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1.
J Am Soc Nephrol ; 31(2): 424-433, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31857351

RESUMO

BACKGROUND: Although most American patients with ESKD become eligible for Medicare by their fourth month of dialysis, some never do. Information about where patients with limited health insurance receive maintenance dialysis has been lacking. METHODS: We identified patients initiating maintenance dialysis (2008-2015) from the US Renal Data System, defining patients as "safety-net reliant" if they were uninsured or had only Medicaid coverage at dialysis onset and had not qualified for Medicare by the fourth dialysis month. We examined four dialysis facility ownership categories according to for-profit/nonprofit status and ownership (chain versus independent). We assessed whether patients who were safety-net reliant were more likely to initiate dialysis at certain facility types. We also examined hospital-based affiliation. RESULTS: The proportion of patients <65 years initiating dialysis who were safety-net reliant increased significantly over time, from 11% to 14%; 73% of such patients started dialysis at for-profit/chain-owned facilities compared to 76% of all patients starting dialysis. Patients who were safety-net reliant had a 30% higher relative risk of initiating dialysis at nonprofit/independently owned versus for-profit/independently owned facilities (odds ratio, 1.30; 95% CI, 1.24 to 1.36); they had slightly lower relative risks of initiating dialysis at for-profit and non-profit chain-owned facilities, and were more likely to receive dialysis at hospital-based facilities. These findings primarily reflect increased likelihood of dialysis among patients without insurance at certain facility types. CONCLUSIONS: Although most patients who were safety-net reliant received care at for-profit/chain-owned facilities, they were disproportionately cared for at nonprofit/independently owned and hospital-based facilities. Ongoing loss of market share of nonprofit/independently owned outpatient dialysis facilities may affect safety net-reliant populations.


Assuntos
Diálise Renal/economia , Provedores de Redes de Segurança , Adulto , Idoso , Feminino , Instituições Privadas de Saúde , Hospitais , Humanos , Masculino , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Medicare , Pessoa de Meia-Idade , Estados Unidos
2.
Rev Chilena Infectol ; 36(3): 283-291, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859746

RESUMO

INTRODUCTION: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. OBJECTIVES: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. METHODS: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. RESULTS: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. CONCLUSIONS: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.


Assuntos
Condiloma Acuminado/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Antineoplásicos/uso terapêutico , Chile/epidemiologia , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/tratamento farmacológico , Demografia/estatística & dados numéricos , Dermatologistas/estatística & dados numéricos , Feminino , Ginecologia/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Imiquimode/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Adulto Jovem
3.
JAMA ; 322(10): 957-973, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31503308

RESUMO

Importance: For-profit (vs nonprofit) dialysis facilities have historically had lower kidney transplantation rates, but it is unknown if the pattern holds for living donor and deceased donor kidney transplantation, varies by facility ownership, or has persisted over time in a nationally representative population. Objective: To determine the association between dialysis facility ownership and placement on the deceased donor kidney transplantation waiting list, receipt of a living donor kidney transplant, or receipt of a deceased donor kidney transplant. Design, Setting, and Participants: Retrospective cohort study that included 1 478 564 patients treated at 6511 US dialysis facilities. Adult patients with incident end-stage kidney disease from the US Renal Data System (2000-2016) were linked with facility ownership (Dialysis Facility Compare) and characteristics (Dialysis Facility Report). Exposures: The primary exposure was dialysis facility ownership, which was categorized as nonprofit small chains, nonprofit independent facilities, for-profit large chains (>1000 facilities), for-profit small chains (<1000 facilities), and for-profit independent facilities. Main Outcomes and Measures: Access to kidney transplantation was defined as time from initiation of dialysis to placement on the deceased donor kidney transplantation waiting list, receipt of a living donor kidney transplant, or receipt of a deceased donor kidney transplant. Cumulative incidence differences and multivariable Cox models assessed the association between dialysis facility ownership and each outcome. Results: Among 1 478 564 patients, the median age was 66 years (interquartile range, 55-76 years), with 55.3% male, and 28.1% non-Hispanic black patients. Eighty-seven percent of patients received care at a for-profit dialysis facility. A total of 109 030 patients (7.4%) received care at 435 nonprofit small chain facilities; 78 287 (5.3%) at 324 nonprofit independent facilities; 483 988 (32.7%) at 2239 facilities of large for-profit chain 1; 482 689 (32.6%) at 2082 facilities of large for-profit chain 2; 225 890 (15.3%) at 997 for-profit small chain facilities; and 98 680 (6.7%) at 434 for-profit independent facilities. During the study period, 121 680 patients (8.2%) were placed on the deceased donor waiting list, 23 762 (1.6%) received a living donor kidney transplant, and 49 290 (3.3%) received a deceased donor kidney transplant. For-profit facilities had lower 5-year cumulative incidence differences for each outcome vs nonprofit facilities (deceased donor waiting list: -13.2% [95% CI, -13.4% to -13.0%]; receipt of a living donor kidney transplant: -2.3% [95% CI, -2.4% to -2.3%]; and receipt of a deceased donor kidney transplant: -4.3% [95% CI, -4.4% to -4.2%]). Adjusted Cox analyses showed lower relative rates for each outcome among patients treated at all for-profit vs all nonprofit dialysis facilities: deceased donor waiting list (hazard ratio [HR], 0.36 [95% CI, 0.35 to 0.36]); receipt of a living donor kidney transplant (HR, 0.52 [95% CI, 0.51 to 0.54]); and receipt of a deceased donor kidney transplant (HR, 0.44 [95% CI, 0.44 to 0.45]). Conclusions and Relevance: Among US patients with end-stage kidney disease, receiving dialysis at for-profit facilities compared with nonprofit facilities was associated with a lower likelihood of accessing kidney transplantation. Further research is needed to understand the mechanisms behind this association.


