The quality of care in outpatient primary care in public and private sectors in Malaysia

2019 ◽  
Author(s):  
May Chien Chin ◽  
Sheamini Sivasampu ◽  
Nilmini Wijemunige ◽  
Ravindra P Rannan-Eliya ◽  
Rifat Atun
Keyword(s):  
Primary Care ◽  
Public Sector ◽  
Private Sector ◽  
Clinical Care ◽  
Developed Countries ◽  
Prescribing Practices ◽  
Public And Private ◽  
The Public ◽  
The Usa

Abstract In Malaysia, first-contact, primary care is provided by parallel public and private sectors, which are completely separate in organization, financing and governance. As the country considers new approaches to financing, including using public schemes to pay for private care, it is crucial to examine the quality of clinical care in the two sectors to make informed decisions on public policy. This study intends to measure and compare the quality of clinical care between public and private primary care services in Malaysia and, to the extent possible, assess quality with the developed economies that Malaysia aspires to join. We carried out a retrospective analysis of the National Medical Care Survey 2014, a nationally representative survey of doctor–patient encounters in Malaysia. We assessed clinical quality for 27 587 patient encounters using data on 66 internationally validated quality indicators. Aggregate scores were constructed, and comparisons made between the public and private sectors. Overall, patients received the recommended care just over half the time (56.5%). The public sector performed better than the private sector, especially in the treatment of acute conditions, chronic conditions and in prescribing practices. Both sectors performed poorly in the indicators that are most resource intensive, suggesting that resource constraints limit overall quality. A comparison with 2003 data from the USA, suggests that performance in Malaysia was similar to that a decade earlier in the USA for common indicators. The public sector showed better performance in clinical care than the private sector, contrary to common perceptions in Malaysia and despite providing worse consumer quality. The overall quality of outpatient clinical care in Malaysia appears comparable to other developed countries, yet there are gaps in quality, such as in the management of hypertension, which should be tackled to improve overall health outcomes.

scholarly journals Contraction and Expansion: The Divergence of Private Sector and Public Sector Unionism in the United States

1988 ◽  
Vol 2 (2) ◽  
pp. 63-88 ◽  
Author(s):  
Richard B Freeman
Keyword(s):  
United States ◽  
Public Sector ◽  
Private Sector ◽  
Developed Countries ◽  
The United States ◽  
Public And Private ◽  
The Public ◽  
Union Status ◽  
Contraction And Expansion ◽  
Public Sector Unionism

The institutional structure of the American labor market changed remarkably from the 1950s and 1960s to the 1980s. What explains the decline in union representation of private wage and salary workers? Why have unions expanded in the public sector while contracting in the private sector? Is the economy-wide fall in density a phenomenon common to developed capitalist economies, or is it unique to the United States? To what extent should economists alter their views about what unions do to the economy in light of the fact that they increasingly do it in the public sector? To answer these questions I examine a wide variety of evidence on the union status of public and private workers. I contrast trends in unionization in the United States with trends in other developed countries, particularly Canada, and use these contrasts and the divergence between unions in the public and private sectors of the United States to evaluate proposed explanations.

scholarly journals Hedonic indexes for public and private housing in Costa Rica

2017 ◽  
Vol 10 (1) ◽  
pp. 140-155
Author(s):  
Porfirio Guevara ◽  
Robert Hill ◽  
Michael Scholz
Keyword(s):  
Costa Rica ◽  
Public Sector ◽  
Private Sector ◽  
Public Housing ◽  
Public And Private ◽  
Content Type ◽  
The Public ◽  
Private Housing ◽  
Public And Private Sector

Purpose This study aims to show how hedonic methods can be used to compare the performance of the public and private sector housing markets in Costa Rica. Design/methodology/approach Hedonic price indexes are computed using the adjacent-period method. Average housing quality is measured by comparing hedonic and median price indexes. The relative performance of the public and private sector residential construction is compared by estimating separate hedonic models for each sector. A private sector price is then imputed for each house built in the public sector, and a public sector price is imputed for each house built in the private sector. Findings The real quality-adjusted price of private housing rose by 12 per cent between 2000 and 2013, whereas the price of private housing rose by 9 per cent. The average quality of private housing rose by 45 per cent, whereas that of public housing fell by 18 per cent. Nevertheless, the hedonic imputation analysis reveals that public housing could not be produced more cheaply in the private sector. Social implications The quality of public housing has declined over time. The hedonic analysis shows that the decline is not because of a lack of competition between construction firms in the public sector. An alternative demand side explanation is provided. Originality/value This study applies hedonic methods in novel ways to compare the relative performance of the public and private housing sectors in Costa Rica. The results shed new light on the effectiveness of public sector housing programs.

scholarly journals Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ka Chun Chong ◽  
Hong Fung ◽  
Carrie Ho Kwan Yam ◽  
Patsy Yuen Kwan Chau ◽  
Tsz Yu Chow ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Public Sector ◽  
System Dynamics ◽  
The Elderly ◽  
Healthcare Services ◽  
Dynamics Simulation ◽  
Public And Private ◽  
The Public ◽  
The Impact

Abstract Background The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme. Methods Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources. Results The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period. Conclusions Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.

