DIFFERENCES IN LENGTH OF STAY FOR HIP REPLACEMENT BETWEEN PUBLIC HOSPITALS,SPECIALISED TREATMENT CENTRES AND PRIVATE PROVIDERS: SELECTION OR EFFICIENCY?

We investigate differences in patients’ length of stay between National Health Service (NHS) public hospitals, specialised public treatment centres and private treatment centres that provide elective (non‐emergency) hip replacement to publicly funded patients. We find that the specialised public treatment centres and private treatment centres have, on average, respectively 18% and 40% shorter length of stay compared with NHS public hospitals, even after controlling for differences in age, gender, number and type of diagnoses, deprivation and regional variation. Therefore, we interpret such differences as because of efficiency as opposed to selection of less complex patients. Quantile regression suggests that the proportional differences between different provider types are larger at the higher conditional quantiles of length of stay. Copyright © 2012 John Wiley & Sons, Ltd.     

Specialist payment schemes and patient selection in private and public hospitals

It has been observed that specialist physicians who work in private hospitals are usually paid by fee-for-service while specialist physicians who work in public hospitals are usually paid by salary. This paper provides an explanation for this observation. Essentially, fee-for-service aligns the interests of income preferring specialists with profit maximizing private hospitals and results in private hospitals treating a high proportion of short stay patients. On the other hand, salary aligns the interests of fairness preferring specialists with benevolent public hospitals that commit to admit all patients irrespective of their expected length of stay.     

Social and Medical Factors Affecting Hospital Discharge of Persons with HIV/AIDS

Although outpatient care and Pharmaceuticals have rendered community-based care possible, hospitals remain the locus of the most costly and intensive HIV/AIDS care. Little is know, however, about the impact of patients' social circumstances upon hospital length of stay. This paper examines the impact of housing status, living arrangements, and a range of barriers to discharge on hospital length of stay. Findings are based on retrospective medical chart reviews by nurses and social workers of 749 HIV/AIDS hospitalizations, occurring between June-August 1991 in four New York City medical centers. One third of the sample experienced at least one barrier to discharge. Medical need barriers were the most common (18%), and were associated with the longest length of stay (35.3 days), followed by home care and housing barriers (32.7 and 30.2 days, respectively). Fourteen percent of the sample were either homeless or in unstable housing situations (e.g., transient or doubled up) prior to admission. Homelessness and unstable housing were associated with a 5 day increment in hospital length of stay, and remained a significant factor even controlling for morbidity. These results indicate that inadequate housing remains a significant barrier to discharge among hospitalized persons with HIV/AIDS.     

Lien précarité – durée et complexité des séjours hospitaliers en secteur de court séjour

BackgroundSeveral studies have shown that socioeconomic deprivation is associated with increased hospitalization lengths of stay (LOS) and costs. Yet, the French DRG-based information system (PMSI) does not take deprived situations into account. Hence, we aimed at extracting routinely available variables measuring deprivation from the Hospital Information System and at assessing their association with severity of illness and hospital LOS.MethodsWe performed record linkage between the PMSI database concerning stays of patients aged more than 16 years in the short-stay sector of Assistance publique–Hôpitaux de Paris in 2007 and an administrative database which provided the following deprivation measures: recipients of Couverture Médicale Universelle (basic or complementary health insurances adapted for underprivileged French citizens) or Aide Médicale d’État (health and medical emergency insurances adapted for underprivileged non French citizens living in France) and homeless patients. We compared length of stays showing a deprivation measure to others after adjustment on morbidity, age and sex.ResultsAmong 352,721 stays, the prevalence of the deprivation measures ranged from 0.71% for “homelessness” to 6.24% for complementary Couverture Médicale Universelle. Stays showing a deprivation measure had specific illnesses and had more frequently associated comorbidities or complications than others. After adjustment, deprivation measures were associated with significantly increased LOS (by 5% for Couverture Médicale Universelle to 48% for emergency Aide Médicale d’État.ConclusionRoutine extraction of deprivation measures from Hospital Information Systems is feasible. Age, sex and illness being equal, these deprivation measures were associated with more complicated cases and increased LOS. We recommend that case mix-based hospital prospective payment systems take socioeconomic deprivation into account.     

Where Do Women Veterans Get Their Inpatient Care?