Assuntos
Instituições Privadas de Saúde , Acesso aos Serviços de Saúde , Falência Renal Crônica/terapia , Transplante de Rim , Propriedade , Diálise Renal , Humanos , Doadores Vivos , Diálise Renal/economia , Estudos Retrospectivos , Estados Unidos , Listas de Espera
4.
Health Serv Res ; 54(6): 1357-1365, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31429482

RESUMO

OBJECTIVE: To identify differences between independent treatment centers (ITCs) and general hospitals (GHs) regarding costs, quality of care, and efficiency. DATA SOURCES: Anonymous claims data (2013-2015) were used. We also obtained quality indicators from a semipublic platform. STUDY DESIGN: This study uses a comparative multilevel analysis, controlling for case mix, to evaluate the performance of ITCs and GHs for patients diagnosed with cataract. DATA COLLECTION: Reimbursement claims were extracted from existing claims databases of the largest Dutch health insurer. Quality indicators were obtained by external agencies through a mixed-mode survey. PRINCIPAL FINDINGS: There are no stark differences in complexity of cases for cataract care. ITCs seem to perform surgeries more frequently per care pathway, but conduct a lower number of health care activities per surgical claim. Total average costs are lower in ITCs compared with GHs, but when adjusted for case mix, the differences in costs are lower. The findings with the adjusted quality differences suggest that ITCs outperform GHs on patient satisfaction, but patients' outcomes are similar. CONCLUSION: This finding supports the postulation-based on the focus factory theory-that ITCs can provide more value for cataract care than GHs.


Assuntos
Catarata/economia , Catarata/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Instituições Privadas de Saúde/economia , Instituições Privadas de Saúde/estatística & dados numéricos , Hospitais Gerais/economia , Hospitais Gerais/estatística & dados numéricos , Feminino , Humanos , Masculino , Estados Unidos
5.
PLoS One ; 14(3): e0197789, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30822307

