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1.
Adv Health Care Manag ; 202021 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-34779183

RESUMO

The long-term financial stability of hospital systems represents a "grand challenge" in health care. New ownership forms, such as private equity (PE), promise to achieve better financial performance than nonprofit or for-profit systems. In this study, we compare two systems with many similarities, but radically different ownership structures, missions, governance, and merger and acquisition (M&A) strategies. Both were nonprofit, religious systems serving low-income communities - Montefiore Health System and Caritas Christi Health Care. Montefiore's M&A strategy was to invest in local hospitals and create an integrated regional system, increasing revenues by adding primary doctors and community hospitals as feeders into the system and achieving efficiencies through effective resource allocation across specialized units. Slow and steady timing of acquisitions allowed for organizational learning and balancing of debt and equity. By 2019, it owned 11 hospitals with 40,000 employees and had strong positive financials and low reliance on debt. By contrast, in 2010, PE firm Cerberus Capital bought out Caritas (renamed Steward Health Care System) and took control of the Board of Directors, who set the system's strategic direction. Cerberus used Steward as a platform for a massive debt-driven acquisition strategy. In 2016, it sold off most of its hospitals' property for $1.25 billion, leaving hospitals saddled with long-term inflated leases; paid itself almost $500 million in dividends; and used the rest for leveraged buyouts of 27 hospitals in 9 states in 3 years. The rapid, scattershot M&A strategy was designed to create a large corporation that could be sold off in five years for financial gain - not for health care integration. Its debt load exploded, and by 2019, its financials were deeply in the red. Its Massachusetts hospitals were the worst financial performers of any system in the state. Cerberus exited Steward in 2020 in a deal that left its physicians, the new owners, holding the debt.


Assuntos
Hospitais Filantrópicos , Propriedade , Eficiência , Instituições Privadas de Saúde , Humanos , Massachusetts , Estados Unidos
2.
Artigo em Inglês | MEDLINE | ID: mdl-34769830

RESUMO

Workers in nursing homes are at high risk of occupational injury. Understanding whether-and which-nursing homes implement integrated policies to protect and promote worker health is crucial. We surveyed Directors of Nursing (DON) at nursing homes in three US states with the Workplace Integrated Safety and Health (WISH) assessment, a recently developed and validated instrument that assesses workplace policies, programs, and practices that affect worker safety, health, and wellbeing. We hypothesized that corporate and for-profit nursing homes would be less likely to report policies consistent with Total Worker Health (TWH) approaches. For each of the five validated WISH domains, we assessed the association between being in the lowest quartile of WISH score and ownership status using multivariable logistic regression. Our sample included 543 nursing homes, 83% which were corporate owned and 77% which were for-profit. On average, DONs reported a high implementation of TWH policies, as measured by the WISH. We did not find an association between either corporate ownership or for-profit status and WISH score for any WISH domain. Results were consistent across numerous sensitivity analyses. For-profit status and corporate ownership status do not identify nursing homes that may benefit from additional TWH approaches.


Assuntos
Propriedade , Local de Trabalho , Instituições Privadas de Saúde , Promoção da Saúde , Humanos , Casas de Saúde
3.
Ann Intern Med ; 174(10): 1447-1449, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34487452

RESUMO

The steady growth of corporate interest and influence in the health care sector over the past few decades has created a more business-oriented health care system in the United States, helping to spur for-profit and private equity investment. Proponents say that this trend makes the health care system more efficient, encourages innovation, and provides financial stability to ensure access and improve care. Critics counter that such moves favor profit over care and erode the patient-physician relationship. American College of Physicians (ACP) underscores that physicians are permitted to earn a reasonable income as long as they are fulfilling their fiduciary responsibility to provide high-quality, appropriate care within the guardrails of medical professionalism and ethics. In this position paper, ACP considers the effect of mergers, integration, private equity investment, nonprofit hospital requirements, and conversions from nonprofit to for-profit status on patients, physicians, and the health care system.


