scholarly journals Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kerensa Govender ◽  
Sarah Girdwood ◽  
Daniel Letswalo ◽  
Lawrence Long ◽  
G. Meyer-Rath ◽  
...  
Keyword(s):  
South Africa ◽  
Health Insurance ◽  
Private Sector ◽  
Low Income ◽  
Primary Healthcare ◽  
Public Facility ◽  
Public And Private ◽  
The Public ◽  
Factors Influencing ◽  
Private And Public

Abstract Background The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice. Methods We conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income mostly uninsured patient population) and their matched public PHC clinic (7 facilities). Results The majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice. Conclusions It is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI.

scholarly journals Primary Healthcare Seeking Behaviour of Low-income, Uninsured Patients Across the Public and Private Health Sectors in South Africa

2020 ◽  
Author(s):  
Kerensa Govender ◽  
Sarah Girdwood ◽  
Daniel Letswalo ◽  
Lawrence Long ◽  
G Meyer-Rath ◽  
...  
Keyword(s):  
South Africa ◽  
Health Insurance ◽  
Private Sector ◽  
Low Income ◽  
Primary Healthcare ◽  
Uninsured Patients ◽  
Public And Private ◽  
The Public ◽  
Factors Influencing ◽  
Private And Public

Abstract Background: The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, uninsured patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice. Methods: We conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income uninsured patient population) and their matched public PHC clinic (7 facilities). Results: The majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice. Conclusions: It is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI.

scholarly journals Evaluating the impact of the nationwide public–private mix (PPM) program for tuberculosis under National Health Insurance in South Korea: A difference in differences analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (7) ◽  
pp. e1003717
Author(s):  
Sarah Yu ◽  
Hojoon Sohn ◽  
Hae-Young Kim ◽  
Hyunwoo Kim ◽  
Kyung-Hyun Oh ◽  
...  
Keyword(s):  
South Korea ◽  
Private Sector ◽  
Treatment Outcomes ◽  
Difference In Differences ◽  
Public And Private ◽  
The Public ◽  
Tb Control ◽  
Tb Treatment ◽  
Private And Public ◽  
Public Private Mix

Background Public–private mix (PPM) programs on tuberculosis (TB) have a critical role in engaging and integrating the private sector into the national TB control efforts in order to meet the End TB Strategy targets. South Korea’s PPM program can provide important insights on the long-term impact and policy gaps in the development and expansion of PPM as a nationwide program. Methods and findings Healthcare is privatized in South Korea, and a majority (80.3% in 2009) of TB patients sought care in the private sector. Since 2009, South Korea has rapidly expanded its PPM program coverage under the National Health Insurance (NHI) scheme as a formal national program with dedicated PPM nurses managing TB patients in both the private and public sectors. Using the difference in differences (DID) analytic framework, we compared relative changes in TB treatment outcomes—treatment success (TS) and loss to follow-up (LTFU)—in the private and public sector between the 2009 and 2014 TB patient cohorts. Propensity score matching (PSM) using the kernel method was done to adjust for imbalances in the covariates between the 2 population cohorts. The 2009 cohort included 6,195 (63.0% male, 37.0% female; mean age: 42.1) and 27,396 (56.1% male, 43.9% female; mean age: 45.7) TB patients in the public and private sectors, respectively. The 2014 cohort included 2,803 (63.2% male, 36.8% female; mean age: 50.1) and 29,988 (56.5% male, 43.5% female; mean age: 54.7) patients. In both the private and public sectors, the proportion of patients with transfer history decreased (public: 23.8% to 21.7% and private: 20.8% to 17.6%), and bacteriological confirmed disease increased (public: 48.9% to 62.3% and private: 48.8% to 58.1%) in 2014 compared to 2009. After expanding nationwide PPM, absolute TS rates improved by 9.10% (87.5% to 93.4%) and by 13.6% (from 70.3% to 83.9%) in the public and private sectors. Relative to the public, the private saw 4.1% (95% confidence interval [CI] 2.9% to 5.3%, p-value < 0.001) and −8.7% (95% CI −9.7% to −7.7%, p-value <0.001) higher rates of improvement in TS and reduction in LTFU. Treatment outcomes did not improve in patients who experienced at least 1 transfer during their TB treatment. Study limitations include non-longitudinal nature of our original dataset, inability to assess the regional disparities, and verify PPM program’s impact on TB mortality. Conclusions We found that the nationwide scale-up of the PPM program was associated with improvements in TB treatment outcomes in the private sector in South Korea. Centralized financial governance and regulatory mechanisms were integral in facilitating the integration of highly diverse South Korean private sector into the national TB control program and scaling up of the PPM intervention nationwide. However, TB care gaps continued to exist for patients who transferred at least once during their treatment. These programmatic gaps may be improved through reducing administrative hurdles and making programmatic amendments that can help facilitate management TB patients between institutions and healthcare sectors, as well as across administrative regions.