PURPOSE: In this study we explore women veterans' use of Veterans Administration (VA) and private sector inpatient services. METHODS: Using a comprehensive dataset of VA and private hospital admissions, we identified 1,409 female patients who were enrolled in the VA system and had an inpatient admission between 1998 and 2000 in either the VA or the private sector. For Major Diagnostic Categories (MDCs) with >20 admits in each sector, we compared care provided in the private sector with care provided in the VA with respect to patient characteristics and resource utilization. In addition, we determined payment sources for women who used the private sector for inpatient care. FINDINGS: Women who used the VA were younger (mean, 54 vs. 60 years; p < .001) and more likely to be service connected (39% vs. 24%; p < .001), African American (25% vs. 13%; p < .001), and urban dwelling (81% vs. 75%; p < .01). Women veterans were significantly more reliant on the VA system for mental diseases, alcohol and drug use, and skin/subcutaneous/breast diseases. For every MDC examined, VA hospitals had longer mean lengths of stay. Among VA eligible women <65 years old using the private sector, 56% used private insurance, 15% used Medicare, 14% used Medicaid, and 9% did not have insurance. CONCLUSIONS: In New York, female veterans admitted to VA hospitals differed from women admitted to private hospitals by patient characteristics, admission reason, and admission resource consumption. Many younger women who used the private sector were reliant on other government agencies (Medicaid or Medicare) or out-of-pocket payments for their inpatient care.     

Private health expenditure in the Greek health care system: Where truth ends and the myth begins

Greece today has the most “privatized” health care system among EU countries. Given the country's universal coverage by a public system this may be called “the Greek paradox”. The Objective of this paper is to analyze private health payments by provider and type of service in order to bring to light the reasons for and the nature of the extraordinary private expenditure in Greece. Methods: We used a randomized countrywide sample of 1616 households. Regression analysis was used to determine the extent to which social and economic household characteristics influence the frequency of use of certain health services and the size of household payments for such services. In all statistical analyses we used the p < 0.05 level of significance. Results: Out of the total private household health expenditure (€6141 million), 66% is for outpatient services, with the largest share for dental services, absorbing 31.1% (€1912 million or 1.5% of GDP) of the total out-of-pocket health expenditure. Rural dwellers seek private outpatient care more often, because of the understaffed public primary facilities. The hospital sector absorbs less than 15% (or €884 million) of household private health expenditure. A significant part (20%) of hospital care financed privately concerns informal payments within public hospitals, an amount almost equal with formal payments in the form of cost sharing. Admissions to private hospitals are only 16% of total admissions. Our results indicate that this is a result of the political emphasis in public hospitals and of the considerably high cost of private hospital care. Conclusions: The rise in private health expenditure and the development of the private sector during the last 20 years in Greece is associated with public under financing. The gap was filled by the private sector through increased investment, mostly in upgraded amenities and new technology. Today, the complementary nature of private care in Greece is no longer disputed, but is a matter of serious concern, as it undermines the constitutionally guaranteed free access and equitable distribution of health resources.     

Do the poor cost much more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001 to 2008

The Blair/Brown reforms of the English NHS in the early to mid 2000s gave hospitals strong new incentives to reduce waiting times and length of stay for elective surgery. One concern was that these efficiency-oriented reforms might harm equity, by giving hospitals new incentives to select against socio-economically disadvantaged patients who stay longer and cost more to treat. This paper aims to assess the magnitude of these new selection incentives in the test case of hip replacement. Anonymous hospital records are extracted on 274,679 patients admitted to English NHS Hospital Trusts for elective total hip replacement from 2001/2 through 2007/8. The relationship between length of stay and small area income deprivation is modelled allowing for other patient characteristics (age, sex, number and type of diagnoses, procedure type) and hospital effects. After adjusting for these factors, we find that patients from the most deprived tenth of areas stayed just 6% longer than others in 2001/2, falling to 2% by 2007/8. By comparison, patients aged 85 or over stayed 57% longer than others in 2001/2, rising to 71% by 2007/8, and patients with seven or more diagnoses stayed 58% longer than others in 2001/2, rising to 73% by 2007/8. We conclude that the Blair/Brown reforms did not give NHS hospitals strong new incentives to select against socio-economically deprived hip replacement patients.     