Assuntos
Atenção à Saúde/economia , Administração Financeira , Política Organizacional , Sociedades Médicas , Atenção à Saúde/ética , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Economia Hospitalar/ética , Economia Hospitalar/organização & administração , Economia Hospitalar/normas , Administração Financeira/ética , Administração Financeira/normas , Instituições Privadas de Saúde/economia , Instituições Privadas de Saúde/ética , Instituições Privadas de Saúde/normas , Humanos , Relações Médico-Paciente/ética , Médicos/economia , Médicos/ética , Médicos/normas , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Sociedades Médicas/normas , Estados Unidos
4.
BMJ Open ; 11(9): e045832, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475147

RESUMO

OBJECTIVES: Over the past two decades, debates on whether the profit status of dialysis facilities influences patient prognosis have been popular in the USA. Taiwan is one of the regions with the highest rate per capita of kidney replacement therapy worldwide, but no similar research has been conducted to date. This is the first study to address this issue. DESIGN: This was a nationwide retrospective cohort study based on the Taiwan Renal Registry Data System. SETTING: Patients were categorised into two groups based on the profit status (for-profit, not-for-profit (NFP)) of dialysis facilities, with 31 350 patients in each group. The patients were followed up from 2005 to 2012. PARTICIPANTS: Patients with uraemia who underwent long-term haemodialysis in private dialysis facilities and public facilities were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: Survival analyses were performed to compare prognosis between the two groups. Adjustments to patients' basic profile, and facilities' geographical distribution, level, and length of ownership were carried out to minimise possible confounding effects. RESULTS: Analysis revealed that NFP dialysis facilities had better outcomes (HR=0.91, 95% CI (0.89 to 0.93)). A favourable effect remains with the adjustment of the facilities' level, geographical distribution (HR=0.89, 95% CI (0.86 to 0.93)) or length of ownership (HR=0.95, 95% CI (0.89 to 0.95)). Survival analysis based on the geographical distribution and level of facilities was also conducted, which showed better prognosis in medical centres in the six municipalities, whereas worse prognosis was found in local hospitals not located in these municipalities. CONCLUSION: Our findings suggest that in contemporary settings in Taiwan, treatment at NFP dialysis facilities was associated with a better prognosis. The results should be interpreted with caution since the possibility of residual confounding effects and uncertainty of casual relations exist due to the nature of observational studies.


Assuntos
Falência Renal Crônica , Diálise Renal , Estudos de Coortes , Instituições Privadas de Saúde , Humanos , Falência Renal Crônica/terapia , Propriedade , Estudos Retrospectivos
5.
BMC Health Serv Res ; 21(1): 838, 2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34407808

RESUMO

INTRODUCTION: Understanding the cost of care associated with different kinds of healthcare providers is necessary for informing the policy debates in mixed health-systems like India's. Existing studies reporting Out of Pocket Expenditure (OOPE) per episode of outpatient care in public and private providers in India do not provide a fair comparison because they have not taken into account the government subsidies received by public facilities. Public and private health insurance in India do not cover outpatient care and for-profit providers have to meet all their costs out of the payments they take from patients. METHODS: The average direct cost per acute episode of outpatient care was compared for public providers, for-profit formal providers and informal private providers in Chhattisgarh state of India. For public facilities, government subsidies for various inputs were taken into account. Resources used were apportioned using Activity Based Costing. Land provided free to public facilities was counted at market prices. The study used two datasets: a) household survey on outpatient utilisation and OOPE b) facility survey of public providers to find the input costs borne by government per outpatient-episode. RESULTS: The average cost per episode of outpatient care was Indian Rupees (INR) 400 for public providers, INR 586 for informal private providers and INR 2643 for formal for-profit providers and they managed 39.3, 37.9 and 22.9% of episodes respectively. The average cost for government and households put together was greater for using formal for-profit providers than the public providers. The disease profile of care handled by different types of providers was similar. Volume of patients and human-resources were key cost drivers in public facilities. Close to community providers involved less cost than others. CONCLUSIONS AND RECOMMENDATIONS: The findings have implications for the desired mix of public and private providers in India's health-system. Poor regulation of for-profit providers was an important structural cost driver. Purchasing outpatient care from private providers may not reduce average cost. Policies to strengthen public provisioning of curative primary care close to communities can help in reducing cost.


