What motivates physicians to propose private services in a mixed private-public healthcare system? A mixed methods study

Tal Michael,Dani Filc,Nadav Davidovitch

doi:10.1186/s12913-022-07474-9

Tal Michael, Dani Filc + Show 1 more

Open Access

https://doi.org/10.1186/s12913-022-07474-9

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Abstract

BackgroundImplementation of private elements, including private insurances, in public healthcare system is now common in many countries, and its impacts have been well studied. Little, however, is known about the motives leading physicians, major role players in the system, to promote the usage of private services. The aim of this study was to explore the various motives leading physicians within public systems to propose private services to their patients, while examining the possible associations to their specialty and level of commitment.MethodsA total of 197 physicians from specialisms loaded more to private/public sectors participated in a cross-sectional telephone survey regarding their attitudes on their practices, private insurances, access to healthcare, and job satisfaction. The association between the likert scale questions to their recommendation to purchase private insurance, and the commitment they felt towards patients were analyzed using Generalized Estimating Equations (GEE) as well as logistic regression models.ResultsOur findings suggest physicians engaged in dual practice are less likely to promote private insurances among their patients if they are satisfied with their public job (OR = 0.92, 95%CI 0.89,0.94). Physicians perceived private insurances as beneficial for patients, were found likely to promote them (OR = 1.65, %95CI 1.16, 2.35). The commitment physicians felt toward patients who paid out-of-pocket money was associated to their sense of being trusted and valued (OR = 1.99, 95%CI 1.33, 2.88; OR = 1.5, 95%CI 1.05, 2.13 respectively).ConclusionThis study suggests a deeper understanding of physicians’ daily experience of the private-public mix and it’s consequences, and could provide a platform for future studies. Further studies on physician’s role in health privatization processes are needed, and could aid policymakers in their efforts to strengthen healthcare systems around the world.

Highlights

Implementation of private elements, including private insurances, in public healthcare system is common in many countries, and its impacts have been well studied
Opponents of private-public mix (PPM) claim that imposing private-public collaboration on healthcare systems can lead to conflicts of interest, as services provided by private organizations are not always compatible with the values of the public system [5]
PPM comes in many forms, and choosing how to integrate private elements into the public sector system depends both on the role of public regulators and the degree of risk and responsibility the private sector is willing to take

Summary

Introduction

Implementation of private elements, including private insurances, in public healthcare system is common in many countries, and its impacts have been well studied. By assimilating the common habits of their predominant working framework, whether private or public, physicians who have specialism loaded more to the private sector would tend to offer their patients more private services than specialists loaded to the public sector This hypothesis was not confirmed in our study, as no significant difference was found in the proportions of physicians who would recommend PHI across the two sectors. Our study has found that, if physicians are discontented with their income levels, this can affect their decisions on whether to engage in dual practice, and the recommendations they make to their patients on a day-to-day basis Another factor that might play a role in these and related decisions is the sense of being valued

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