Choice and evaluation of hospitals in Bangladesh: insights from patients and policy implications

This paper attempts to gain insights into the health care system of Bangladesh from the perspectives of hospital patients. The study is based on survey data obtained from 207 recipients of health care services from 57 hospitals in Dhaka City. Patients' choice of hospital is influenced by referrals of doctors (28.7%), reputation of the hospital (23.7%), referral by family and friends (17.4%), closeness to home (14.9%), cost (7.4%) and other miscellaneous factors (7.9%). The major reason for selecting a particular hospital is for treatment (86%). Only few choose preventive or health maintenance services. Demographic trends indicate that better educated and more affluent people are more likely to seek private hospital care, while those who are less educated and less affluent are more inclined to seek public hospital care. The average length of hospital stay, both for private and public hospitals, was 9.9 days. Longer hospital stays are positively associated with nonavailability of needed medicines, poor upkeep of facilities, need to provide "tips" for services, lack of prompt services, a suffocating environment, and unexplained hospital costs. Average satisfaction rate was 4.85, with private hospitals earning higher average ratings than public facilities. The highest income groups gave the highest quality ratings (5.26) compared to other income groups. Implications of findings for health policy are outlined.     

Affording what's free and paying for choice: comparing the cost of public and private hospitalizations in urban Kerala

OBJECTIVE: To assess the cost of public and private hospitalizations in urban Kerala and discuss policy implications of social disparities in the economic burden of hospital care. METHODS: The NSSO survey on health care (1995-1996) for urban Kerala was analysed with regards to expenditure incurred by hospital episodes. Multilevel linear models were built to assess factors associated with levels of health expenditure. FINDINGS: Hospital care involves paying admission fees in 68% of cases of hospitalizations (98% in private and 20% in public sector) in urban Kerala. Poor households and those headed by casual workers show significantly lower levels of health expenditure and a higher proportion of health-related loss of income than other social groups. Although there is significant expenditure in both sectors for these groups, hospitalization on free public wards is associated with lower expenditure than other options. Factors linked with higher expenditure are: duration of stay; hospitalizations on paying public wards and in the private sector; hospitalizations for above poverty line households and hospitalizations for chronic illnesses. Expenditure for services bought from outside the hospital is important in the public sector. CONCLUSION: Hospitalization incurs significant expenditure in urban Kerala. Greater availability of free medical services in the public sector and financial protection against the cost of hospitalization are warranted.     

Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries

Objective

To investigate potential differences in the availability of medicines for chronic and acute conditions in low- and middle-income countries.

Methods

Data on the availability of 30 commonly-surveyed medicines – 15 for acute and 15 for chronic conditions – were obtained from facility-based surveys conducted in 40 developing countries. Results were aggregated by World Bank country income group and World Health Organization region.

Findings

The availability of medicines for both acute and chronic conditions was suboptimal across countries, particularly in the public sector. Generic medicines for chronic conditions were significantly less available than generic medicines for acute conditions in both the public sector (36.0% availability versus 53.5%; P = 0.001) and the private sector (54.7% versus 66.2%; P = 0.007). Antiasthmatics, antiepileptics and antidepressants, followed by antihypertensives, were the drivers of the observed differences. An inverse association was found between country income level and the availability gap between groups of medicines, particularly in the public sector. In low- and lower-middle income countries, drugs for acute conditions were 33.9% and 12.9% more available, respectively, in the public sector than medicines for chronic conditions. Differences in availability were smaller in the private sector than in the public sector in all country income groups.

Conclusion

Current disease patterns do not explain the significant gaps observed in the availability of medicines for chronic and acute conditions. Measures are needed to better respond to the epidemiological transition towards chronic conditions in developing countries alongside current efforts to scale up treatment for communicable diseases.     

The Effect of Neighborhood Socioeconomic Status on Education and Health Outcomes for Children Living in Social Housing