Assuntos
Gastos em Saúde , Hospitais Privados , Assistência Ambulatorial , Instituições Privadas de Saúde , Humanos , Índia , Seguro Saúde
6.
Int J Health Econ Manag ; 21(3): 271-294, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34086196

RESUMO

Standard theories of health provider behavior suggest that providers are motivated by both profit and an altruistic interest in patient health benefit. Detailed empirical data are seldom available to measure relative preferences between profit and patient health outcomes. Furthermore, it is difficult to empirically assess how these relative preferences affect quality of care. This study uses a unique dataset from rural Myanmar to assess heterogeneous preferences toward treatment efficacy relative to provider profit and the impact of these preferences on the quality of provider diagnosis and treatment. Using conjoint survey data from 187 providers, we estimated the marginal utilities of higher treatment efficacy and of higher profit, and the marginal rate of substitution between these outcomes. We also measured the quality of diagnosis and treatment for malaria among these providers using a previously validated observed patient simulation. There is substantial heterogeneity in providers' utility from treatment efficacy versus utility from higher profits. Higher marginal utility from treatment efficacy is positively associated with the quality of treatment among providers, and higher marginal utility from profit are negatively associated with quality of diagnosis. We found no consistent effect of the ratio of marginal utility of efficacy vs marginal utility of profit on quality of care. Our findings suggest that providers vary in their preferences towards profit and treatment efficacy, with those providers that place greater weight on treatment efficacy providing higher quality of care.


Assuntos
Instituições Privadas de Saúde , População Rural , Humanos , Mianmar , Qualidade da Assistência à Saúde
9.
Health Aff (Millwood) ; 40(2): 317-325, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33523744

RESUMO

The use of acute, short-term residential care for opioid use disorder has grown rapidly, with policy makers advocating to increase the availability of "treatment beds." However, there are concerns about high costs and misleading recruitment practices. We conducted an audit survey of 613 residential programs nationally, posing as uninsured cash-paying individuals using heroin and seeking addiction treatment. One-third of callers were offered admission before clinical evaluation, usually within one day. Most programs required up-front payments, with for-profit programs charging more than twice as much ($17,434) as nonprofits ($5,712). Recruitment techniques (for example, offering paid transportation) were used frequently by for-profit, but not nonprofit, programs. Practices including admission offers during the call, high up-front payments, and recruitment techniques were common even among programs with third-party accreditation and state licenses. These findings raise concerns that residential programs, including accredited and licensed ones, may be admitting a clinically and financially vulnerable population for costly treatment without assessing appropriateness for other care settings.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Tratamento Domiciliar , Instituições Privadas de Saúde , Hospitalização , Humanos , Transtornos Relacionados ao Uso de Opioides/terapia , Organizações sem Fins Lucrativos
10.
Fam Med ; 53(1): 48-53, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33471922

RESUMO

The COVID-19 pandemic, together with its resultant economic downturn, has unmasked serious problems of access, costs, quality of care, inequities, and disparities of US health care. It has exposed a serious primary care shortage, the unreliability of employer-sponsored health insurance, systemic racism, and other dysfunctions of a system turned on its head without a primary care base. Fundamental reform is urgently needed to bring affordable health care that is accessible to all Americans. Over the last 40-plus years, our supposed system has been taken over by corporate stakeholders with the presumption that a competitive unfettered marketplace will achieve the needed goal of affordable, accessible care. That theory has been thoroughly disproven by experience as the ranks of more than 30 million uninsured and 87 million underinsured demonstrates. Three main reform alternatives before us are: (1) to build on the Affordable Care Act; (2) to implement some kind of a public option; and (3) to enact single-payer Medicare for All. It is only the third option that can make affordable, comprehensive health care accessible for our entire population. As the debate goes forward over these alternatives during this election season, the likelihood of major change through a new system of national health insurance is becoming increasingly realistic. Rebuilding primary care and public health is a high priority as we face a new normal in US health care that places the public interest above that of corporate stakeholders and Wall Street investors. Primary care, and especially family medicine, should become the foundation of a reformed health care system.


Assuntos
COVID-19 , Medicina de Família e Comunidade , Reforma dos Serviços de Saúde , Setor de Assistência à Saúde , Disparidades em Assistência à Saúde/etnologia , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Cobertura Universal do Seguro de Saúde , Recessão Econômica , Emprego , Tabela de Remuneração de Serviços , Instituições Privadas de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Seguro Saúde , Medicare , National Health Insurance, United States , Médicos de Família/provisão & distribuição , Médicos de Atenção Primária/provisão & distribuição , SARS-CoV-2 , Desemprego , Estados Unidos
11.
Health Econ Policy Law ; 16(2): 216-231, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32758326

