The quality of outpatient primary care in public and private sectors in Sri Lanka—how well do patient perceptions match reality and what are the implications?

Rannan-Eliya, Ravindra P; Wijemanne, Nilmini; Liyanage, Isuru K; Jayanthan, Janaki; Dalpatadu, Shanti; Amarasinghe, Sarasi; Anuranga, C.

doi:10.1093/heapol/czu115

Cited by 30 publications

(28 citation statements)

References 19 publications

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“…25 These results deviate from ndings of other studies indicating that private health facilities appear to be of higher (interpersonal) process quality, including responsiveness and effort, and conceivably being more patient-orientated than public facilities. 21,22,23 Our results do suggest that while the overall quality ratings were similar, private providers are rated better, on quality of basic amenities, con dentiality and autonomy. Although con dentiality was well rated in terms of responsiveness (patients' experience when receiving care, as assessed by the mean sores), ( Table 2, Figure 1), this domain was considered by respondents as of comparatively low importance for consulting a PHC service (Figure 1).…”

Section: Quality Of Care By Type Of Health Care Providermentioning

confidence: 54%

“…20 Both the public and private health organization are engaged in improving quality of care. The private sector is often viewed as more client-centered, 21 better at patient education and interpersonal satisfaction, 22 and patients seem to experience better timeliness and hospitality. 23 Quality of care is comparatively well rated in public health services in some western European countries.…”

Section: Quality Of Care and Patient Experience Across Settingsmentioning

confidence: 99%

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Users' perspectives on non-clinical quality of care in public and private primary healthcare in Albania

Gabrani

Schindler

Wyss

2020

Preprint

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Background: Aiming to tackle the rise of non-communicable diseases and an ageing population, Albania is engaged in boosting primary healthcare services and quality of care. The patients’ perspectives on their experience with public and private providers are, however, missing, although their viewpoints are critical while shaping the developing services. Consequently, we analyse perceptions of users of primary healthcare as it relates to non-clinical quality of care and the association to sociodemographic characteristics of patients and the type of provider. Methods: A facility-based survey was conducted in 2018 using the World Health Organization responsiveness questionnaire which is based on a 4-point scale along eight non-clinical domains of quality of care. The data of 954 patients were analysed through descriptive statistics and linear mixed regression models.Results: Similar mean values were reported on total scale of the quality of care for private and public providers, also after sociodemographic adjustments. The highest mean score was reported for the domain ‘communication’ (3.75) followed by ‘dignity’ (3.65), while the lowest mean scores were given for ‘choice’ (2.89) and ‘prompt attention’ (3.00). Urban governmental PHC services were rated significantly better than private outpatient clinics in ‘coordination of care’ (2.90 vs 2.12, p < 0.001). In contrast, private outpatient clinics were judged significantly better than urban PHC clinics in ‘confidentiality’ (3.77 vs 3.38, p = 0.04) and ‘quality of basic amenities’ (3.70 vs 3.02, p < 0.001). For the other domains, no statistically significant differences were observed. ‘Autonomy’ was reported as least important attribute of quality. Enrolment in health insurance was a predictor of higher quality ratings (coefficient = 0.06, p = 0.02).Conclusion: While the perception of non-clinical care quality was found to be high and similar for public and private providers, promptness and coordination of care require attention to meet patient’s expectations on good quality of care. There is a need to shift from a ‘paternalistic’ model to a ‘co-managing the illness’, raising awareness on autonomy.

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Section: Quality Of Care By Type Of Health Care Providermentioning

confidence: 54%

Section: Quality Of Care and Patient Experience Across Settingsmentioning

confidence: 99%

Users' perspectives on non-clinical quality of care in public and private primary healthcare in Albania

Gabrani

Schindler

Wyss

2020

Preprint

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“…Our results show that despite the free health care policy, people purchase many health care services from the private sector. The increase in income over the past 2 decades allows people to buy higher quality, in form of supplementary private services, characterized not necessarily only by higher clinical quality, but also other quality aspects such as shorter waiting times, better interpersonal communication by doctors and other health staff, and cleanliness and availability of luxurious private facilities (individual room and bed, TVs, and unrestricted visiting time) …”

Section: Resultsmentioning

confidence: 99%

Have out‐of‐pocket health care payments risen under free health care policy? The case ofSriLanka

Pallegedara

Grimm

2018

Health Planning & Management

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SummaryCompared to its neighbors, Sri Lanka performs well in terms of health. Health care is provided for free in the public sector, yet households' out‐of‐pocket health expenditures are steadily increasing. We explore whether this increase can be explained by supply shortages and insufficient public health care financing or whether it is rather the result of an income‐induced demand for supplementary and higher quality services from the private sector. We focus on total health care expenditures and health care expenditures for specific services such as expenses on private outpatient treatments and expenses on laboratory and other diagnostic services. Overall, we find little indication that limited supply of public health care per se pushes patients into the private sector. Yet income is identified as one key driver of rising health care expenditures, ie, as households get richer, they spend an increasing amount on private services suggesting a dissatisfaction with the quality offered by the public sector. Hence, quality improvements in the public sector seem to be necessary to ensure sustainability of the public health care sector. If the rich and the middle class increasingly opt out of public health care, the willingness to pay taxes to finance the free health care policy will certainly shrink.

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“…clinical care is likely to be equally good, if not better. Some studies argue that quality of care provided by private sector professionals is likely comparable to those in developed economies (Jayawardhana, Rannan-Eliya, and Karunaratne 2002;Rannan-Eliya, Jayawardhane, and Karunaratne 2003;Rannan-Eliya et al 2015a, 2015b.…”

Section: Health and Agingmentioning

confidence: 99%

Growing Old Before Becoming Rich:

2019

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The views expressed in this publication are those of the authors and do not necessarily reflect the views and policies of the Asian Development Bank (ADB) or its Board of Governors or the governments they represent. ADB does not guarantee the accuracy of the data included in this publication and accepts no responsibility for any consequence of their use. The mention of specific companies or products of manufacturers does not imply that they are endorsed or recommended by ADB in preference to others of a similar nature that are not mentioned. By making any designation of or reference to a particular territory or geographic area, or by using the term "country" in this document, ADB does not intend to make any judgments as to the legal or other status of any territory or area.

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The quality of outpatient primary care in public and private sectors in Sri Lanka—how well do patient perceptions match reality and what are the implications?

Cited by 30 publications

References 19 publications

Users' perspectives on non-clinical quality of care in public and private primary healthcare in Albania

Users' perspectives on non-clinical quality of care in public and private primary healthcare in Albania

Have out‐of‐pocket health care payments risen under free health care policy? The case ofSriLanka

Growing Old Before Becoming Rich:

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