How and why public sector doctors engage in private practice in Portuguese-speaking African countries

OBJECTIVE: To explore the type of private practice supplementary income-generating activities of public sector doctors in the Portuguese-speaking African countries, and also to discover the motivations and the reasons why doctors have not made a complete move out of public service. DESIGN: Cross-sectional qualitative survey. SUBJECTS: In 1996, 28 Angolan doctors, 26 from Guinea-Bissau, 11 from Mozambique and three from S Tomé and Principe answered a self-administered questionnaire. RESULTS: All doctors, except one unemployed, were government employees. Forty-three of the 68 doctors that answered the questionnaire reported an income-generating activity other than the one reported as principal. Of all the activities mentioned, the ones of major economic importance were: public sector medical care, private medical care, commercial activities, agricultural activities and university teaching. The two outstanding reasons why they engage in their various side-activities are 'to meet the cost of living' and 'to support the extended family'. Public sector salaries are supplemented by private practice. Interviewees estimated the time a family could survive on their public sector salary at seven days (median value). The public sector salary still provides most of the interviewees income (median 55%) for the rural doctors, but has become marginal for those in the urban areas (median 10%). For the latter, private practice has become of paramount importance (median 65%). For 26 respondents, the median equivalent of one month's public sector salary could be generated by seven hours of private practice. Nevertheless, being a civil servant was important in terms of job security, and credibility as a doctor. The social contacts and public service gave access to power centres and resources, through which other coping strategies could be developed. The expectations regarding the professional future and regarding the health systems future were related mostly to health personnel issues. CONCLUSION: The variable response rate per question reflects some resistance to discuss some of the issues, particularly those related to income. Nevertheless, these studies may provide an indication of what is happening in professional medical circles in response to the inability of the public sector to sustain a credible system of health care delivery. There can be no doubt that for these doctors the notion of a doctor as a full-time civil-servant is a thing of the past. Switching between public and private is now a fact of life.     

Patient satisfaction in VA medical centers and private sector hospitals: a comparison

For the first time, we have data that can validly compare the satisfaction level of inpatients in Department of Veterans Affairs (VA) medical centers and private sector hospitals. It shows the satisfaction levels to be very similar. Since the VA will soon be changing its survey, this has been a very short time window. It may never recur. In addition to the general finding, there are some interesting comparisons regarding specific questions. For example, satisfaction with VA physicians, who are salaried and assigned to patients, is just as high as satisfaction with private physicians who are paid by fee and selected by the patient. This would seem to be critical information in the debate over U.S. health care reform.     

Regulation of the private health sector in India

The expansion of the private sector in India has forced the passages of a number of regulations to promote quality of care and protect consumers. This has expanded the role of government in developing and enforcing regulations in three areas of the health sector: drugs, medical practice, and health facilities. These regulations have been promulgated by both national and state governments. Three particular Acts are examined: the Consumer Protection Act, Medical Councils, and the Nursing Home Act. These Acts have provided basic guidelines for regulation of certain aspects of the health sector, but have also created new challenges, as consumers have become more involved in monitoring health service delivery. The challenge for the future will be to ensure the quality and efficiency of health services in both the public and private sectors through these regulatory mechanisms while seeking to promote national health objectives.     

Physician perceptions of managed care strategies, and impact of these on their clinical performance, in the South African private health sector.

Managed care strategies have been introduced into the South African private health sector a decade ago to help reduce medical costs in this sector. A cross-sectional survey using a self-administered questionnaire was conducted among primary care physicians in this sector to access their perceptions of these strategies and to analyse impact of these on their clinical behaviour. The results indicate that although insurers were not using these strategies extensively, doctors generally perceived them negatively. It was, however, pleasing to note that the newer generation of doctors, appear to be more accepting of this new philosophy of health-care delivery.     

Working with the private sector for child health

Private sector providers are the most commonly consulted source of care for child illnesses in many countries, offering significant opportunities to expand the reach of essential child health services and products. Yet collaboration with private providers presents major challenges - the suitability and quality of the services they provide is often questionable and governments' capacity to regulate them is limited. This article assesses the actual and potential contributions of the private sector to child health, and classifies and evaluates public sector strategies to promote and rationalize the contributions of private sector actors. Governments and international organizations can use a variety of strategies to collaborate with and influence private sector actors to improve child health - including contracting, regulating, financing and social marketing, training, coordinating and informing the public. These mutually reinforcing strategies can both improve the quality of services currently delivered in the private sector, and expand and rationalize the coverage of these services. One lesson from this review is that the private sector is very heterogeneous. At the country level, feasible strategies depend on the potential of the different components of the private sector and the capacity of governments and their partners for collaboration. To date, experience with private sector strategies offers considerable promise for children's health, but also raises many questions about the feasibility and impact of these strategies. Where possible, future interventions should be designed as experiments, with careful assessment of the intervention design and the environment in which they are implemented.     

Work satisfaction of professional nurses in South Africa: a comparative analysis of the public and private sectors

Background  

Work satisfaction of nurses is important, as there is sufficient empirical evidence to show that it tends to affect individual, organizational and greater health and social outcomes. Although there have been several studies of job satisfaction among nurses in South Africa, these are limited because they relate to studies of individual organizations or regions, use small samples or are dated. This paper presents a national study that compares and contrasts satisfaction levels of nurses in both public and private sectors.     

