Abstract
ObjectiveTo examine in Peru the nature of dual practice (doctors holding two jobs at once – usually public sector doctors with private practices), the factors that influence individuals' decisions to undertake dual practice, the conditions faced when doing so and the potential role of regulatory intervention in this area.MethodsThe study entailed qualitative interviews with a sample of twenty medical practitioners based in metropolitan Lima, representing a cross-section of those primarily employed in either the private or public sectors and engaged in clinical practice or policy making. The interviews focused on:1. individuals' experience with dual practice;2. the general underlying pressures that influence the nature and extent of such activities; and3. attitudes toward, and the influence of, regulation on such activities.ResultsDual practice is an activity that is widespread and well-accepted, and the prime personal motivation is financial. However, there are also a number of important broad macroeconomic influences on dual practice particularly the oversupply of medical services, the deregulated nature of this market, and the economic crisis throughout the country, which combine to create major hardships for those attempting to make a living through medical practice. There is some support among doctors for tighter regulation.ConclusionResearch findings suggest appropriate policy responses to dual practice involve tighter controls on the supply of medical practitioners; alleviation of financial pressures brought by macro-economic conditions; and closer regulation of such activities to ensure some degree of collective action over quality and the maintenance of professional reputations. Further research into this issue in rural areas is needed to ascertain the geographical generalizability of these policy responses.
Highlights
The population of Peru as estimated in the 2005 census was 26 million [13]
Research findings suggest appropriate policy responses to dual practice involve tighter controls on the supply of medical practitioners; alleviation of financial pressures brought by macro-economic conditions; and closer regulation of such activities to ensure some degree of collective action over quality and the maintenance of professional reputations
Individuals' experience with dual practice Many of the interviewees confirmed the common view that dual practice is widespread amongst public sector doctors: Table 1: Summary table of results
Summary
The population of Peru as estimated in the 2005 census was 26 million [13]. In 1996 there were 9.8 physicians per 10,000 population the distribution was uneven across the country. In Lima the rate was 17.3 per 10,000, while in more impoverished areas of the country such as Huancavelica, Apurimac and Cajamarca the rates were 2.8, 2.8 and 3.1 respectively [14]. The health system in Peru broadly comprises three sectors: the Ministry of Health, the Peruvian social security institute (EsSALUD) and the private sector. Until 1968, Lima's main hospitals were managed by religious orders and were charitable private institutions. In 1968, the national health system was created: hospitals were transformed into being part of the national public health system with doctors within them becoming public servants [15]. Recent official statistics suggest that 66% of physicians are primarily employed in government institutions, the private sector in physician services has again become more prominent [16]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
