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Speaking from the UK context ,Jeff is spot on: financial and legal liability are the main issues.
 
Private medical insurance pays for approx 30%   of privately provided healthcare
Self funding pays for approximately 20% of privately provided healthcare
In recent years another 30% is NHS funded less complicated treatments (on mass tariffs with reduced length of stay built into the cost model)
 
Combining private and NHS care is difficult as there is much ambiguity over whether local regulations allow it.
By and large the private and public funded aspects of care for the same condition need to be at separate provider areas.
 
By and large it is difficult to get private health insurers to agree to pay for any care that they perceive is additional as a result of the trial process or outcomes.
 
So the key barrier to recruitment of subjects would be the cost to the subject ( place where treatment is received, additional diagnostic and pathology services etc) - apportioning liabilty for payments with the existing billing systems would be difficult for everybody.

 
Vijaya Madhavan
Healthcare Business Consultant
 
 
On 24 March 2011 00:24, Jeff Harrison <[log in to unmask]> wrote:

Caroline

It strikes me that this is probably a financial or medico-legal rather than ethical or methodological problem.  If one believed the patient recruited through private practice were, in some important way, different from those recruited in ‘standard’ ways then one might decide to exclude them.  One must bear in mind the ramifications for subsequently generalising the findings of your study to such patients though.  If there is no methodological reason to exclude then surely there is an ethical imperative to include them?  Having enough money to pay for private care doesn’t preclude one from the natural history of disease progression does it?  All other things being equal, in the same way one shouldn’t exclude people because they can’t pay, one shouldn’t exclude people who can.

I would ask for clarification/justification.  Sometimes these things are said without being

On 24 March 2011 00:24, Jeff Harrison <[log in to unmask]> wrote:

Caroline

It strikes me that this is probably a financial or medico-legal rather than ethical or methodological problem.  If one believed the patient recruited through private practice were, in some important way, different from those recruited in ‘standard’ ways then one might decide to exclude them.  One must bear in mind the ramifications for subsequently generalising the findings of your study to such patients though.  If there is no methodological reason to exclude then surely there is an ethical imperative to include them?  Having enough money to pay for private care doesn’t preclude one from the natural history of disease progression does it?  All other things being equal, in the same way one shouldn’t exclude people because they can’t pay, one shouldn’t exclude people who can.

I would ask for clarification/justification.  Sometimes these things are said without being thought through.

Jeff

 

From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Caroline Boulind
Sent: Wednesday, 23 March 2011 10:05 p.m.
To: [log in to unmask]
Subject: Private patients in clinical trials

 

Dear all,

 

One of the research nurses in my department has recently asked me about my experience of recruiting private patients into clinical trials. We have recruited several private patients into both of our surgical trials, and I can't see any reason why they shouldn't be approached for trials in the same way as any other patients. However, the research network manager has told the nurse that private practice is a barrier to research.

I would be very interested to hear your experience of clinical research with private patients, and your thoughts about this. A very simple search on google scholar returns a good number of publications reporting trials that recruite from both private and NHS/federal practice, so this is obviously not something that is widely concerning...

 

Caroline

 

Dr. Caroline Boulind
Clinical Research Fellow
01935 384559

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