RESUMO

BACKGROUND AND OBJECTIVES: Nursing or care home characteristics may have a long-term impact on the residents' mortality risks that has not been studied previously. The study's main objective was to assess the association between facility ownership and long-term, all-cause mortality. RESEARCH DESIGN AND METHODS: We conducted a mortality follow-up study on a cohort of 611 nursing-home residents in the city Madrid, Spain, from their 1998-1999 baseline interviews up to September 2013. Residents lived in three types of facilities: public, subsidized and private, which were also sub-classified according to size (number of beds). Residents' information was collected by interviewing the residents themselves, their caregivers and facility physicians. We used time-to-event multivariable models and inverse probability weighting to estimate standardized mortality risk differences. RESULTS: After a 3728 person-year follow-up (median/maximum of 4.8/15.2 years), 519 participants had died. In fully-adjusted models, the standardized mortality risk difference at 5 years of follow-up between medium-sized private facilities and large-sized public facilities was -18.9% (95% confidence interval [CI]: -33.4 to -4.5%), with a median survival (95% CI) of 3.6 (0.5 to 6.8) additional years. The fully-standardized 5-year mortality difference (95% CIs) between for-profit private facilities and not-for-profit public institutions was -15.1% (-31.1% to 0.9%), and the fully-standardized median survival difference (95% CIs) was 3.0 (-1.7 to 7.7) years. DISCUSSION AND IMPLICATIONS: These results are compatible with an association between factors related with the ownership of facilities and the long-term mortality risk of their residents. One of these factors, the facility size, could partly explain this association.


Assuntos
Instituições Privadas de Saúde/organização & administração , Instituição de Longa Permanência para Idosos/organização & administração , Mortalidade , Casas de Saúde/organização & administração , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Instituições Privadas de Saúde/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Assistência de Longa Duração/organização & administração , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Casas de Saúde/estatística & dados numéricos , Propriedade , Espanha/epidemiologia
6.
Mol Genet Genomic Med ; 7(4): e00572, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30712332

RESUMO

BACKGROUND: Just as there is inconsistency with respect to coverage of genomic testing with insurance carriers, there is interprovincial discrepancy in Canada. Consequently, the option of private pay (e.g., self pay) arises, which can lead to inequities in access, particularly when patients may not be aware of this option. There are currently no published data regarding how the Canadian genetics community handles discussions of private pay options with patients. The purpose of this study was to assess the attitudes of genetic healthcare professionals (GHPs: medical geneticists, genetic counselors, and genetic nurses) practicing in Canada toward these discussions. METHODS: An online survey was distributed to members of the Canadian College of Medical Geneticists and the Canadian Association of Genetic Counsellors to assess frequencies, rationale, and ethical considerations regarding these conversations. Quantitative data were analyzed using descriptive statistics. RESULTS: Of 144 respondents, 95% reported discussing private pay and 65% reported working in a clinic without a policy on this issue. There were geographic and practice-specific differences. The most common circumstance for these discussions was when a test was clinically indicated (e.g., but funding was denied) followed by when the patient initiated the conversation. The most frequently discussed tests included: multi-gene panels (73% of respondents), noninvasive prenatal testing (62%), and pre-implantation genetic diagnosis (58%). Although 65% felt it was ethical to discuss private pay, 35% indicated it was "sometimes" ethical. CONCLUSION: With the increasing availability of genomic technologies, these findings inform how we practice and demonstrate the need for policy in this area.


Assuntos
Atitude , Testes Genéticos/economia , Gastos em Saúde , Pessoal de Saúde/psicologia , Canadá , Feminino , Instituições Privadas de Saúde/economia , Humanos , Masculino , Inquéritos e Questionários
7.
Emerg Med Australas ; 31(2): 262-265, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30033561

RESUMO

OBJECTIVE: While prior experience, favourable location and anticipation of high quality care are known to influence patient choice to attend a private ED, it is likely that decision-making is also influenced by other persons. In particular, patients arriving by ambulance are under the care of paramedics, whose values towards healthcare and rationale for choosing one ED over another have not been studied. This study aimed to describe reasons why paramedics choose to bring patients to a private ED. METHODS: Exploratory, qualitative study using semi-structured, face-to-face interviews with paramedics bringing patients to a private ED from the community. Two primary questions reinforced by structured prompts were asked: 'Why did you choose to come to this emergency department?' and 'What are your general expectations of this emergency department visit?' Interviews were audio recorded, transcribed verbatim and analysed thematically. RESULTS: Fifty paramedics were interviewed with 48 interviews able to be transcribed and used in analysis. Four factors were identified to increase the likelihood of a private ED destination: specific direction, institutional allegiance, hospital logistics and systems and receiving hospital service ethos. CONCLUSIONS: Paramedics take into consideration when possible patient's wishes and are more likely to bring a patient to a private ED if they have specific direction from the patient or the patient's family or GP. The likelihood of presenting to a private ED is increased if the patient has an allegiance with the facility and the paramedics perceive favourably the hospital logistics and systems as well as service ethos.


