This causes an ethical dilemma for physicians, which must treat patients depending on the health care provider and reimbursement policies rather than based on evidence. One limitation of this work is the high percentage of unanswered surveys. Conclusion LA is far from complying with international recommendations for MM approach. The most striking finding is the great difference between public and private centers in all variables. This gap is likely to translate into differences in survival, which is greatly concerning. Solving these inequities should be a priority. Disclosures No relevant conflicts of interest to declare.


2020 ◽  
Author(s):  
Abolhasan Afkar ◽  
Habib Jalilian ◽  
Abolghasem Pourreza ◽  
Habibeh Mir ◽  
Abdolhosein Emami Sigaroudi ◽  
...  

Abstract Backgrounds: Breast cancer is the most prevalent cancer among women. Breast cancer imposes a considerable economic burden on the health system. This study aimed to compare the cost of breast cancer among patients who referred to private and public hospitals in Iran (2017). Methods: This was a prevalence-based cost of illness study. A total of 179 patients were selected from private and public hospitals using the census method. The researcher-constructed checklist was used for data collection. Data were analyzed using SPSS software version 22. Results: The estimated total mean ±SD direct cost of patients who referred to the private hospital and the public hospital was $10051.78±19484.61 and $3956.33±6783.02, respectively. Further, the total mean indirect cost of patients who referred to the private hospital was lower than those referring to the public hospital at $1870.89 (%15.69 of total costs) and $22348.5 (%84.95 of total costs), respectively. These differences were statistically significant (P<0.05). Conclusions: Breast cancer imposes a substantial cost on patients, health insurance organizations and the whole society in Iran. Therefore, the adoption of effective measures for the prevention and early diagnosis of breast cancer is urgently needed.


2021 ◽  
Vol 4 (2) ◽  
pp. 081-091
Author(s):  
Assefa Endalkachew Mekonnen ◽  
Janbo Adem ◽  
Ghiwot Yirgu

Objectives: We analyzed the indications of cesarean section (CS) using Robson Ten-Group. Classification Systems (RTGCS) and comparison between private and public health facilities in Addis Abeba hospitals, Ethiopia, 2017. Methods: Facility-based retrospective cross-sectional study was carried out between January 1 and December 31, 2017, including 2411 mothers who delivered by CS were classified using the RTGCS. Data were entered into SPSS version 20 for cleaning and analyzing. Binary logistic regression and AOR with 95% CI were used to assess the determinants of the CS. Results: The overall CS rate was 41% (34.8% and 66.8% in public & private respectively, p < .0001). The leading contributors for CS rate in the private were Robson groups 5,1,2,3 whereas in the public 5,1,3,2 on descending order. Robson group 1 (nulliparous, cephalic, term, spontaneous labor) and group 3 [Multiparous (excluding previous cesarean section), singleton, cephalic, ≥ 37 weeks’ gestation& spontaneous labor], the CS rate was over two-fold higher in the private than the public sector. Women in Robson groups 1, 2, 5 & 9 are two and more times higher for the absolute contribution of CS in private than public. The top medical indications of CS were non-reassuring fetal status (NRFS, 39.1%) and repeat CS for previous CS scars (39.4%) in public and private respectively. Mothers who delivered by CS in private with history of previous CS scar (AOR 2.9, 95% CI 1.4-6.2), clinical indications of maternal request (AOR 7.7, 95% CI 2.1-27.98) and pregnancy-induced hypertension (AOR 4.2, 95% CI 1.6-10.7), induced labor (AOR 2.5, 95% CI 1.4-4.6) and pre-labored (AOR 2.2, 95% CI 1.6-3.0) were more likely to undergo CS than in public hospital. Conclusion: The prevalence of CS was found to be high, and was significantly higher in private hospitals than in a public hospital. Having CS scar [having previous CS scar, Robson group 5(Previous CS, singleton, cephalic, ≥ 37 weeks’ gestation) and an indication of repeat CS for previous CS scar] is the likely factor that increased the CS rate in private when compared within the public hospital. Recommendation: It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS, encouraging vaginal birth after CS (VBAC). Policies should be directed at the private sector where CS indication seems not to be driven by medical reasons solely.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abolhasan Afkar ◽  
Habib Jalilian ◽  
Abolghasem Pourreza ◽  
Habibeh Mir ◽  
Abdolhosein Emami Sigaroudi ◽  
...  

Abstract Backgrounds Breast cancer is the most prevalent cancer among women. Breast cancer imposes a considerable economic burden on the health system. This study aimed to compare the cost of breast cancer among patients who referred to private and public hospitals in Iran (2017). Methods This was a prevalence-based cost of illness study. A total of 179 patients were selected from private and public hospitals using the census method. The researcher-constructed checklist was used for data collection. Data were analyzed using SPSS software version 22. Results The estimated total mean (SD) direct cost of patients who referred to the private hospital and the public hospital was $10,050 (19,480) and $3960 (6780), respectively. Further, the total mean indirect cost of patients who referred to the private hospital was lower than those referring to the public hospital at $1870 (15 % of total costs) and $22,350 (85 % of total costs), respectively. These differences were statistically significant (P < 0.05). Conclusions Breast cancer imposes a substantial cost on patients, health insurance organizations and the whole society in Iran. Therefore, the adoption of effective measures for the prevention and early diagnosis of breast cancer is urgently needed.


Author(s):  
G. Z. Yuzbashieva ◽  
A. M. Mustafayev ◽  
R. A. Imanov

The indicators that determine the change in the macroeconomic situation in the economy of Azerbaijan in 2010–2017, as well as the conditions for increasing the effectiveness of state intervention in solving economic problems are analyzed. It is noted that it is not the size of the public sector that becomes important, but its qualitative component (management and redistribution of resources and revenues, coordination of government intervention in economic relations). The main reasons limiting economic growth are identified, and the mechanisms for overcoming them are disclosed, since economic growth is of particular importance in the transformational period of state development. It substantiates the assertion that the forms and methods of state regulation should be the result of a reasonable combination of the private and public sectors of the economy to more effectively achieve the goal of economic development of the country and increase the welfare of the population. To this end, it is advisable to limit the actions of market forces and find a rational ratio of market and government measures that stimulate economic growth and development.It is shown that in the near future the development of the economy of Azerbaijan should be focused on the transition to the integration of various models of economic transformation; at the same time, “attraction of investments” should be carried out by methods of stimulating consumption, and the concept of a socially oriented economy, which the state also implements, should prevail, thereby ensuring social protection of the population and at the same time developing market relations. Disproportions in regional and sectoral development are also noted, which are the result of an ineffective distribution of goods produced, inadequate investment in human capital, a low level of coordination and stimulation of economic growth and development.


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