RESUMO

A primary care choice reform launched in Sweden in 2010 led to a rapid growth of private providers. Critics feared that the reform would lead to an increased tendency among new, profit-driven, providers, to select patients with lower health risks. Even if open risk selection is prohibited, providers can select patients in more subtle ways, such as establishing their practices in areas with higher health status. This paper investigates to what extent strategies were employed by local governments to avoid risk selection and whether there were any differences between left- and right-wing governments in this regard. Three main strategies were used: risk adjustment of the financial reimbursements on the basis of health and/or socio-economic status of listed patients; design of patient listing systems; and regulatory requirements regarding the scope and content of the services that had to be offered by all providers. Additionally, left-wing local governments were more prone than right-wing governments to adopt risk adjustment strategies at the onset of the reform but these differences diminished over time. The findings of the paper contribute to our understanding of how social inequalities may be avoided in tax-based health care systems when market-like steering models such as patient choice are introduced.


Assuntos
Reforma dos Serviços de Saúde/economia , Instituições Privadas de Saúde/economia , Atenção Primária à Saúde/economia , Prática Privada/economia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Instituições Privadas de Saúde/legislação & jurisprudência , Governo Local , Política , Atenção Primária à Saúde/legislação & jurisprudência , Prática Privada/legislação & jurisprudência , Risco Ajustado , Fatores Socioeconômicos , Suécia
12.
J Appl Gerontol ; 40(9): 1029-1038, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-32613885

RESUMO

This is the first nationally representative study to identify differences between adult day services centers, a unique home- and community-based service, by racial/ethnic case-mix: Centers were classified as having a majority of participants who were Hispanic, non-Hispanic Black, or non-Hispanic other race/ethnicities and non-Hispanic White. The associations between racial/ethnic case-mix and geographic and operational characteristics of centers and health and functioning needs of participants were assessed using multivariate regression analyses, using the 2014 National Study of Long-term Care Providers' survey of 2,432 centers. Half of all adult day centers predominantly served racial/ethnic minorities, which were more likely to be for-profit, had lower percentages of self-pay revenue, more commonly provided transportation services, and had higher percentages of participants with diabetes, compared with predominantly non-Hispanic White centers. Findings show differences by racial/ethnic case-mix, which are important when considering the long-term care needs of a diverse population of older adults.


Assuntos
Grupos Étnicos , Hispano-Americanos , Idoso , Instituições Privadas de Saúde , Humanos , Assistência de Longa Duração , Grupos Minoritários , Estados Unidos
13.
Brasília; CONASS; 2021. 342 p.
Monografia em Português | LILACS, Coleciona SUS, CONASS | ID: biblio-1150769

RESUMO

A Coleção COVID-19 apresenta em seus livros diferentes temas e debates. O Volume 5 ­ Acesso e Cuidados Especializados traz reflexões sobre a saúde pública e privada nos tempos da pandemia e suas respectivas interações, no âmbito dos cuidados especializados. Avança para os conteúdos relacionados à atuação da atenção especializada durante a pandemia, a abordagem clínica do paciente com a COVID-19, a atenção hospitalar em suas diferentes configurações: nas filantrópicas, nos hospitais universitários, nos hospitais de campanha e com a telemedicina. Os textos que seguem se preocupam com as comissões de controle de infecção e o cuidado seguro com os pacientes da COVID-19. Alcançam os cuidados paliativos e as diretivas antecipadas de vontade. Ultrapassados os conteúdos mais gerais, os textos passam a revelar sobre os cuidados com os pacientes com doença renal e oncológicos, até adentrarem na temática da assistência farmacêutica. Nesse campo, os debates comtemplam a escassez, o uso seguro, os casos do kit intubação e da Cloroquina/Hidroxicloroquina que ocuparam fortemente os noticiários brasileiros e que se revelaram problemas ímpares para a gestão em saúde. Por fim, o livro contempla os debates relacionados à pesquisa clínica, o registro sanitário de vacinas para a COVID-19 e a necessária sustentabilidade do SUS, pelo olhar de quem defende


Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Sistema Único de Saúde/organização & administração , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Monitoramento Epidemiológico , Brasil/epidemiologia , Política de Saúde , Fatores Socioeconômicos , Instituições Privadas de Saúde
14.
Int J Health Serv ; 51(3): 371-378, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33323016