Objectives. We explored differences in health and education outcomes between children living in social housing and not, and effects of social housing’s neighborhood socioeconomic status.Methods. In this cohort study, we used the population-based repository of administrative data at the Manitoba Centre for Health Policy. We included children aged 0 to 19 years in Winnipeg, Manitoba, in fiscal years 2006–2007 to 2008–2009 (n = 13 238 social housing; n = 174 017 others). We examined 5 outcomes: age-2 complete immunization, a school-readiness measure, adolescent pregnancy (ages 15–19 years), grade-9 completion, and high-school completion. Logistic regression and generalized estimating equation modeling generated rates. We derived neighborhood income quintiles (Q1 lowest, Q5 highest) from average household income census data.Results. Children in social housing fared worse than comparative children within each neighborhood income quintile. When we compared children in social housing by quintile, preschool indicators (immunization and school readiness) were similar, but adolescent outcomes (grade-9 and high-school completion, adolescent pregnancy) were better in Q3 to Q5.Conclusions. Children in social housing had poorer health and education outcomes than all others, but living in social housing in wealthier areas was associated with better adolescent outcomes.Adequate housing is a critical determinant of health. Social housing (also known as public housing) is an important aspect of public policy, the purpose being to provide quality housing at affordable rents to individuals and families who could not otherwise afford this.In the province of Manitoba, Canada, social housing residents pay approximately one quarter of their income for rent. In 2009, there were approximately 13 000 social housing units, accommodating 31 000 Manitobans, nearly 50% of whom were younger than 20 years.1 Because children constitute almost half the residents in social housing, it is important to investigate children’s health and education outcomes when one is exploring the impact of social housing. Is living in social housing associated with differential outcomes compared with not living in social housing? Does placement of the social housing unit itself, in wealthier or poorer neighborhoods, have an additional effect? A study of the provincial capital city, Winnipeg, is an ideal setting to answer these questions. Social housing units are distributed throughout Winnipeg’s neighborhoods ranging from low to high socioeconomic status (SES) based on average household income (Figure 1).Open in a separate windowFIGURE 1—Placement of social housing units in Winnipeg, by 72 Community Centre Areas and neighborhood income quintiles (2006 census data).Note. Neighborhood income quintile groupings of the Community Centre Areas are from lowest (Q1) to highest (Q5) income quintile.Many studies show associations between area-level SES and child health or education outcomes, such that the wealthier the area, the better the outcomes.2–6 Studies around the world have shown an independent effect of neighborhood SES on child and adolescent educational outcomes, even after they controlled for family, peer, and school effects.4,7–18However, some studies contradict this, finding nonsignificant or trivial effects of neighborhood.19–23 A review by Leventhal et al.8 reinforces the importance of neighborhood SES effect on adolescent development, with those living in higher socioeconomic areas showing more positive results in educational achievement and behavioral and emotional outcomes, and less risky sexual activity (including reductions in adolescent pregnancy). The authors describe conceptual models relating this advantage to institutional resources, norms, and collective efficacy of neighborhoods, and relationships. But they also identify a weakness in most studies to date—people have a choice where they live, so some low-SES families may choose to live in a higher-SES area because of motivation, which may also influence outcomes.The strength of our study is that we controlled for this effect by researching those living in social housing where choice is limited because of allocation methods and high occupancy rates; thus, although families are given choice as to neighborhood when filling out an application, Manitoba Housing may not be able to accommodate applicants with their first location of preference because of the size of the unit required. As well, population-based analyses possible by using administrative databases housed at the Manitoba Centre for Health Policy allow for analyses of all children, not just those agreeing to primary data collection.There are mixed results in the literature concerning social housing and health or educational outcomes. The Moving to Opportunity study found limited effects in reading and mathematics scores 4 to 7 years after families were given the opportunity to move from social housing to private dwellings in a higher-SES area.24 One limitation was that few families moved to a high-SES area; rather, most families moved to a “less poor” area where the school’s ranking was similar to the school in the families’ area of origin. As well, during the 4 to 7 years following, most families resided in a substantially less affluent neighborhood compared with their first move in the Moving to Opportunity study, whereas control families often moved to a more affluent area from their original neighborhood. Other evaluations of Moving to Opportunity found lower psychological distress for female youths and better adolescent male achievement scores among the intervention group.25,26The earlier Gautreaux Study in 1976 found that when families in Chicago, Illinois, received vouchers to move from low- to higher-SES neighborhoods, children were 4 times less likely to drop out of high school.27,28 A more recent Chicago study by Burdick-Will et al., involving randomized allocation of housing vouchers, found a significant increase in mathematics and verbal skills when families relocated to higher-SES areas.5 Jacob studied the effect of offering private housing vouchers for those involved in a social housing demolition in Chicago, compared with those in the same complex whose social housing was not being demolished.29 They found no effect on educational outcomes of children, and concluded that social housing did not bestow an independent effect above and beyond neighborhood SES. However, the social housing residents mostly moved to similar-SES neighborhoods. All of these studies revolve around individual families leaving social housing and going into private housing by using voucher programs. None of the literature examined the effect of social housing itself, and the effect of surrounding neighborhood SES on those living in social housing.We examined the effect of living in social housing on health and educational outcomes of children. We specifically addressed the following:

• 1. Are there differences in the health and education outcomes of children living in social housing versus those who do not?
• 2. Is there an effect of area-level SES on health and education outcomes of children, both in social housing and not?
• 3. After adjustment for family poverty and other confounders, is there a relationship between placement of social housing in wealthier or poorer neighborhoods and the health and education outcomes of children living in social housing?

     

The "unexpected" growth of the private health sector in Greece

The article analyses the situation which exists in the private health sector in Greece, it presents data on the growth of the private sector and discusses the reasons for this phenomenon in relation to privatisation trends in other European countries. The growth of private health care in Greece in the last 10 years is evident despite governmental attempts to minimise its role through the development of the National Health System in 1983 and the legislative restrictions on the private sector. Private health expenditure has increased, reaching 3.9% of the country's GNP (43% of the total expenditure in health) in 2000. The number of private hospitals and hospital beds has decreased (hospitals decreased from 468 in 1990 to 218 in 2000 and private beds decreased from 25,075 in 1980 to 15,806 in 2000) mainly because of the reduction in the number of small private hospitals. On the other hand, private doctors and private diagnostic centres have significantly increased. This situation is believed to be attributed mainly to the provision of inadequate and low quality public health services which have caused widespread dissatisfaction among the general public, and factors associated to improved standards of living, as well as the rapid growth of private insurance.     

A small-area index of socioeconomic deprivation to capture health inequalities in France

In the absence of individual data, ecological or contextual measures of socioeconomic level are frequently used to describe social inequalities in health. This work focuses on the methodological aspects of the development and validation of a French small-area index of socioeconomic deprivation and its application to the evaluation of the socioeconomic differentials in health outcomes. This index was derived from a principal component analysis of 1999 national census data from the Strasbourg metropolitan area in eastern France, at the census block level. Composed of 19 variables that reflect the multiple aspects of socioeconomic status (income, employment, housing, family and household, and educational level), it can discriminate disadvantaged urban centres from more privileged rural and suburban areas. Several statistical tests (Cronbach's alpha coefficient, convergent validity tests with other deprivation indices from the literature) provided internal and external validation. Its successful application to another French metropolitan area (Lille, in northern France) confirmed its transposability. Finally, its capacity to capture the social inequalities in health when applied to myocardial infarction data shows its potential value. This study thus provides a new tool in French public health research for characterising neighbourhood deprivation and detecting socioeconomic disparities in the distribution of health outcomes at the small-area level.     

Determinants of mortality following a diagnosis of prostate cancer in Veterans Affairs and private sector health care systems

OBJECTIVES: We compared patterns of mortality among men with prostate cancer at 2 Department of Veterans Affairs (VA) and 2 private-sector hospitals in the Chicago area. METHODS: Mortality rates for 864 cases diagnosed between 1986 and 1990 were estimated using Cox proportional hazards models that incorporated age; income; cancer stage, differentiation, and treatments; and baseline comorbidity. RESULTS: Race tended to associate with all-cause mortality irrespective of health care setting (Blacks vs Whites: hazard rate ratio [HRR] = 1.68 [95% confidence interval (CI) = 1.06, 2.67]; P <.001 in the private sector; HRR = 1.50 [95% CI = 0.94, 2.38]; P =.088 in the VA). However, comorbidity determined risk in the VA, whereas age and income predicted risk in the private sector. CONCLUSIONS: Determinants of all-cause mortality in men with prostate cancer vary according to health care setting.     

Factors related to length of hospitalization of elderly patients during short stay

Length of stay of elderly patients in hospitals can be subdivised into a medical stay followed by a social stay. The average length of stay of 2134 patients aged 75 and over, admitted to 23 medical or geriatric acute wards in Aquitaine, was 13.6 days; 18% of the patients experienced a social stay of at least one day. The mean social stay was almost null (1 day) when the patient returned home, but could reach 5 days when he was discharged to a long term care facility. The kind of hospital, domicile in a rural area, the social network, and the grounds for hospitalization were significantly related to the total length of stay, but explained only 5% of variance if diagnosis was not taken into account. This percentage rose to 29% in the group with "bronchitis" as a main diagnosis. The length of social stay was related to the grounds for hospitalization, but also to recent family modifications; it did not depend on the kind of hospital. These results suggest a lack of accessibility to nursing-homes, following acute hospitalization.     

