scholarly journals A systematic review of the accessibility, acceptability, safety, efficiency, clinical effectiveness and cost-effectiveness of private providers of elective surgical services compared with public providers

2021 ◽  
Author(s):  
Ilke Akpinar ◽  
Erin Kirwin ◽  
Lisa Tjosvold ◽  
Dagmara Chojecki ◽  
Jeff Round
Keyword(s):  
Cost Effectiveness ◽  
Health Systems ◽  
Clinical Effectiveness ◽  
Publicly Funded ◽  
Public And Private ◽  
Private Provision ◽  
Surgical Services ◽  
Public Facilities ◽  
Safety Outcomes

Abstract Many publicly funded health systems use a mix of privately and publicly operated providers of care to deliver elective surgical services. We review the role of private elective surgical provision within publicly funded health systems in high-income countries. The outcomes evaluated include accessibility, acceptability, safety, clinical effectiveness, efficiency, and cost/cost-effectiveness. Twenty-seven articles met the review inclusion criteria. We found mixed results across each of our reported outcomes. Wait times were shorter for patients treated in private facilities in most studies, and inequalities by age and socioeconomic deprivation were found to increase with private provision in some studies. Acceptability results were mixed, with most studies finding no differences between public and private provision and others finding higher satisfaction at public facilities. The results for safety outcomes were divided, but most studies that found improved safety outcomes in private facilities, noting that private patients had a lower preoperative risk of complications. Clinical effectiveness was similar in most studies, with differences in outcomes mainly attributed to patient selection or prosthesis choice. Very few studies reported cost and cost-effectiveness outcomes, and just two included studies concluded that private facilities are economically viable.

Stiffen the sinews, summon up the blood, and strain upon the start: enfranchising the medical profession for clinically proximate advocacy of improved healthcare

2021 ◽  
pp. 103985622110250
Author(s):  
Jeffrey C L Looi ◽  
Stephen Allison ◽  
Stephen R Kisely ◽  
Tarun Bastiampillai
Keyword(s):  
Resource Allocation ◽  
Health Systems ◽  
Medical Profession ◽  
Continuing Professional Development ◽  
Health Advocacy ◽  
Public And Private ◽  
Medical Practitioners ◽  
The Public ◽  
Team Activity

Objective: To discuss and reflect upon the role of medical practitioners, including psychiatrists, as health advocates on behalf of patients, carers and staff. Conclusions: Health advocacy is a key professional competency of medical practitioners, and is part of the RANZCP framework for training and continuing professional development. Since advocacy is often a team activity, there is much that is gained experientially from volunteering and working with other more experienced health advocates within structurally and financially independent (of health systems and governments) representative groups (RANZCP, AMA, unions). Doctors may begin with clinically proximate advocacy for improved healthcare in health systems, across the public and private sectors. Health advocacy requires skill and courage, but can ultimately influence systemic outcomes, sway policy decisions, and improve resource allocation.

scholarly journals Community participation in demanding accountability for health systems strengthening

2021 ◽  
pp. 279-281
Author(s):  
YK Sandhya ◽  
Renu Khanna
Keyword(s):  
Health Systems ◽  
Community Action ◽  
Social Accountability ◽  
Health Systems Strengthening ◽  
Contextual Analysis ◽  
Health System Strengthening ◽  
Public And Private ◽  
Call To Action ◽  
Transformative Potential

This paper describes how the COPASAH Global Symposium treated the Theme of ‘Community Action in Governance and Accountability for Health System Strengthening’. We first lay out COPASAH’s understanding of Social Accountability in health systems as centre-staging the transformative potential of the power of the communities rather than seeing social accountability as merely a tokenistic participation of the community. Through case studies presented by practitioners from across the globe, the Theme positioned communities and civil society at large as central to the governance and accountability of health systems (both public and private). The important role of contextual analysis in defining the strategies and interventions for demanding accountability was discussed. Participants’ experiences of demanding accountability brought out clearly the importance of linkages from local action to global mobilisation. Further, the discussions reaffirmed the COPASAH’s principles of Social Accountability in Health that informed the COPASAH Charter and Call to Action for Social Accountability for Health.

NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (NICE)

2002 ◽  
Vol 18 (2) ◽  
pp. 166-170 ◽  
Author(s):  
Rod Taylor
Keyword(s):  
Cost Effectiveness ◽  
Policy Making ◽  
National Policy ◽  
Clinical Excellence ◽  
Clinical Effectiveness ◽  
Technology Appraisal ◽  
England And Wales ◽  
Appraisal Process ◽  
Healthcare Technologies

The technology appraisal program of the National Institute for Clinical Excellence (NICE) was established on April 1, 1999. Its role is to advise the NHS in England and Wales on the clinical effectiveness, cost-effectiveness, and service impact of new and emerging as well as established healthcare technologies. This paper describes the role of HTA in the NICE technology appraisal process, discusses some of the challenges of the use of HTA in national policy making, and considers some of the potential ways forward.

scholarly journals On the Performance of the U.S. Transportation System: Caution Ahead

2013 ◽  
Vol 51 (3) ◽  
pp. 773-824 ◽  
Author(s):  
Clifford Winston
Keyword(s):  
United States ◽  
The United States ◽  
Transportation System ◽  
Government Policies ◽  
Public Provision ◽  
Public And Private ◽  
Private Provision ◽  
Optimal Mix ◽  
The U.S

Transportation is a vital sector of the U.S. economy based on consumers', firms', and government's enormous expenditures in money and time and on its effect on virtually all other sectors in the economy. I assess the performance of the transportation system and consider how it could be improved by analyzing whether the United States has the optimal mix of public and private provision. The empirical evidence indicates that our hugely important transportation system has been compromised by various government policies and the significant welfare costs motivate either vastly improving public provision or expanding the role of the private sector. (JEL H44, H54, H76, L91, L98, R41, R48)

Public and Private Net Savings in Developing Countries: Some Empirical Tests for the Period 1972-88 (Distinguishedl Lecture)

1992 ◽  
Vol 31 (4I) ◽  
pp. 431-447
Author(s):  
Peter A. Cornelisse ◽  
Elma Van De Mortel
Keyword(s):  
Public Debt ◽  
World Economy ◽  
Socioeconomic Development ◽  
Critical Size ◽  
Public And Private ◽  
Critical Dimensions ◽  
The Public ◽  
Empirical Tests ◽  
Financial Issues

The severe shocks that rocked the world economy in the 1970s and the ensuing efforts to adjust and to renew economic growth have had a profound effect on the economic literature. Especially the external and public debt problems which reached critical dimensions in many countries attracted much attention. Thus, in the field of macroeconomics financial issues have gained more prominence over the last two decades. Studies relating to the fiscal deficit have been particularly numerous. The critical size of national public debts, the contribution of the public debt to external debt, the reduced confidence in the state as the guide in socioeconomic development and the role of fiscal policy in adjustment processes are among the main reasons for this increased interest.

What Can Economists Contribute to the Common Good Tradition?

2017 ◽  
Author(s):  
Andrew M. Yuengert
Keyword(s):  
Common Good ◽  
Common Pool Resources ◽  
Economic Approach ◽  
Public And Private ◽  
Private Provision ◽  
The Public ◽  
The Common Good ◽  
The Common ◽  
The Individual ◽  
Insight Into

Although most economists are skeptical of or puzzled by the Catholic concept of the common good, a rejection of the economic approach as inimical to the common good would be hasty and counterproductive. Economic analysis can enrich the common good tradition in four ways. First, economics embodies a deep respect for economic agency and for the effects of policy and institutions on individual agents. Second, economics offers a rich literature on the nature of unplanned order and how it might be shaped by policy. Third, economics offers insight into the public and private provision of various kinds of goods (private, public, common pool resources). Fourth, recent work on the development and logic of institutions and norms emphasizes sustainability rooted in the good of the individual.

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