RESUMO

We conducted a systematic review and meta-analysis to assess differences in risk-adjusted mortality rates between for-profit (FP) and not-for-profit (NFP) hemodialysis facilities. We searched 10 databases for studies published between January 2001 to December 2019 that compared mortality at private hemodialysis facilities. We included observational studies directly comparing adjusted mortality rates between FP and NFP private hemodialysis providers in any language or country. We excluded evaluations of dialysis facilities that changed their profit status, studies with overlapping data, and studies that failed to adjust for patient age and some measure of clinical severity. Pairs of reviewers independently screened all titles and abstracts and the full text of potentially eligible studies, abstracted data, and assessed risk of bias, resolving disagreement by discussion. We included nine observational studies of hemodialysis facilities representing 1,163,144 patient-years. In pooled random-effects meta-analysis, the odds ratio of mortality in FP relative to NFP facilities was 1.07 (95% CI 1.04-1.11). Patients at FP hemodialysis facilities have 7 percent greater odds of death annually than patients with similar risk profiles at NFP facilities. Approximately 3,800 excess deaths might be averted annually if U.S. FP hemodialysis operators matched NFP mortality rates.


Assuntos
Instituições Privadas de Saúde , Diálise Renal , Humanos
15.
JAMA Netw Open ; 3(12): e2029419, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33331918

RESUMO

Importance: Little is known about the breadth of health care networks or the degree to which different insurers' networks overlap. Objective: To quantify network breadth and exclusivity (ie, overlap) among primary care physician (PCP), cardiology, and general acute care hospital networks for employer-based (large group and small group), individually purchased (marketplace), Medicare Advantage (MA), and Medicaid managed care (MMC) plans. Design, Setting, and Participants: This cross-sectional study included 1192 networks from Vericred. The analytic unit was the network-zip code-clinician type-market, which captured attributes of networks from the perspective of a hypothetical patient seeking access to in-network clinicians or hospitals within a 60-minute drive. Exposures: Enrollment in a private insurance plan. Main Outcomes and Measures: Percentage of in-network physicians and/or hospitals within a 60-minute drive from a hypothetical patient in a given zip code (breadth). Number of physicians and/or hospitals within each network that overlapped with other insurers' networks, expressed as a percentage of the total possible number of shared connections (exclusivity). Descriptive statistics (mean, quantiles) were produced overall and by network breadth category, as follows: extra-small (<10%), small (10%-25%), medium (25%-40%), large (40%-60%), and extra-large (>60%). Networks were analyzed by insurance type, state, and insurance, physician, and/or hospital market concentration level, as measured by the Hirschman-Herfindahl index. Results: Across all US zip code-network observations, 415 549 of 511 143 large-group PCP networks (81%) were large or extra-large compared with 138 485 of 202 702 MA (68%), 191 918 of 318 082 small-group (60%), 60 425 of 149 841 marketplace (40%), and 21 781 of 66 370 MMC (40%) networks. Large-group employer networks had broader coverage than all other network plans (mean [SD] PCP breadth: large-group employer-based plans, 57.3% [20.1]; small-group employer-based plans, 45.7% [21.4]; marketplace, 36,4% [21.2]; MMC, 32.3% [19.3]; MA, 47.4% [18.3]). MMC networks were the least exclusive (a mean [SD] overlap of 61.3% [10.5] for PCPs, 66.5% [9.8] for cardiology, and 60.2% [12.3] for hospitals). Networks were narrowest (mean [SD] breadth 42.4% [16.9]) and most exclusive (mean [SD] overlap 47.7% [23.0]) in California and broadest (79.9% [16.6]) and least exclusive (71.1% [14.6]) in Nebraska. Rising levels of insurer and market concentration were associated with broader and less exclusive networks. Markets with concentrated primary care and insurance markets had the broadest (median [interquartile range {IQR}], 75.0% [60.0%-83.1%]) and least exclusive (median [IQR], 63.7% [52.4%-73.7%]) primary care networks among large-group commercial plans, while markets with least concentration had the narrowest (median [IQR], 54.6% [46.8%-67.6%]) and most exclusive (median [IQR], 49.4% [41.9%-56.9%]) networks. Conclusions and Relevance: In this study, narrower health care networks had a relatively large degree of overlap with other networks in the same geographic area, while broader networks were associated with physician, hospital, and insurance market concentration. These results suggest that many patients could switch to a lower-cost, narrow network plan without losing in-network access to their PCP, although future research is needed to assess the implications for care quality and clinical integration across in-network health care professionals and facilities in narrow network plans.