Behaviour of the private sector in the health market of Bombay

In Bombay, the private sector plays a major role in providingmedical care to all strata of society and these services arewell utilized by everyone. Of late there have been criticismsabout the quality of private medical care and there is a needfor a proper policy on the development and regulation of privatesector health services. This paper contributes to this by unravellingthe inadequacies in the medical infrastructure and manpower,and highlighting the unethical medical practice rampant in privatepractice. The paper also assesses the existing regulatory mechanismsand their inability to control the quality of private sectormedical care. After exposing the behaviour of the private sector,the paper suggests a holistic policy approach to increase andstrengthen the public sector health services in poor areas,to develop norms to maintain quality in medical infrastructureand manpower, and to discipline unethical professional behaviour.     

The diffusion of new medical technologies in the private sector of the U.K. health care system

Eleven percent of the U.K. population holds private health care insurance, and 2.2 billion Pounds are spent annually in the acute sector of private health care. Although isolated from policy discussions about new medical technology in the National Health Service, the private sector encounters these interventions regularly. During 18 months in one company, a new medical technology was encountered on average every week; 59 leading edge technologies were submitted for authorization (18 on multiple occasions). There are certain constraints on purchasers of health care in the private sector in dealing with new technology; these include fragmentation of the sector, differing rationalities within companies about limitations on eligibility of new procedures while competing for business, the role and expertise of the medical adviser, and demands of articulate customers. A proactive approach by the private sector to these challenges is hampered by its independence. Poor communication between the public and private sectors, and the lack of a more inclusive approach to policy centrally, undermine the rational diffusion and use of new medical technology in the U.K. health care system.     

四川省民营医院医务人员工作满意度调查研究

目的 通过对四川省民营医院医务人员的工作满意度进行调查,探讨影响因素,为提升民营医院医务人员工作满意度,稳定人才队伍提供参考。方法 采用多阶段分层抽样,对四川省民营医院4 908名医务人员进行满意度问卷调查,并采用t检验和方差分析研究其工作满意度及影响因素。结果 民营医院医务人员总满意度较低,为(3.13±0.26)分,其中低年龄(F=12.460,P<0.001)、低职称(F=9.066,P<0.001)、低收入(F=36.487,P<0.001)、非临床岗(F=20.325,P<0.001)、临聘人员(F=9.277,P<0.001)对工作的总体满意度不高。各维度中,满意度平均得分最高的是:工作环境(3.62±0.73)分,满意度平均得分后三位分别是:安全(2.67±0.77)分、工作成就(2.67±0.79)分、工作压力(2.69±0.77)分。 结论 四川省民营医院医务人员的总体工作满意度低于公立医院,其中低年龄、低职称、低收入、非临床岗、临聘人员满意度是重点关注人群。民营医院需要重点聚焦医务人员的工作压力、工作成就和安全三方面,采取措施提升满意度。     

The role of health insurance in the growth of the private health sector in Korea

The Korean health care system has been recognized by other countries for its rapid expansion of national health insurance. The government's policy of promoting the private sector, relying on market forces for various allocation decisions, and using the fee-for-service payment system has created a number of challenges for the Korean health system. Among these are rapid growth of health care expenditure, proliferation and duplication of medical technology, and lack of access for low-income groups due to high out-of-pocket payments for services covered by insurance. A number of recommendations are made concerning national health policy, modifying health insurance, and developing political consensus for bringing about health reform.     

The first private sector health insurance company in Ghana

This article analyses the development of Ghana's first private sector health insurance company, the Nationwide Medical Insurance Company. Taking both policy and practical considerations into account (stakeholders' perspectives, economic viability, equity and efficiency), it is structured around key questions which help to define the position and roles of stakeholders--the insurance agency itself, contributors, beneficiaries, and providers--and how they relate to one another and the insurance scheme. These relationships will to a large extent determine Nationwide's long-term success or failure. By creating a unique alliance between physician providers and private sector companies, Nationwide has used employers' interest in cost containment and physicians' interest in expanding their client base as an entrée into the virgin territory of health insurance, and created a hybrid variety of private sector insurance with some of the attributes of a health maintenance organization or managed care. The case study is unusual in that, while public sector programs are often open to academic scrutiny, researchers have rarely had access to detailed data on the establishment of a single private sector insurance company in a developing country. Given that Ghana is planning to launch a national health insurance plan, the article concludes by considering what the experience of this private sector initiative might have to offer public sector planners.     

Work satisfaction and physical health

This analysis asks how satisfaction with one's main work role (whether that is a paid job or housework) is related to physical health. Data from a Detroit survey show that: (1) Dissatisfied people have poorer health status and take more curative health actions than do satisfied people. The dissatisfied people have higher health risks due to more smoking, drinking, and stress, and they also have health attitudes that encourage symptom perception. Poorer health explains why they take more curative actions; they actually have less faith in the value of medical care and restricted activity and less access to care than do satisfied people. (2) Work satisfaction is more important for nonemployed people than employed ones. Dissatisfied homemakers have especially numerous symptoms and high drug use. And dissatisfied, nonemployed men report a great deal of recent restricted activity and medical care. The data suggest that the homemakers focus on their day-to-day symptoms and try to relieve them by drugs; on the other hand, poor health has forced the men to quit work, and they are very unhappy about the situation. (3) Women (whether they are employed or homemakers) are more sensitive to work satisfaction than are employed men. Apparently employed men adjust better to job stresses and suffer few health consequences, whereas women cannot buffer their dissatisfactions as well. In summary, the Detroit data indicate that work satisfaction is related to good health for both sexes, and that being a dissatisfied homemaker poses especially high risks of poor health.