Assuntos
Pessoal Técnico de Saúde/psicologia , Ambulâncias , Comportamento de Escolha , Serviço Hospitalar de Emergência/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa
8.
J Health Econ ; 63: 1-18, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30439574

RESUMO

Many markets maintain a nontrivial mix of both nonprofit and for-profit firms, particularly in health care industries such as hospice, nursing homes, and home health. What are the effects of coexistence vs. dominance of one ownership type? We show how the presence of both ownership types can lead to greater diversity in consumer types served, even if both firms merely profit-maximize. This is the case where firms serve consumers for multiple consumption durations, but where donations are part of a nonprofit firm objective function and happen after services have been provided. This finding is strengthened if the good or service has value beyond immediate consumption or the direct consumer. We show these predictions empirically in the hospice industry, using data containing over 90 percent of freestanding U.S. hospices, 2000-2008. Nonprofit and for-profit providers split the patient market according to length of stay, leading to a wider range of patients being served than in the absence of this coexistence.


Assuntos
Instituições Privadas de Saúde , Hospitais para Doentes Terminais , Organizações sem Fins Lucrativos , Idoso , Idoso de 80 Anos ou mais , Feminino , Instituições Privadas de Saúde/economia , Instituições Privadas de Saúde/organização & administração , Instituições Privadas de Saúde/estatística & dados numéricos , Hospitais para Doentes Terminais/economia , Hospitais para Doentes Terminais/organização & administração , Humanos , Masculino , Medicare/estatística & dados numéricos , Modelos Estatísticos , Organizações sem Fins Lucrativos/economia , Organizações sem Fins Lucrativos/organização & administração , Organizações sem Fins Lucrativos/estatística & dados numéricos , Estados Unidos
10.
Cad Saude Publica ; 34(7): e00067218, 2018 08 06.
Artigo em Português | MEDLINE | ID: mdl-30088570

RESUMO

This article describes changes in the public, nonprofit, and private components of the health care networks and health insurance and health plan companies in Brazil, based on the accumulated knowledge concerning the gains and obstacles in the Brazilian Unified National Health System (SUS) and differences between policies for democratization and democratizing processes. This central premise allowed analyzing praise versus criticism for the SUS and the contemporary nature of relations between the public and private sectors, drawing on secondary data from agencies in the Executive, Legislative, and Judiciary branches. The article concludes that the highly financialized private and private-charitable sectors imposed anti-democratic and anti-democratizing standards in the use of public funds. The article further concludes that although these sectors have not raised barriers to certain public policies for the expansion of access, they nevertheless prevent the development of the SUS according to the principles set out in the 1988 Constitution.


Assuntos
Assistência à Saúde/tendências , Programas Nacionais de Saúde/história , Atenção Primária à Saúde/tendências , Brasil , Constituição e Estatutos , Assistência à Saúde/organização & administração , Democracia , Instituições Privadas de Saúde/organização & administração , Política de Saúde/história , Política de Saúde/legislação & jurisprudência , Política de Saúde/tendências , História do Século XX , História do Século XXI , Humanos , Programas Nacionais de Saúde/tendências , Atenção Primária à Saúde/organização & administração
14.
PLoS One ; 13(7): e0200233, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30044796

RESUMO

BACKGROUND: Providers' qualification (Medical doctor [MD] or nurse); type of care facility ownership (for-profit [FP] or not-for-profit [NFP]) may all influence individuals' healthcare-seeking behavior and therefore merits empirical assessment to provide valuable evidence-informed policy orientation in the present context of private health system development. Previous studies have not examined these factors in combination, especially within the urban context of sub-Sahara Africa, where the private sector is rapidly growing. This study aims to explore factors associated with urban residents' preferences between private MD-led and private nurse-led outpatient care and how these factors vary by type of private health facility ownership (FP and NFP) and levels of disease severity (severe and non-severe cases). METHODS: A cross-sectional household survey was conducted in July-November 2011 on a random final sample of 2064 adults (646 households). We used a face-to-face interview to capture participants' choice of provider and their associated factors. A multivariable logistic regression was applied. RESULTS: For severe conditions, participants, almost equally sought FP and NFP facilities, only 36.4% preferred nurses compared to MDs, while for non-severe cases 53.2% preferred FP facilities and only 29.2% patronized nurses. For non-severe conditions, university educated were more likely to use MDs-led FP compared to nurse-led FP facilities (Odds Ratio [OR] = 4.66, 95% confidence interval [CI] = 2.62-8.30) and MD-led FP over MD-led NFP facilities (OR = 1.03, 95%CI = 1.01-1.04), for severe health conditions. Having insurance predicted MD-led FP preference over nurse-led FP. Furthermore, insurance predicted the preference for MD-led FP over MD-led NFP facilities. Employment did not distinguish participants' choice of provider. CONCLUSION: The findings suggest that, at different levels, MDs and nurses from FP and NFP facilities importantly contribute to health services delivery regardless of the severity of health conditions. The results offer some valuable evidence for policy orientation in the current rising tide of the private system, including workforce development, and practitioners' role definition. We suggested that health insurance mechanism would reinforce the private health services utilization and could enhance progress towards the attainment of Sustainable Development Goals.