scholarly journals Work as a central life interest for legal professionals

2005 ◽  
Vol 31 (1) ◽  
Author(s):  
Jacques Genis ◽  
Taryn Wallis
Keyword(s):  
South Africa ◽  
Public Sector ◽  
Law Firms ◽  
Work Centrality ◽  
Public And Private ◽  
Legal Professionals ◽  
The Public ◽  
Public Sector Employees ◽  
Private And Public ◽  
Two Sectors

Dubin’s theory of Central Life Interests (CLIs) was used to investigate whether work is a CLI for legal professionals in South Africa. The research also served as a comparative exploration between the public and private sectors based on their work centrality and work orientation. 59 employees from three public sector organisations and 27 employees from various private sector law firms completed questionnaires. Contrary to Dubin’s theory, results indicated that two-thirds of respondents did not have work as a CLI. Also, contrary to previous work on private and public sector employees, some interesting similarities emerged between the two sectors. Opsomming Dubin (1992) se teorie van Sentrale Lewensbelangstellings was gebruik om te ondersoek of werk ’n sentrale lewensbelangstelling is vir individue in die Suid-Afrikaanse regsprofessie. Die navorsing was ook ’n vergelykende ondersoek tussen die publieke en privaat sektore met betrekking tot hul werk sentraliteit en werk orientasie. 59 werknemers van drie publieke organisasies en 27 werknemers van verskeie privaat firmas het vraelyse beantwoord. Teenstellig met Dubin se teorie het resultate gewys dat vir twee-derdes van die deelnemers werk nie ’n sentrale lewensbelangstelling was nie. Daar was ook interessante resultate wat te voorskyn gekom het, wat teenstrydig was met vorige navorsing op werknemers in die privaat en publieke sektore.

scholarly journals Aggregate Public-Private Remuneration Patterns in South Africa

2020 ◽  
Author(s):  
Andreas Wörgötter ◽  
Sihle Nomdebevana
Keyword(s):  
South Africa ◽  
Public Sector ◽  
Private Sector ◽  
Inflation Targeting ◽  
Public And Private ◽  
The Public ◽  
Causal Direction ◽  
Long Run ◽  
Causality Tests ◽  
Public And Private Sector

AbstractThis paper investigates the public-private remuneration patterns in South Africa with time-series methods for the first time since the introduction of an inflation-targeting framework in 2000. Co-integration tests and analysis confirm that there is a stable, long-run relationship between nominal and real remuneration in the public and private sector. The adjustment to the deviations from this long-run relationship is strong and significant for public-sector remuneration, while private-sector wages neither respond to deviations from the long-run relationship nor lagged changes in public-sector remuneration. The causal direction from private- to public-sector remuneration does not change if real earnings are calculated with the gross domestic product deflator. This is confirmed by simple Granger-causality tests.

scholarly journals Availability, prices, and affordability of selected essential cancer medicines in a middle-income country – the case of Mexico

2019 ◽  
Author(s):  
Daniela Moye-Holz ◽  
Margaret Ewen ◽  
Anahi Dreser ◽  
Sergio Bautista-Arredondo ◽  
Rene Soria-Saucedo ◽  
...  
Keyword(s):  
Health Insurance ◽  
Public Sector ◽  
Private Sector ◽  
Public Hospitals ◽  
World Health ◽  
Public And Private ◽  
Middle Income ◽  
The Public ◽  
Middle Income Countries ◽  
Public And Private Sector

Abstract Background: More alternatives have become available for the diagnosis and treatment of cancer in low- and middle-income countries. Because of increasing demands, governments are now facing a problem of limited affordability and availability of essential cancer medicines. Yet, precise information about the access to these medicines is limited, and the methodology is not very well developed. Objective: To assess the availability and affordability of essential cancer medicines in Mexico, and compare their prices against those in other countries of the region. Methods: We surveyed 21 public hospitals and 19 private pharmacies in 8 states of Mexico. Data were collected on the availability and prices of 49 essential cancer medicines. Prices were compared against those in Chile, Peru, Brazil, Colombia and PAHO’s Strategic Fund. Results: Of the various medicines, mean availability in public and private sector outlets was 61.2% and 67.5%, respectively. In the public sector, medicines covered by the public health insurance “People’s Health Insurance” were more available. Only seven (public sector) and five (private sector) out of the 49 medicines were considered affordable. Public sector procurement prices were 41% lower than in other countries of the region. Conclusions: The availability of essential cancer medicines, in the public and private sector, falls below World Health Organization’s 80% target. The affordability remains suboptimal as well. A national health insurance scheme could serve as a mechanism to improve access to cancer medicines in the public sector. Comprehensive pricing policies are warranted to improve the affordability of cancer medicines in the private sector.

