Negotiating markets for health: an exploration of physicians' engagement in dual practice in three African capital cities
Negotiating markets for health: an exploration of physicians' engagement in dual practice in three African capital cities
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DOI：
10.1093/heapol/czt071
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发表时间：
2014-09-01
影响因子：
3.2
通讯作者：
Ferrinho, Paulo
中科院分区：
文献类型：
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作者：
Russo, Giuliano;McPake, Barbara;Ferrinho, Paulo
关于医生双重执业的特征、决定因素和影响的证据很少，特别是在资源贫乏的环境中。本研究考虑了三个非洲城市的双重执业模式和各自的医生服务市场，目的是了解当地决定因素对执业的影响。在这三个城市进行了48次半结构化定性访谈，以了解实践和各自市场的特点。对331名医生进行了抽样调查，以探讨他们的特点和决定在公共和私营部门工作。描述性分析和推理统计，以探讨在医生的双重执业在三个地点的参与差异。不同形式的双重执业被发现存在于这三个城市，公共医生从事私人执业以外，但也在公共设施内，在管制和不管制的方式。百分之三十四的受访者表示他们只在公共机构执业，百分之十一表示他们只从事私人执业。其余55%表示他们从事某种形式的双重执业，31%“外部”公共设施，8%“内部”和16%“外部”和“内部”。地方卫生系统的治理和医生服务市场的结构与在每个地方发现的双重实践形式及其流行程度有关。我们的分析表明，医生从事双重执业的决定受到供求因素的影响，但也受到公共和私人市场的明确分离的影响。如果有可能在公共基础设施内提供很少受到管制的服务，那么参与正规私营部门的积极性似乎就比较低，这对提供服务的公平性和效率产生了影响。这项研究显示了分析保健市场以了解医生从事专业活动的价值，并有助于为其监管提供证据基础。
Scarce evidence exists on the features, determinants and implications of physicians' dual practice, especially in resource-poor settings. This study considered dual practice patterns in three African cities and the respective markets for physician services, with the objective of understanding the influence of local determinants on the practice. Forty-eight semi-structured qualitative interviews were conducted in the three cities to understand features of the practice and the respective markets. A survey was carried out in a sample of 331 physicians to explore their characteristics and decisions to work in public and private sectors. Descriptive analysis and inferential statistics were employed to explore differences in physicians' engagement in dual practice across the three locations. Different forms of dual practice were found to exist in the three cities, with public physicians engaging in private practice outside but also inside public facilities, in regulated as well as unregulated ways. Thirty-four per cent of the respondents indicated that they worked in public practice only, and 11% that they engaged exclusively in private practice. The remaining 55% indicated that they engaged in some form of dual practice, 31% 'outside' public facilities, 8% 'inside' and 16% both 'outside' and 'inside'. Local health system governance and the structure of the markets for physician services were linked to the forms of dual practice found in each location, and to their prevalence. Our analysis suggests that physicians' decisions to engage in dual practice are influenced by supply and demand factors, but also by how clearly separated public and private markets are. Where it is possible to provide little-regulated services within public infrastructure, less incentive seems to exist to engage in the formal private sector, with equity and efficiency implications for service provision. The study shows the value of analysing health markets to understand physicians' engagement in professional activities, and contributes to an evidence base for its regulation.