Relationship between CSR motivations and corporate social performance: a study in the power industry in India

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Moumita Acharyya ◽  
Tanuja Agarwala
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Corporate Social Performance ◽  
Social Performance ◽  
Power Sector ◽  
Public And Private ◽  
Content Type ◽  
The Public ◽  
Self Interest ◽  
Public And Private Sector

PurposeThe paper aims to understand the different motivations / reasons for engaging in CSR initiatives by the organizations. In addition, the study also examines the relationship between CSR motivations and corporate social performance (CSP).Design/methodology/approachThe data were collected from two power sector organizations: one was a private sector firm and the other was a public sector firm. A comparative analysis of the variables with respect to private and public sector organizations was conducted. A questionnaire survey was administered among 370 employees working in the power sector, with 199 executives from public sector and 171 from private sector.Findings“Philanthropic” motivation emerged as the most dominant CSR motivation among both the public and private sector firms. The private sector firm was found to be significantly higher with respect to “philanthropic”, “enlightened self-interest” and “normative” CSR motivations when compared with the public sector firms. Findings suggest that public and private sector firms differed significantly on four CSR motivations, namely, “philanthropic”, “enlightened self-interest”, “normative” and “coercive”. The CSP score was significantly different among the two power sector firms of public and private sectors. The private sector firm had a higher CSP level than the public sector undertaking.Research limitations/implicationsFurther studies in the domain need to address differences in CSR motivations and CSP across other sectors to understand the role of industry characteristics in influencing social development targets of organizations. Research also needs to focus on demonstrating the relationship between CSP and financial performance of the firms. Further, the HR outcomes of CSR initiatives and measurement of CSP indicators, such as attracting and retaining talent, employee commitment and organizational climate factors, need to be assessed.Originality/valueThe social issues are now directly linked with the business model to ensure consistency and community development. The results reveal a need for “enlightened self-interest” which is the second dominant CSR motivation among the organizations. The study makes a novel contribution by determining that competitive and coercive motivations are not functional as part of organizational CSR strategy. CSR can never be forced as the very idea is to do social good. Eventually, the CSR approach demands a commitment from within. The organizations need to emphasize more voluntary engagement of employees and go beyond statutory requirements for realizing the true CSR benefits.

Research from China finds no significant difference in impact of public service motivation (PSM) in public and private sectors

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Employee Performance ◽  
Intention To Leave ◽  
Public And Private ◽  
Content Type ◽  
The Public ◽  
Significant Difference ◽  
Set Up ◽  
The Impact

Purpose The authors assumed PSM would be higher in the public sector, but they set up a trial to find out if this was the case. Design/methodology/approach To test their theories, the authors conducted two independent surveys. The first consisted of 220 usable responses from public sector employees in Changsha, China. The second survey involved 260 usable responses from private sector employees taking an MBA course at a university in the Changsha district. A questionnaire was used to assess attitudes. Findings The results found no significant difference between the impact of public sector motivation (PSM) on employee performance across the public and private sectors. The data showed that PSM had a significant impact on self-reported employee performance, but the relationship did not differ much between sectors. Meanwhile, it was in the private sector that PSM had the greatest impact on intention to leave. Originality/value The authors said the research project was one of the first to test if the concept of PSM operated in the same way across sectors. It also contributed, they said, to the ongoing debate about PSM in China.

scholarly journals Evaluation of rational prescribing and dispensing of medicines in Mali

2017 ◽  
Author(s):  
Yaya Coulibaly ◽  
Fanta Sangho ◽  
Aboubacar Alassane Oumar
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Treatment Guidelines ◽  
Generic Drugs ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical Practitioners ◽  
The Public ◽  
Quality Of Prescribing