scholarly journals Service Quality and Customer Satisfaction: A Comparative Study of an Indian Public VS Private Bank

2020 ◽  
Author(s):  
Dharmendra Singh
Keyword(s):  
Customer Satisfaction ◽  
Service Quality ◽  
Private Sector ◽  
Financial Services ◽  
Banking Sector ◽  
Public And Private ◽  
The Public ◽  
Public Sector Banks ◽  
Private And Public ◽  
Public And Private Sector

This study focuses on the service quality and customer satisfaction among the private and public sector banks in India. Today customers are supposed to have awareness about the financial services provided by the banking sector. An attempt has therefore, been made in this paper to quantify the ‘awareness level’ of the customers and analyze the ‘service quality experience’ of the customers from their banks. The study has been carried out to compare the service quality experienced by customers of the public and private sector banks and to study the link between service quality and customer satisfaction. For that reason a well structured questionnaire was used to collect the views of customers on various service dimensions and the satisfaction of the customers regarding the services offered by the public and private sector banks. Various statistical tools like ANOVA, Factor Analysis and Multiple Regressions were used for analyzing the data collected on five service dimensions of SERVQUAL and satisfaction of customers. The results indicate that the private sector bank was better in terms of providing services and creating awareness about their products and services. The study also proves that an increase in service quality will most likely lead to customer satisfaction.  

scholarly journals Private and public schools: A spatial analysis of social segregation in France

Urban Studies ◽  
2019 ◽  
Vol 57 (4) ◽  
pp. 865-882 ◽  
Author(s):  
Pierre Courtioux ◽  
Tristan-Pierre Maury
Keyword(s):  
Public Schools ◽  
Private Sector ◽  
Urban Areas ◽  
Local Level ◽  
Public And Private ◽  
Large Cities ◽  
The Public ◽  
Information Index ◽  
Social Segregation ◽  
Private And Public

This article shifts our understanding of the geographies of education away from large cities. It provides a geographical and urban analysis of the contribution of differences in enrolment between the public and private sectors to social segregation in French middle schools. Using the mutual information index, we show that the contribution of public/private divergences is rising and is higher in middle-sized urban areas and central municipalities. These geographical areas, however, are not those where social segregation is highest, nor those where the private sector is commonly regarded as the main cause of segregation. Moreover, the gaps between the public and the private sectors are stronger at the local level. This confirms the idea that the private sector is indeed a tool for circumventing France’s School Map ( la Carte scolaire) for allocating places to pupils and that private schools create additional social differences locally.

scholarly journals The role of the public and private health sectors on factors associated with early essential newborn care practices among institutional deliveries in Ghana

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maxwell Tii Kumbeni ◽  
Paschal Awingura Apanga ◽  
Mary-Ann Wepiamo Chanase ◽  
John Ndebugri Alem ◽  
Nana Mireku-Gyimah
Keyword(s):  
Health Insurance ◽  
Public Sector ◽  
Private Sector ◽  
Newborn Care ◽  
Health Facilities ◽  
Essential Newborn Care ◽  
Public And Private ◽  
The Public ◽  
Factors Associated ◽  
Public Sector Health

Abstract Background Early essential newborn care is one of the important interventions developed by the World Health Organization to reduce morbidities and mortalities in neonates. This study investigated the role of the public and private sector health facilities on factors associated with early essential newborn care practices following institutional delivery in Ghana. Methods We used data from the 2017/2018 multiple indicator cluster survey for our analysis. A total of 2749 mothers aged 15–49 years were included in the study. Logistic regression analysis was used to assess the factors associated with early essential newborn care in both public and private health sectors. Results The prevalence of good early essential newborn care in the public sector health facilities was 26.4 % (95 % CI: 23.55, 29.30) whiles that of the private sector health facilities was 19.9 % (95 % CI: 13.55, 26.30). Mothers who had a Caesarean section in the public sector health facilities had 67 % lower odds of early essential newborn care compared to mothers who had a vaginal delivery [adjusted prevalence odds ratios (aPOR) = 0.33, 95 % CI: 0.20, 0.53]. Mothers without a health insurance in the public sector health facilities had 26 % lower odds of early essential newborn care compared to mothers with a health insurance (aPOR = 0.74, 95 % CI: 0.56, 0.97). However, these associations were not observed in the private sector health facilities. Conclusions The findings suggest that the prevalence of good early essential newborn care in the public sector health facilities was higher than that reported in the private sector health facilities. Child health programs on early essential newborn care needs to be prioritized in the private healthcare sector. The Government of Ghana may also need to increase the coverage of the national health insurance scheme for women in reproductive age.

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