Who are more responsive? Mixed-methods comparison of public and private sector physicians in rural Bangladesh

Bibliographic Data

ID11491935
AuthorsTaufique Joarder (0000-0002-3299-2628, Johns Hopkins University, corresponding author), Asha George (0000-0002-5968-1424, Western Cape Department of Health), Malabika Sarker (0000-0001-7293-8805, BRAC University), Saifuddin Ahmed (0000-0001-6372-213X, Johns Hopkins University), David H Peters (0000-0001-8377-3444, Johns Hopkins University)
Year2017
Volume32
Issuesuppl_3
Pagesiii14-iii24
Publication date2017-11-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czx111
PMID29149312
OpenAlexW2768548832
LanguageEN
Citations received2
References cited35

Responsiveness of physicians (ROPs) reflects the social actions by physicians to meet the legitimate expectations of health care users. Responsiveness is important since it improves understanding and care seeking by users, as well as fostering trust in health systems rather than replicating discrimination and entrenching inequality. Given widespread public and private sector health care provision in Bangladesh, we undertook a mixed-methods study comparing responsiveness of public and private physicians in rural Bangladesh. The study included in-depth interviews with physicians (n = 12, seven public, five private) and patients (n = 7, three male, four female); focus group discussions with users (four sessions, two male and two female); and observations in consultation rooms of public and private sector physicians (1 week in each setting). This was followed by structured observation of patient consultations with 195 public and 198 private physicians using the ROPs Scale, consisting of five domains (Friendliness; Respecting; Informing and guiding; Gaining trust; and Financial sensitivity). Qualitative data were analysed by framework analysis and quantitative data were analyzed using two-sample t-test, multiple linear regression, multivariate analysis of variance, and descriptive discriminant analyses. The mean responsiveness score of public sector physicians was statistically different from private sector physicians: -0.29 vs 0.29, i.e. a difference of - 0.58 (P-value < 0.01; 95% CI - 0.77, -0.39) on a normalized scale. Despite relatively higher level of responsiveness of private sector, according to qualitative findings, neither of the sectors performed optimally. Private physicians scored higher in Friendliness, Respecting and Informing and guiding; while public sector physicians scored higher in other domains. 'Respecting' domain was found as the most important. Unlike findings from other studies in Bangladesh, instead of seeing one sector as better than the other, this study identified areas of responsiveness where each sector needs improvements.

Business · Descriptive statistics · Economic growth · Economics · Family medicine · Focus group · Geography · Health care · Multivariate analysis · Multivariate analysis of variance · Political science · Private sector · Public health · Public sector · Qualitative property · Scale (ratio) · Healthcare Policy and Management · Marketing · Medicine · Nursing · Patient Satisfaction in Healthcare · Patient-Provider Communication in Healthcare · Psychology