Ferrinho P, Van Lerberghe W, Julien M R, Fresta E, Gomes A, Dias F, Gonçalves A, Bäckström B
Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal.
Health Policy Plan. 1998 Sep;13(3):332-8. doi: 10.1093/heapol/13.3.332.
To explore the type of private practice supplementary income-generating activities of public sector doctors in the Portuguese-speaking African countries, and also to discover the motivations and the reasons why doctors have not made a complete move out of public service.
Cross-sectional qualitative survey.
In 1996, 28 Angolan doctors, 26 from Guinea-Bissau, 11 from Mozambique and three from S Tomé and Principe answered a self-administered questionnaire.
All doctors, except one unemployed, were government employees. Forty-three of the 68 doctors that answered the questionnaire reported an income-generating activity other than the one reported as principal. Of all the activities mentioned, the ones of major economic importance were: public sector medical care, private medical care, commercial activities, agricultural activities and university teaching. The two outstanding reasons why they engage in their various side-activities are 'to meet the cost of living' and 'to support the extended family'. Public sector salaries are supplemented by private practice. Interviewees estimated the time a family could survive on their public sector salary at seven days (median value). The public sector salary still provides most of the interviewees income (median 55%) for the rural doctors, but has become marginal for those in the urban areas (median 10%). For the latter, private practice has become of paramount importance (median 65%). For 26 respondents, the median equivalent of one month's public sector salary could be generated by seven hours of private practice. Nevertheless, being a civil servant was important in terms of job security, and credibility as a doctor. The social contacts and public service gave access to power centres and resources, through which other coping strategies could be developed. The expectations regarding the professional future and regarding the health systems future were related mostly to health personnel issues.
The variable response rate per question reflects some resistance to discuss some of the issues, particularly those related to income. Nevertheless, these studies may provide an indication of what is happening in professional medical circles in response to the inability of the public sector to sustain a credible system of health care delivery. There can be no doubt that for these doctors the notion of a doctor as a full-time civil-servant is a thing of the past. Switching between public and private is now a fact of life.
探究葡语非洲国家公共部门医生从事的私人执业补充创收活动的类型，同时找出医生未完全脱离公共服务的动机及原因。
横断面定性调查。
1996年，28名安哥拉医生、26名来自几内亚比绍的医生、11名莫桑比克医生以及3名圣多美和普林西比医生回答了一份自填式问卷。
除一名失业医生外，所有医生均为政府雇员。回答问卷的68名医生中有43人报告了除主要收入来源之外的创收活动。在提及的所有活动中，具有重大经济意义的活动有：公共部门医疗服务、私人医疗服务、商业活动、农业活动及大学教学。他们从事各种副业活动的两个突出原因是“维持生计”和“补贴大家庭”。私人执业补充了公共部门的薪资。受访者估计，一个家庭仅靠公共部门薪资维持生活的时间为七天（中位数）。公共部门薪资仍为大多数农村医生提供了大部分收入（中位数为55%），但对城市地区的医生而言已变得微不足道（中位数为10%）。对后者来说，私人执业变得至关重要（中位数为65%）。对于26名受访者而言，七小时的私人执业可产生相当于一个月公共部门薪资的中位数收入。然而，作为公务员在工作保障以及作为医生的信誉方面很重要。社会交往和公共服务使人能够接触权力中心和资源，借此可制定其他应对策略。对职业未来和卫生系统未来的期望主要与卫生人员问题相关。
每个问题的可变回答率反映出在讨论某些问题，尤其是与收入相关的问题时存在一定抵触情绪。然而，这些研究或许能表明，鉴于公共部门无力维持可靠的医疗服务体系，专业医学界正在发生什么。毫无疑问，对这些医生来说，医生作为全职公务员的概念已成为过去。在公共和私人之间转换如今已成为现实。