Assuntos
Instituições Privadas de Saúde , Pessoal de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Burkina Faso , Comportamento de Escolha , Estudos Transversais , Feminino , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Organizações sem Fins Lucrativos , Setor Privado , Adulto Jovem
15.
Health Econ ; 27(11): 1653-1669, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29968263

RESUMO

The literature on provider ownership has primarily focused broadly on for-profits compared with nonprofits and chains versus nonchains. However, the understanding of more nuanced ownership arrangements within individual facilities is limited. Utilizing the principal-agent and managerial control frameworks, we study the role of managerial ownership and its relationship to quality among for-profit nursing homes (NHs). We identify NH administrators with more than 5% ownership (owner-manager) from Ohio Medicaid Cost Reports (2005-2010) and link these data to long-stay resident records in the Minimum Data Set. Using differential distance to the nearest NHs with a salaried manager relative to an owner-manager, we address the differential selection into these two types of NHs. After instrumenting for admissions to owner-managed NHs, quality among long-stay residents at owner-managed NHs is generally better than NHs with salaried managers. We find suggestive evidence that the magnitudes of quality difference are larger when the principal-agent problem is likely more pronounced, such as when NHs that are part of a multifacility chain and located in more concentrated markets.


Assuntos
Instituições Privadas de Saúde/economia , Modelos Organizacionais , Casas de Saúde/organização & administração , Propriedade , Indicadores de Qualidade em Assistência à Saúde , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Casas de Saúde/estatística & dados numéricos , Ohio
16.
Gerontologist ; 58(6): 1136-1146, 2018 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-28637215

RESUMO

Purpose of the Study: Ownership of nursing homes (NHs) has primarily focused broadly on differences between for-profit (FP), nonprofit (NFP), and government-operated facilities. Yet, among FPs, the understanding of detailed ownership structures at individual NHs is rather limited. Particularly, NH administrators may hold significant equity interests in their facilities, leading to heterogeneous financial incentives and NH outcomes. Through the principal-agent theory, this article studies how managerial ownership of individual facilities affects NH outcomes. Design and Methods: We use a unique panel dataset of Ohio NHs (2005-2010) to empirically examine the relationship between managerial equity ownership and NH staffing, quality, and financial performance. We identify facility administrators as owner-managers if they have more than 5% of the equity stakes or are relatives of the owners. The statistical analysis is based on the pooled ordinary least squares and NH-fixed effect models. Results: We find that owner-managed NHs are associated with higher nursing staff levels compared to other FP NHs. Surprisingly, despite higher staffing levels, owner-managed NHs are not associated with better quality and we find no statistically significant difference in financial performance between owner-managed and nonowner-managed FP NHs. Our results do not support the principal-agent model and we offer alternative explanations for future research. Implications: Our findings provide empirical evidence that NH ownership structures are more nuanced than simply broadly categorizing facilities as FP or NFP, and our results do not fully align with the standard principal-agent model. The role of managerial ownership should be considered in future NH research and policy discussions.


