The private management of public hospitals.

Since the public sector traditionally has provided the public goods viewed as unprofitable by the private sector, the growing trend to manage public hospitals under outside private contract raises some fundamental issues of concern. It is hypothesized here that the system maintenance and output goals of privately managed public hospitals become increasingly similar to those of investor-owned hospitals. The thesis is empirically tested using documented effects of private contract management on the operative goals of short-term, general hospitals owned by local governmental bodies. Traditionally managed public hospitals matched with the study hospitals on important characteristics serve as the control group. Costs do appear to be reduced under private contract management, but the service structure becomes somewhat altered. It is the task of public health policymakers to reconcile the cost-control and efficiency mechanisms brought about by private management with the community's right of access to comprehensive medical care. Carefully structured regionalization plans--a possible means of providing both--will require the stimulation of more government involvement during an era of cutbacks.     

Low HIV testing rates among tuberculosis patients in Kampala,Uganda

Background  

HIV testing among tuberculosis patients is critical in improving morbidity and mortality as those found to be HIV positive will be offered a continuum of care including ART if indicated. We conducted a cross-sectional study in three Kampala City primary care clinics: to assess the level of HIV test uptake among newly diagnosed pulmonary tuberculosis (PTB) patients; to assess patient and health worker factors associated with HIV test uptake; and to determine factors associated with HIV test uptake at the primary care clinics     

Comparing public and private hospitals in China: Evidence from Guangdong

Background  

The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care.     

公立医院与民营医院适用的税收政策比较

目的:揭示公立医院和民营医院适用税收政策面临的问题,为引导公立医院和民营医院健康发展提供政策支持。方法:采用对比分析和描述分析方法,对公立医院和民营医院应税收入与适用的税收政策进行比较。结果:公立医院与民营医院税收政策面临企业所得税和营改增试点衔接制度不完备的问题,难以指导实务;以医院性质作为纳税或免税认定条件违背税收公平原则;过高税负影响民营医院竞争力和发展后劲;医院财务不透明,监管缺位,税收优惠政策难以落实。结论:明确医院增值税应税项目及其会计核算体系;按医院医疗服务项目性质,确定是否缴纳增值税和企业所得税;建立医院财务信息公开制度,增强收支和税费透明度。     

User fees in private non-for-profit hospitals in Uganda: a survey and intervention for equity

Background  

In developing countries, user fees may represent an important source of revenues for private-non-for-profit hospitals, but they may also affect access, use and equity.     

Burden of tuberculosis in Kampala, Uganda

OBJECTIVE: To determine the prevalence and incidence of tuberculosis in one of Uganda's poor peri-urban areas. METHODS: Multi-stage sampling was used to select a sample of households whose members were evaluated for presence of signs and/or symptoms of active tuberculosis; history of tuberculosis treatment; and relevant demographic, socioeconomic, and household environment characteristics. Patients with suspected tuberculosis underwent standardized evaluation for active disease. FINDINGS: A sample of 263 households with 1142 individuals was evaluated. Nineteen people were classified as having had tuberculosis during the one-year reference period (May 2001-April 2002): nine (47%) cases already had been diagnosed through the health care system, while 10 cases (53%) were diagnosed through the survey. The prevalences for all forms of tuberculosis and for sputum smear-positive tuberculosis were 14.0 (95% confidence interval (CI) 7.8-20.3) and 4.4 (CI = 0.83-7.89) per thousand, respectively. The incidences for all forms of tuberculosis and for sputum smear-positive tuberculosis were 9.2 (CI = 3.97-14.4) and 3.7 (CI = 0.39-6.95) per thousand per year, respectively. CONCLUSION: The rate of tuberculosis in this peri-urban community was exceptionally high and may be underestimated by current surveillance systems. The need for interventions aimed at reducing tuberculosis transmission in this, and other similar communities with high case rates, is urgent.     

Survey of chemotherapy practice in public and private hospitals in Brittany

With the objective of planning for cancer research, an assessment of chemotherapy practices in public and private establishments was carried out in 1997 by the Regional Direction of Health and Social Affairs of Brittany. This retrospective survey was carried out during the first trimester of 1997. A questionnaire collected quantitative and qualitative data: skills of mobilised personnel, modes of preparation and dispensation of cytostatic drugs and partner relations. In the 38 establishments reporting that they provide chemotherapy, the data showed varied practices for: the number of patients treated (0 to 579), number of visits per patient (2.07 to 9.4), and skills of the practitioner. The indicators used in this study, with the objective of analysis and aid in planning, will serve in the evaluation phase of the implementation of the regional health programme in cancer research.     

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.     

Service quality in public and private hospitals in urban Bangladesh: a comparative study

This study compared the quality of services provided by private and public hospitals in urban Bangladesh. Using twenty-four scale items, patient perceptions were sought on five aspects of service quality including responsiveness, assurance, communication, discipline and baksheesh. Because private hospitals are not subsidized, it was felt that the incentive structure would induce them to provide better services than public hospitals on the measures of service quality. This contention was largely supported. The results also indicated that both groups have room for improvement.     

