Characteristics of private medical practice in India: a provider perspective.

Supply factors, depicted by input market conditions and government regulations, and demand factors, depicted by financing mechanisms and utilization patterns, are likely to determine the shape and character of private medical practice. The interaction of this complex set of factors will have considerable implications for the cost access and quality of services offered by this sector. Understanding these characteristics from a provider perspective is imperative to influence the behaviour of providers in this sector. This paper describes some of the important characteristics of private medical practice using a case study of an urban district in India, Ahmedabad, and analyzes their implications. Using survey data of 130 private doctors in the allopathic system, the paper describes broad characteristics of private medical practice using parameters such as growth of private practice, patient load and referrals within the sector, payment methods and determinants, patient concerns, and risks associated with private practice. The paper presents views on the prevalence of various undesirable practices in the private medical sector. It also discusses the awareness of providers about selected important regulations. The findings suggest that growing capital intensity due to cost of location, medical equipment and technology, and financial sources of capital investments are some unfavourable environmental factors experienced by private providers. The findings also indicate a high prevalence of various undesirable practices and low awareness of the objectives of important legislation among practicing doctors. Lack of awareness of important and relevant legislation raises serious questions about the implementation of these laws. The paper identifies the strong need for instituting and implementing an effective continuing medical education programme for practicing doctors, and linking it with their registration and continuation of their license to practice. The paper also suggests that cost of health care, access and quality problems will worsen with the growth of the private sector. The public policy response to check some of the undesirable consequences of this growth is critical and should focus on strengthening the existing institutional mechanisms to protect patients, developing and implementing an appropriate regulatory framework and strengthening the public health care delivery system. The study also discusses various other policy implications arising.     

The nature and content of physician telephone calls in a private practice

Telephone encounters received by two physicians in a private rural family practice setting were examined over a 61-day sampling period. A total of 1,264 calls were received during the study period, with 905 (71.6 percent) being received in the office setting. An average of 10.4 calls per physician were received each day, and a mean of 16.2 minutes per physician was spent each day with telephone encounters. Each call was brief, lasting 1.6 minutes (standard deviation 1.5 minutes); administrative and personal calls each lasted significantly longer than other call categories (F = 20.8, P = .0001). More chronic disease diagnoses tended to be handled during office when compared with nonoffice telephone encounters. The majority of calls (932, or 83.1 percent) did not require a face-to-face visit as judged by the physician. Of the office calls, 58.2 percent were handled by the physicians through a message system rather than a direct physician telephone call. It is estimated that uncharged care over the telephone saved patients in this practice up to $150,000 per year.     

Characteristics of individuals who identify a regular source of medical care.

Having a source where medical services are regularly received is an antecedent to securing high quality medical care; it facilitates access and indicates that the individual is not alienated from the health care delivery system. In this paper we develop models to characterize individuals, both children and adults, who claim a regular source of care. The models are estimated using a logit analysis (since the dependent variable is 0-1) applied to survey data on residents of East Palo Alto, California. These data indicate that in this low-income, predominately black population the most important factor influencing whether a child will have a regular source of medical care is whether the parents have a regular source. For adults, the anticipated need for care (as measured by health status), time in community, and sex were all found to be important. The type of individual least likely to have a regular source of care is a low-income, unmarried male who is in good health and is a recent arrival to the community. The individuals most likely to need easy access to medical care and continuity of care are most likely to have a regular source of care, and vice versa.     

Legal requirement of private practice medical records

The hospital medical record is a critical communication vehicle for the numerous health professionals who provide care to each patient. It is also an essential evidentiary tool in malpractice suits. Even though the medical record is not the sole information upon which the courts will rely in determining negligence liability, it can serve as an important chronology of care. Dietitians entering private practice, whether with a physician or not, should establish a system of record keeping. Although specific standards have not been set for private patient records, it is argued that records kept must meet many of the requisite guidelines for medical records in institutional settings. Additionally, the records must provide documentation that may be absent and difficult to obtain in the private setting. Discussed are legal issues surrounding patient records of the dietitian in private practice.     

Characteristics of patients who do not use primary care services

OBJECTIVE: To determine the proportion of patients who do not consult their doctor for one year time and to investigate their characteristics, to determine of they are different from patients that do consult. METHODS: This is a prospective study, with a follow-up of one year in the city of Valencia, Spain. The patients included were all registered in a general practitioner's list, 1473 subjects. We took every day all the patients that consulted: home visits were excluded, and so were visits from patients that did not belong to our territory, patients of another general practitioner's list and all patients under 14 years. We included patients attended without citation. We counted the number of visits for each subject, and their age and gender, presence of hypertension, diabetes, hyperlipidemia, chronic respiratory disease, HIV/Aids and health problems that limit their autonomy. RESULTS: 46.3% of patients did not consult, 48.7% made between 1 and 14 visits, and 4.9% 15 visits or more (high utilization is defined as the average plus 2 standard deviations). Among the subjects that did not consult, there were significantly less women, they were younger and had less chronic problems than the patients that consulted and these ones less than high users. CONCLUSIONS: The percent of subjects that did not use primary care medical consultations is 46.3% in one year; they were more frequently men, young people and persons without chronic health problems.     

