Physician dual practice

Eggleston, Karen; Bir, Anupa

doi:10.1016/j.healthpol.2005.09.007

Cited by 78 publications

(88 citation statements)

References 26 publications

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“…Evidence from studies of medical career paths indicates that doctors, and to a lesser extent nurses, move between the public and private sectors, influencing the performance of both sectors (37). Dual practice may lead to increased referral to the private sector, leading to increased patient costs, increased absenteeism in the public sector, suppression of quality of care in the public sector, increased capacity to retain health workers in the health system as a whole, but such potential impacts are themselves contingent on other health system features such as attempts at regulation and the extent of market opportunities (38)(39)(40).…”

Section: Structure and Performance Of The Public And Private Sectorsmentioning

confidence: 99%

Performance of private sector health care: implications for universal health coverage

2016

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While the private sector is an important health care provider in many low and middle income countries (LMICs), its role in relation to progress towards Universal Health Coverage (UHC) varies. Drawing on a review of the published and grey literature, we explore the factors that affect private sector contribution to UHC: i.e. we are interested in the overall impact on system outcomes such as . Evidence on the performance of both the private and public healthcare sectors is used to examine the characteristics of private providers that are associated with their performance, and the implications for how these factors might interrelate to influence progress towards UHC. Studies of private sector performance have focused on three main dimensions: quality, equity of access, and efficiency. We found that the characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers including their size, objectives, and technical competence the interaction of these factors influences how the sector performs within different contexts. Changing the performance of the private sector will require interventions which target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector appears to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health sector requires a regulatory response focused on the health sector as a whole. Key messages The critical policy relevant question about the private sector is not its performance in isolation, or relative to the public sector, but the extent to which it supports or detracts from progress towards Universal Health Coverage  There is a dearth of evidence on factors affecting system level performance, reflecting the complexity and heterogeneity of the private health sector and the difficulty in exploring the inter-relationships of factors at the system level, and their effect on overall performance.  Deriving population benefit from the private health sector will require interventions which target the sector as a whole, rather than individual providers alone.

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Section: Structure and Performance Of The Public And Private Sectorsmentioning

confidence: 99%

Performance of private sector health care: implications for universal health coverage

2016

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“…7 Dual practice is emerging as an important challenge to health policy makers in developing countries because it may have direct implications for health workers' labor supply, and for the quantity and quality of care provided. 5,8,9 Its opponents argue that it induces undesirable behavior in health workers, such as supplier-induced demand and cream skimming. 10 Increased absenteeism of physicians from public hospitals to focus their time and attention in private practice, from which they generate more income, is featured widely in the literature.…”

Section: Introductionmentioning

confidence: 99%

To Ban or Not to Ban? Regulating Dual Practice in Palestine

Alaref

Awwad²,

Araújo

et al. 2017

Health Systems & Reform

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“…These further complicate the concept of price as some sources, such as informal charges or dual practice income, may be derived from or enhanced by the health worker's primary employment, while others, such as income earned from agricultural work, are unrelated. The first type of (related) private income sources may be conceptualized as resulting in a divergence of the price paid by the employer and that received by the employee, and indeed this was seen to be among the rationales for the tolerance of dual practice that has been identified in other studies (Eggleston and Bir 2006;. Akwataghibe et al (2012) report in detail on the nature of private income sources in two states of Nigeria and find the most significant sources as among those derived or enhanced by public health sector employment: undertaking activities that attract per-diem payments, informal charging, and reselling medicines pilfered from health facilities.…”

Section: Health Workers Charging Patients Directly For Services: Pricmentioning

confidence: 97%

“…The allocation of resources across public and private health sectors is a contentious issue in most countries, including the extent to which doctors and other health workers undertake work in both sectors. Standard approaches in labor economics do not address these issues directly, as they assume that workers choose the highest paying job and that employers discourage their workers from supplying their labor to other firms (Eggleston and Bir 2006).…”

Section: Retentionmentioning

confidence: 99%