公立医院预算管理问题研究

通过对全面预算管理的研究,指出医院实施全面预算管理对提高医院管理能力、降低运营成本、提升财务能力的重要性和作用。针对目前医院预算管理普遍存在的预算管理流于形式、体制不健全、预算制定方法单一、缺乏权威性等问题,提出了医院预算管理的对策和解决方案。     

Doctors' service orientation in public, private, and foreign hospitals

PURPOSE: The purpose of this study is to propose a doctors' service orientation (DSO) scale and uses it to compare the services received in public, private and foreign hospitals in a developing country from the patient's perspective. DESIGN/METHODOLOGY/APPROACH: The scale was derived from the service quality literature and qualitative research. A questionnaire was designed next. Data were collected from patients who had used the services of doctors in a hospital. FINDINGS: The scale demonstrated appropriate psychometric properties. Two clear patterns emerge from the study results: on 10 out of 12 measures of doctors' service orientation, there was no significant difference in their perceived behaviors between public and private hospitals and foreign doctors were "always" rated significantly higher. RESEARCH LIMITATIONS/IMPLICATIONS: This study focused on one major city because of time and resource constraints. The findings are thus not generalizable to hospitals across the country. Also, because of translation and retranslation issues, the scale ought to be further tested for wider use. ORIGINALITY/VALUE: The scale may be used periodically in a comprehensive quality assurance program to exhort doctors to become more service oriented and to improve their performance over time.     

福州市2004-2009年公立与民营医院消毒管理情况的比较分析

目的 开展医院消毒管理和消毒质量调查,为今后加强医院消毒管理提供科学依据.方法 按<医院消毒卫生标准>监测消毒质量,用自行设计的<医院消毒管理现状调查表>开展现场调查.结果 2004-2009年14家市属医院和15家民营医院消毒质量监测平均合格率为93.3%.公立医院消毒合格率(94.1%)高于民营医院(92.1%)...     

基于DEA-Malmquist指数的广东省公立医院和民营医院运营效率研究

目的 测算和比较广东省公立医院和民营医院的运营效率,为广东省公立医院和民营医院的总体规划和绩效提升提供政策参考。方法〓运用数据包络分析的Malmquist指数对2013-2017年广东省2种性质、4种类型医院的运营效率进行分析。结果〓从2013到2017年,广东省民营医院数量增长56.9%;广东省公立医院和民营医院技术进步指标波动幅度较大;民营医院全要素生产率波动幅度较大且平均规模效率为0.996;公立专科和民营专科平均全要素生产率分别为0.993和0.962。结论〓广东省民营医院发展迅速;技术进步是影响广东省公立医院和民营医院运营效率的主要因素;民营医院运营效率不稳定且不存在规模经济;专科医院运营效率较低。     

Reserve capacity of public and private hospitals in response to demand uncertainty

A feature of hospitals is that they face uncertain demand for the services they offer. To cover fluctuations in demand, they need to maintain reserve service capacity in the form of beds, equipment, personnel, etc. to minimize the probability of excess queuing or turning away patients, creating a trade-off between reserve service capacity and economic costs. Using a simple theoretical framework, we show how the reserve capacity established depends on institutional characteristics that can affect the objective of the hospital. In particular, we show that private and public hospitals may provide different levels of reserve capacity. In an empirical application using a panel data set of Spanish hospitals over the period 1996-2006, we model reserve service capacity using a distance frontier approach. Our results show that private hospitals generally react to a lesser extent to demand uncertainty than public hospitals.     

大型公立医院应对新型冠状病毒肺炎的管理举措探讨

新型冠状病毒肺炎(COVID-19)是由严重急性呼吸道综合征冠状病毒2(severe respiratory syndrome coronavirus 2, SARS-CoV-2)感染引起的肺炎。我国现已将新型冠状病毒肺炎纳入国家"乙类"传染病,采取"甲类"传染病防控措施。四川大学华西医院是国家级疑难重症诊疗中心,自四川省启动重大突发公共卫生事件一级应急响应并迅速进入作战状态以来,我院按照国家及地方的统一部署,有序做好院内疫情的防控及诊疗工作。     

Financing and planning of public and private not-for-profit hospitals in the European Union

While much has been written about health care financing in Europe in recent years, discussion has almost entirely focused on revenue. In contrast, there has been remarkably little written on financing of capital investment in European health care systems. Yet major changes are underway in several countries, in particular involving new forms of public-private partnerships (PPP). At the same time, there is growing recognition of the way in which the inherited structure of the health care delivery system constrains the system's ability to adapt to changing circumstances. This paper reports the results of a survey undertaken among key informants in the member states of the European Union to begin to ascertain existing practices and future plans in relation to hospital planning and financing amongst public and private not-for-profit hospitals. The locus of hospital planning decisions reflect the constitutional framework of the country involved, and thus the emphasis on national or local plans. There has been an expansion of private sector involvement, with four basic models identified: private loans direct to the hospital; private loans to a regional health body; a PPP where the private sector's role is to build, design and operate the non-clinical functions of the hospital; and, finally, a PPP, where the private sector's involvement also includes management of the clinical functions of the hospital. It is too early to say whether these approaches will be more successful than the models they are replacing.