Objective: The drug policy of Mali is based on the concept of essential generic drugs. The adoption of generic drugs in a program is often accompanied by irrational use of these drugs precisely because of the availability of these drugs. Thus, this study was initiated to assess the quality of prescribing and dispensing drugs in Mali. Methods: This is a descriptive cross-sectional study was conducted from 2004 to 2013, the survey was conducted in 20 primary health centers and 20 private pharmacies in three regions of the country. In each of these structures, 30 prescriptions filled at the time of the survey were collected. Results: The average number of drugs per prescription was 3.0 ± 1.3 and 2.4 ± 1.2, respectively, in the public and private sectors. Prescription of drugs under international name was 91.6% in the public sector and 37.2% in the private sector. The public sector prescribed 33.7% of injectable drug against 16.2% in the private sector (p <0.001). The average cost of a prescription was lower in the public sector (3415.3 FCFA or 5.21euros) than in the private sector (7111 FCFA or 10.85 euros).Conclusion: Generic drugs are commonly used in the public, but much less in the private sector. The treatment guidelines are already available, should be introduced interactively to medical practitioners, through visits and intensive supervision by more experienced managers in the hierarchy, it would be likely to improve the quality of prescribing practitioners.

scholarly journals Public Sector Finances as Determinants of Private Investment in PPP Projects – Experiences from Select Countries

2019 ◽  
pp. 1-17
Author(s):  
Satinder Bhatia
Keyword(s):  
Developing Countries ◽  
Public Sector ◽  
Private Sector ◽  
Private Investment ◽  
Developed Countries ◽  
Financial Health ◽  
Indian States ◽  
Checks And Balances ◽  
Private Partnership ◽  
The Public

Public-Private Partnership (PPP) projects have been gaining in popularity in many developing countries along with developed countries. While there has been sufficient research on private sector capacity to make the partnership successful, not much research exists on the importance of the financial health of the public sector in PPP projects. The premise of the current research is that strong public sector finances instil confidence in the private sector of governments’ ability to honour PPP commitments and that, in turn, increases the attractiveness of PPP projects. Through a number of case studies relating to government finances of Indian states and other countries, it is seen that governments which have checks and balances to issuance of guarantees and other forms of indirect support for PPP projects are actually able to attract higher levels of PPP investment.

Public-Private-Academic Cooperation as a Trust Building Mechanism

2016 ◽  
pp. 199-223
Author(s):  
Nicholas Virzi ◽  
Juan Portillo ◽  
Mariela Aguirre
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Trust Building ◽  
Public And Private ◽  
The Public ◽  
National Competitiveness ◽  
Working Together ◽  
The Government ◽  
Innovation And Entrepreneurship

The chapter will be a case study from an Ordoliberal perspective of the conception, implementation and policy output of the newly created Private Council of Competitiveness (PCC) in Guatemala, a country wracked by mistrust of the public sector by the private sector. The PCC was founded as a private sector initiative, in conjunction with academia, to work with the government to spawn new efforts aimed at augmenting Guatemala's national competitiveness, by fomenting innovation, entrepreneurship and closer ties between academia and the public and private sectors. The chapter utilizes first hand interviews with the members of the PCC and key public sector players, academics, and other top representatives from the private sector to show how working together built the trust necessary to make the PCC a successful working body with the potential to produce important initiatives in matters of competitiveness, innovation and entrepreneurship.

Underlying values and competencies of public and private sector managers

2016 ◽  
Vol 5 (4) ◽  
pp. 371-387 ◽  
Author(s):  
Sean D. Darling ◽  
J. Barton Cunningham
Keyword(s):  
Decision Making ◽  
Public Sector ◽  
Private Sector ◽  
Critical Incident ◽  
Visionary Leadership ◽  
Political Environment ◽  
Public And Private ◽  
Content Type ◽  
The Public ◽  
Public And Private Sector

Purpose The purpose of this paper is to identify unique values and competencies linked to private and public sector environments. Design/methodology/approach This study is based on critical incident interviews with a sample of senior leaders who had experience in both the public and private sectors. Findings The findings illustrate distinct public and private sector relevant competencies that reflect the unique values of their organizations and the character of the organization’s environments. This paper suggests a range of distinct public sector competencies including: managing competing interests, managing the political environment, communicating in a political environment, interpersonal motivational skills, adding value for clients, and impact assessment in decision-making. These were very different than those identified as critical for the private sector environment: business acumen, visionary leadership, marketing communication, market acumen, interpersonal communication, client service, and timely and opportunistic decision-making. Private sector competencies reflect private sector environments where goals need to be specifically defined and implemented in a timely manner related to making a profit and surviving in a competitive environment. Public sector competencies are driven by environments exhibiting more complex and unresolvable problems and the need to respond to conflicting publics and serving the public good while surviving in a political environment. Originality/value A key message of this study is that competency frameworks need to be connected to the organization’s unique environments and the values that managers are seeking to achieve. This is particularly important for public organizations that have more complex and changing environments.

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