A small-area index of socioeconomic deprivation to capture health inequalities in France

In the absence of individual data, ecological or contextual measures of socioeconomic level are frequently used to describe social inequalities in health. This work focuses on the methodological aspects of the development and validation of a French small-area index of socioeconomic deprivation and its application to the evaluation of the socioeconomic differentials in health outcomes. This index was derived from a principal component analysis of 1999 national census data from the Strasbourg metropolitan area in eastern France, at the census block level. Composed of 19 variables that reflect the multiple aspects of socioeconomic status (income, employment, housing, family and household, and educational level), it can discriminate disadvantaged urban centres from more privileged rural and suburban areas. Several statistical tests (Cronbach's alpha coefficient, convergent validity tests with other deprivation indices from the literature) provided internal and external validation. Its successful application to another French metropolitan area (Lille, in northern France) confirmed its transposability. Finally, its capacity to capture the social inequalities in health when applied to myocardial infarction data shows its potential value.This study thus provides a new tool in French public health research for characterising neighbourhood deprivation and detecting socioeconomic disparities in the distribution of health outcomes at the small-area level.     

Nationwide survey of hospital antibiotic stewardship programs in France

ObjectiveWe aimed to evaluate the current state of antibiotic stewardship (ABS) in French public and private acute care hospitals.MethodsWe conducted a cross-sectional online questionnaire survey. The selection of participating hospitals was performed through a stratified random sampling procedure among all French public and private hospitals with acute care beds.Results97/215 (45%) hospitals participated. A formal ABS program was implemented in 84% (80/95) of hospitals. A person officially in charge of this program (i.e., ABS program leader) was present in almost all participating hospitals (99%, 95/96) and s/he coordinated a multidisciplinary ABS team in 42% (40/96) of cases. The median time spent on ABS activities was 1.7, 1.6, and 0.8 hours/week/100 acute care beds for infectious disease (ID) specialists, pharmacists, and microbiologists respectively; 27% (7/26) of ID specialists/other clinicians, 58% (15/26) of pharmacists, and 80% (16/20) of microbiologists received no salary support for the stewardship activities conducted as part of the team. Local guidelines (94%, 88/94), electronic medical records (85%, 80/94), and an antibiotic restriction policy (92%, 82/89) were implemented in almost all hospitals. Reports on antibiotic consumption and local resistance rates were available in 100% (91/91) and 84% (76/91) of hospitals, respectively.ConclusionDespite the existence of national requirements, hospital ABS programs are not fully implemented in France, mainly because of inadequate institutional support and funding.     

Innovative health service delivery models in low and middle income countries - what can we learn from the private sector?

Background  

The poor in low and middle income countries have limited access to health services due to limited purchasing power, residence in underserved areas, and inadequate health literacy. This produces significant gaps in health care delivery among a population that has a disproportionately large burden of disease. They frequently use the private health sector, due to perceived or actual gaps in public services. A subset of private health organizations, some called social enterprises, have developed novel approaches to increase the availability, affordability and quality of health care services to the poor through innovative health service delivery models. This study aims to characterize these models and identify areas of innovation that have led to effective provision of care for the poor.     

积极主动为贫困人口服务--上海市北站医院平价病房的案例调查

目的:对上海市一所国有民营医院的平价病房进行案例调查,了解运行状况、经验及存在问题。方法:相关人员访谈和现场观察。结果:该院设立了14张床位的平价病房,收治对象是低保户、特困户及经济困难的外来务工人员。对医保病人和自费病人设定不同的减免优惠方案,包括减免50.0%的床位费和10.0%的护理、检查、治疗及手术等劳务费用(药费除外)。以收治急性病为主,住院时间原则上不超过2周。出院病人总费用的实际减免率约为6.0%￣10.0%。结论:创办平价病房的方向应予肯定。是民营机构委托管理医院的一种公益性(非营利性)的表现,对其他公立医疗机构具有促进作用。