Assuntos
Redes Comunitárias , Prestação Integrada de Cuidados de Saúde/organização & administração , Setor de Assistência à Saúde/organização & administração , Instituições Privadas de Saúde/normas , Seguro Saúde/organização & administração , Redes Comunitárias/estatística & dados numéricos , Redes Comunitárias/provisão & distribuição , Estudos Transversais , Sistemas de Informação em Saúde , Humanos , Atenção Primária à Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Estados Unidos
16.
JAMA Netw Open ; 3(10): e2026702, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33112402

RESUMO

Importance: It is not known whether nursing homes with private equity (PE) ownership have performed better or worse than other nursing homes during the coronavirus disease 2019 (COVID-19) pandemic. Objective: To evaluate the comparative performance of PE-owned nursing homes on COVID-19 outcomes. Design, Setting, and Participants: This cross-sectional study of 11 470 US nursing homes used the Nursing Home COVID-19 Public File from May 17, 2020, to July 2, 2020, to compare outcomes of PE-owned nursing homes with for-profit, nonprofit, and government-owned homes, adjusting for facility characteristics. Exposure: Nursing home ownership status. Main Outcomes and Measures: Self-reported number of COVID-19 cases and deaths and deaths by any cause per 1000 residents; possessing 1-week supplies of personal protective equipment (PPE); staffing shortages. Results: Of 11 470 nursing homes, 7793 (67.9%) were for-profit; 2523 (22.0%), nonprofit; 511 (5.3%), government-owned; and 543 (4.7%), PE-owned; with mean (SD) COVID-19 cases per 1000 residents of 88.3 [2.1], 67.0 [3.8], 39.8 [7.6] and 110.8 [8.1], respectively. Mean (SD) COVID-19 deaths per 1000 residents were 61.9 [1.6], 66.4 [3.0], 56.2 [7.3], and 78.9 [5.9], respectively; mean deaths by any cause per 1000 residents were 78.1 [1.3], 91.5 [2.2], 67.6 [4.5], and 87.9 [4.8], respectively. In adjusted analyses, government-owned homes had 35.5 (95% CI, -69.2 to -1.8; P = .03) fewer COVID-19 cases per 1000 residents than PE-owned nursing homes. Cases in PE-owned nursing homes were not statistically different compared with for-profit and nonprofit facilities; nor were there statistically significant differences in COVID-19 deaths or deaths by any cause between PE-owned nursing homes and for-profit, nonprofit, and government-owned facilities. For-profit, nonprofit, and government-owned nursing homes were 10.5% (9.1 percentage points; 95% CI, 1.8 to 16.3 percentage points; P = .006), 15.0% (13.0 percentage points; 95% CI, 5.5 to 20.6 percentage points; P < .001), and 17.0% (14.8 percentage points; 95% CI, 6.5 to 23.0 percentage points; P < .001), respectively, more likely to have at least a 1-week supply of N95 masks than PE-owned nursing homes. They were 24.3% (21.3 percentage points; 95% CI, 11.8 to 30.8 percentage points; P < .001), 30.7% (27.0 percentage points; 95% CI, 17.7 to 36.2 percentage points; P < .001), and 29.2% (25.7 percentage points; 95% CI, 16.1 to 35.3 percentage points; P < .001) more likely to have a 1-week supply of medical gowns than PE-owned nursing homes. Government nursing homes were more likely to have a shortage of nurses (6.9 percentage points; 95% CI, 0.0 to 13.9 percentage points; P = .049) than PE-owned nursing homes. Conclusions and Relevance: In this cross-sectional study, PE-owned nursing homes performed comparably on staffing levels, resident cases, and deaths with nursing homes with other types of ownership, although their shortages of PPE may warrant monitoring.


Assuntos
Infecções por Coronavirus , Instituições Privadas de Saúde , Investimentos em Saúde , Casas de Saúde , Propriedade , Pandemias , Pneumonia Viral , Qualidade da Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Estudos Transversais , Equipamentos e Provisões , Governo , Instituição de Longa Permanência para Idosos , Humanos , Enfermeiras e Enfermeiros , Equipamento de Proteção Individual , Administração de Recursos Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Setor Privado , Setor Público , SARS-CoV-2 , Instituições de Cuidados Especializados de Enfermagem
17.
Brasília; IPEA; 20200500. 20 p. (Nota Técnica / IPEA. Diset, 65).
Monografia em Português | LILACS, ECOS | ID: biblio-1102191