重庆市个体诊所非法行医情况分析

目的了解重庆市个体诊所执业现状,切实加强诊所管理,确保医疗安全。方法收集整理重庆市2011年主城9区个体诊所的机构执业情况、执业分类情况和违法情况,根据经济情况不同分为好、中、差三类,通过描述性统计方法和x^2检验进行统计分析。结果经济水平不同的地区执业情况存在差别,无证诊所中口腔和其他类专科诊所比例相对增加,违法行为中以聘用非卫生技术人员的情况居多。结论通过政府、社会各界及诊所自身共同力量使得个体诊所健康发展。为群众提供安全有效的卫生服务。     

On a policy of transferring public patients to private practice

We consider an economy where public hospitals are capacity-constrained, and we analyse the willingness of health authorities to reach agreements with private hospitals to have some of their patients treated there. When physicians are dual suppliers, we show that a problem of cream-skimming arises and reduces the incentives of the health authority to undertake such a policy. We argue that the more dispersed are the severities of the patients, the greater the reduction in the incentives will be. We also show that, despite the patient selection problem, when the policy is implemented it is often the case that health authorities decide a more intensive transfer of patients to private practice.     

Barriers in the care of patients who have experienced a traumatic event: the perspective of general practice

BACKGROUND: Previous research has indicated that GPs encounter barriers in the care of patients who have experienced a traumatic event. OBJECTIVES: The aims of the present study were to map barriers GPs encounter in the care of patients who experience a traumatic event and solutions for these barriers, and to estimate the influence of GP characteristics on the number of barriers experienced. METHODS: Telephone interviews were conducted among a sample of 500 Dutch GPs stratified by sex. Topics covered barriers in the care of victims of: accidents, incest in the past, ongoing physical or sexual abuse of adults, and ongoing physical or sexual abuse of children. RESULTS: The response rate was 44%. GPs are regularly confronted with patients who have experienced a traumatic event. GPs experience 10% barriers in care of patients who have difficulties getting over an accident, 13% in the care of incest victims, 16% in the care of adults who are physically or sexually abused, and 20% in the care of physically or sexually abused children. Most of the GPs recently updated their knowledge of care of victims of traumatic events, but still the majority feel in need of additional expert training. CONCLUSION: GPs experience the greatest number of barriers in the care of children who are abused. GP characteristics were not related to the number of barriers. However, seeing more victims was related to fewer barriers. To facilitate GP care of victims of traumatic events, GP training and continuing medical education should focus especially on skills education regarding the detection and initial treatment of traumatic events of ongoing physical or sexual abuse.     

Uncompensated care provided by private practice physicians in Florida.

While a great deal of attention has been paid in recent years to establishing the magnitude and characteristics of uncompensated care in hospitals, comparatively little research has been undertaken to study physician uncompensated care. This article reports the results of a prospective patient-specific study of uncompensated care in Florida. Of 4,042 cases examined, 26.2 percent had charges voluntarily reduced below the usual and customary charge at the time of service. However, only 13.5 percent of those reductions were attributed to charity. Overall, 10.4 percent of the total billed amount was left unresolved. When payment source was considered, it was found that self-pay patients accounted for 30.6 percent of the cases but accounted for 52.0 percent of the unresolved amounts. Further analysis indicated that the self-pay patients were 35.5 times more likely to leave an outstanding balance than individuals with some type of insurance coverage. Odds of unresolved balances were also calculated as a function of income, specialty type, practice size, and type of visit.     

Current trends in the practice of home health care of occupational therapists treating patients who have had a stroke

The present study was designed to examine current practices in home health care among occupational therapists in the United States of America treating patients who have had a stroke. On any given day an estimated 1 237 100 patients receive home health care in the USA. This makes home health care a rapidly expanding industry of the 1990s. One of the most significant populations with whom occupational therapists work are patients who have had a stroke. General guidelines for occupational therapists working in home health care include: environmental safety, motor coordination, sensory deficits, perception, cognition, ADL/IADL, and leisure activities. Two hundred surveys were sent to registered occupational therapists working in home health care in the Midwestern region of the USA. Forty-three of the returned surveys were used in the data analysis. The results indicated that therapists are utilising an adaptive approach to treatment techniques within an eclectic frame of reference. Remedial techniques, such as Neurodevelopmental Therapy (NDT), were used often by therapists. The results also indicated that the most frequently used evaluations were standardised tests. Non-reimbursement of services was found to be a result of the patients' insurance not covering occupational therapy services. Further research regarding psychosocial issues with this population in home health care was indicated. Copyright © 1997 Whurr Publishers Ltd.