Negotiating markets for health

An exploration of physicians’ engagement in dual practice in three African capital cities

Bibliographic Data

ID11490474
AuthorsGiuliano Russo (0000-0002-2716-369X, Queen Margaret University, corresponding author), Barbara Mcpake (0000-0002-9904-1077, Queen Margaret University), Inês Fronteira (0000-0003-1406-4585, Queen Margaret University), Paulo Ferrinho, Paulo De Lyz Girou Martins Ferrinho (0000-0002-3722-0803, Queen Margaret University)
Year2014
Volume29
Issue6
Pages774-783
Publication date2014-09-01
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/czt071
PMID24077880
PMCIDPMC4153303
OpenAlexW2163314921
LanguageEN
Citations received12
References cited22

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.

Business · Corporate governance · Dual (grammatical number) · Family medicine · Negotiation · Political science · Private practice · Public health · Public relations · Sociology · Finance · Global Health Workforce Issues · Healthcare Policy and Management · Medicine · Nursing · Primary Care and Health Outcomes