Abstract
Long wait times and crowding are major issues affecting outpatient service delivery, but it is unclear how these affect patients in dual practice settings. This study aims to evaluate the effects of changing consultation start time and patient arrival on wait times and crowding in an outpatient clinic with a dual practice system. A discrete event simulation (DES) model was developed based on real-world data from an Obstetrics and Gynaecology (O&G) clinic in a public hospital. Data on patient flow, resource availability, and time taken for registration and clinic processes for public and private patients were sourced from stakeholder discussion and time-motion study (TMS), while arrival times were sourced from the hospital’s information system database. Probability distributions were used to fit these input data in the model. Scenario analyses involved configurations on consultation start time/staggered patient arrival. The median registration and clinic turnaround times (TT) were significantly different between public and private patients (p < 0.01). Public patients have longer wait times than private patients in this study’s dual practice setting. Scenario analyses showed that early consultation start time that matches patient arrival time and staggered arrival could reduce the overall TT for public and private patients by 40% and 21%, respectively. Similarly, the number of patients waiting at the clinic per hour could be reduced by 10–21% during clinic peak hours. Matching consultation start time with staggered patient arrival can potentially reduce wait times and crowding, especially for public patients, without incurring additional resource needs and help narrow the wait time gap between public and private patients. Healthcare managers and policymakers can consider simulation approaches for the monitoring and improvement of healthcare operational efficiency to meet rising healthcare demand and costs.
Highlights
Malaysia has a hybrid healthcare system consisting of public and private healthcare delivery systems
The growth of the private healthcare sector has partly contributed to the issue of brain drain of skilled health workforce from the public healthcare sector, creating a need for policy changes to address this, with one of them being the introduction of dual practice within the public healthcare system
Dual practice in public hospitals has been established in Malaysia since 2007 with an overarching objective to retain specialists serving under the Ministry of Health (MOH) Malaysia
Summary
Malaysia has a hybrid healthcare system consisting of public and private healthcare delivery systems. The public healthcare system has provided near-universal access to quality healthcare services for free or with a nominal fee over the years despite low levels of government financing for health [1]. Senior specialists who wish to provide private services on top of public services would receive remuneration through fee-for-service in addition to their fixed monthly salaries. Under the dual practice regulations, specialists are restricted to providing private services after the completion of public service provision to ensure that private services do not affect public care provision and resource use [2]. The existence of different patient queues as well as sharing of public healthcare facilities and resources among public and private patients in dual practice settings may inadvertently affect healthcare service access and efficiency if services are not well-regulated [3,4,5]
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