Assuntos
Instituições Privadas de Saúde/economia , Assistência de Longa Duração , Casas de Saúde/economia , Organizações sem Fins Lucrativos/economia , Propriedade/economia , Qualidade da Assistência à Saúde/economia , Instituições Privadas de Saúde/normas , Humanos , Casas de Saúde/classificação , Casas de Saúde/normas , Recursos Humanos de Enfermagem , Ohio , Organizações sem Fins Lucrativos/normas , Propriedade/normas , Admissão e Escalonamento de Pessoal/economia , Qualidade da Assistência à Saúde/normas , Recursos Humanos
17.
Health Care Manage Rev ; 42(4): 352-368, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28885990

RESUMO

BACKGROUND: Expanding the opportunities for for-profit nursing home care is a central theme in the debate on the sustainable organization of the growing nursing home sector in Western countries. PURPOSES: We conducted a systematic review of the literature over the last 10 years in order to determine the broad impact of nursing home ownership in the United States. Our review has two main goals: (a) to find out which topics have been studied with regard to financial performance, employee well-being, and client well-being in relation to nursing home ownership and (b) to assess the conclusions related to these topics. The review results in two propositions on the interactions between financial performance, employee well-being, and client well-being as they relate to nursing home ownership. METHODOLOGY/APPROACH: Five search strategies plus inclusion and quality assessment criteria were applied to identify and select eligible studies. As a result, 50 studies were included in the review. Relevant findings were categorized as related to financial performance (profit margins, efficiency), employee well-being (staffing levels, turnover rates, job satisfaction, job benefits), or client well-being (care quality, hospitalization rates, lawsuits/complaints) and then analyzed based on common characteristics. FINDINGS: For-profit nursing homes tend to have better financial performance, but worse results with regard to employee well-being and client well-being, compared to not-for-profit sector homes. We argue that the better financial performance of for-profit nursing homes seems to be associated with worse employee and client well-being. PRACTICAL IMPLICATIONS: For policy makers considering the expansion of the for-profit sector in the nursing home industry, our findings suggest the need for a broad perspective, simultaneously weighing the potential benefits and drawbacks for the organization, its employees, and its clients.


Assuntos
Administração Financeira/economia , Instituições Privadas de Saúde/economia , Satisfação no Emprego , Casas de Saúde/economia , Propriedade/organização & administração , Qualidade da Assistência à Saúde , Humanos , Reorganização de Recursos Humanos
18.
BMC Health Serv Res ; 17(1): 487, 2017 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-28709461

RESUMO

BACKGROUND: Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies. METHODS: The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures. RESULTS: The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes. CONCLUSIONS: Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier findings. The fact that privately operated homes, including those operated by for-profit companies, had higher processual quality is more unexpected, given previous research. Finally, no significant quality differences were found between private ownership types, i.e. for-profit, non-profit, and private equity companies, which indicates that profit motives are less important for determining quality in Swedish nursing home care than in other countries where similar studies have been carried out.


Assuntos
Instituições Privadas de Saúde/normas , Casas de Saúde/normas , Qualidade da Assistência à Saúde , Competência Clínica , Pesquisas sobre Serviços de Saúde , Instituições Privadas de Saúde/organização & administração , Humanos , Análise Multivariada , Casas de Saúde/organização & administração , Propriedade , Lesão por Pressão/diagnóstico , Análise de Regressão , Suécia , Recursos Humanos
19.
Health Aff (Millwood) ; 36(7): 1291-1298, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28679817

RESUMO

Hospice care is designed to support patients and families through the final phase of illness and death. Yet for more than a decade, hospices have steadily increased the rate at which they discharge patients before death-a practice known as "live discharge." Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices' desire to maximize profits drives them to inappropriately discharge patients. We used Medicare claims data for 2012-13 and cost reports for 2011-13 to explore relationships between hospice-level financial margins and live discharge rates among freestanding hospices. Adjusted analyses showed positive and significant associations between both operating and total margins and hospice-level rates of live discharge: One-unit increases in operating and total margin were associated with increases of 3 percent and 4 percent in expected hospice-level live discharge rates, respectively. These findings suggest that additional research is needed to explore links between profitability and patient-centeredness in the Medicare hospice program.


Assuntos
Instituições Privadas de Saúde/economia , Hospitais para Doentes Terminais/economia , Medicare/economia , Alta do Paciente/economia , Idoso de 80 Anos ou mais , Feminino , Instituições Privadas de Saúde/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Masculino , Alta do Paciente/estatística & dados numéricos , Estados Unidos
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