RESUMO

Esta nota técnica tem o objetivo de analisar, de modo exploratório, algumas vantagens e desvantagens da eventual adoção de uma fila única, conforme vem sendo proposto, para organizar as internações, inclusive em unidades de terapia intesiva (UTIs), em todos os hospitais públicos e privados brasileiros, no contexto da atual pandemia do novo coronavírus (Sars-COV-2), causador da Covid-19. A análise utiliza elementos teóricos, e de resultados práticos, observados em economia da saúde e, de modo complementar, em teoria das filas (Queueing Theory). Essa análise se justifica em função da gravidade da situação atual e da possibilidade de que a fila única seja adotada na presente pandemia, ou que venha a ser novamente objeto de debate, em eventuais futuras pandemias, ou em epidemias que ocorram no país.


Assuntos
Teoria de Sistemas , Leitos , Sistema Único de Saúde , Infecções por Coronavirus , Coronavirus , Pandemias , Instituições Privadas de Saúde , Hospitalização
18.
Int J Health Serv ; 50(4): 431-443, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32276563

RESUMO

This exploratory, mixed-methods study analyzes characteristics of the emerging for-profit nursing home industry in the Netherlands and identifies the interrelated set of factors (context, trends, and sector conditions) that contribute to its growth. Until recently, the Dutch nursing home sector relied almost exclusively on nonprofit providers. Even though profit distribution in nursing home care is still banned, the for-profit nursing home sector is expanding. The study uses economic theory on nonprofit organizations and mixed-form markets to understand this expansion. We find that changes in the regulatory framework have unlocked the potential of the for-profit nursing home sector, enabling for-profit nursing homes to circumvent the for-profit ban. The expansion of the for-profit sector was mainly driven by the low responsiveness of the nonprofit sector to increased and changed demands. For-profit providers took advantage of this void. Moreover, they exploited "cream-skimming" potential in the market and used the wider care system to reduce their labor costs by relying on external specialist care. Another main driver was the access to financial capital from private investors (e.g., private equity firms).


Assuntos
Instituições Privadas de Saúde , Casas de Saúde , Propriedade , Humanos , Países Baixos , Casas de Saúde/economia , Organizações sem Fins Lucrativos , Qualidade da Assistência à Saúde
20.
Cornea ; 39(10): 1207-1214, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32118673

RESUMO

PURPOSE: To describe the ethical attitudes of corneal surgeons and eye bank leadership toward for-profit entities in corneal donation, processing, and distribution. METHODS: Fifty postfellowship corneal surgeons practicing in the United States and 25 eye bank leaders (eg, eye bank directors, CEOs, or presidents) for the Eye Bank Association of America-accredited eye banks completed a 22-question interview, focusing on corneal donation industry changes, including the entry of for-profit institutions. RESULTS: Most participants in both study groups agreed that they have concerns with the entry of for-profit businesses into eye banking (62% corneal surgeons, 68% eye bank leadership), although physicians partnered with a for-profit corneal processor were significantly more likely to have no concerns with the entry of for-profits into eye banking than corneal surgeons partnered with a nonprofit processor (P = 0.04). The most frequently identified concerns with the entry of for-profit businesses into corneal banking were the hypothetical loss of donor trust (56% corneal surgeons, 64% eye bank leadership, P = 0.04) and the potential exploitation of donor generosity (72% corneal surgeons, 60% eye bank leadership). Qualitative theme analysis suggests that both study groups may view increased research/innovation as a potential benefit (64% corneal surgeons, 66% eye bank leadership) of for-profits in eye banking. CONCLUSIONS: Key stakeholders in eye banking do hold relevant ethical beliefs toward recent industry changes, and these attitudes should be considered in the future creation of the ethical corneal donation policy. Further research is needed to assess the attitudes of potential donors and donor families.


Assuntos
Atitude do Pessoal de Saúde , Córnea , Bancos de Olhos/ética , Instituições Privadas de Saúde/ética , Oftalmologistas/ética , Doenças da Córnea/cirurgia , Transplante de Córnea/ética , Ética Institucional , Bancos de Olhos/normas , Feminino , Inquéritos Epidemiológicos , Humanos , Liderança , Masculino , Oftalmologistas/normas , Organizações sem Fins Lucrativos/ética , Inquéritos e Questionários , Doadores de Tecidos/ética , Obtenção de Tecidos e Órgãos/ética , Estados Unidos
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