Centre de recherche en gestion des services de santé, FSA-ULaval-CHU de Québec UL-IUCPQ-UL, Pavillon Palasis-Prince, Université Laval, Québec (Qc), Canada.
École Nationale de Santé Publique, Ouagadougou, Ouagadougou, Burkina Faso.
PLoS One. 2018 Jul 25;13(7):e0200233. doi: 10.1371/journal.pone.0200233. eCollection 2018.
Providers' qualification (Medical doctor [MD] or nurse); type of care facility ownership (for-profit [FP] or not-for-profit [NFP]) may all influence individuals' healthcare-seeking behavior and therefore merits empirical assessment to provide valuable evidence-informed policy orientation in the present context of private health system development. Previous studies have not examined these factors in combination, especially within the urban context of sub-Sahara Africa, where the private sector is rapidly growing. This study aims to explore factors associated with urban residents' preferences between private MD-led and private nurse-led outpatient care and how these factors vary by type of private health facility ownership (FP and NFP) and levels of disease severity (severe and non-severe cases).
A cross-sectional household survey was conducted in July-November 2011 on a random final sample of 2064 adults (646 households). We used a face-to-face interview to capture participants' choice of provider and their associated factors. A multivariable logistic regression was applied.
For severe conditions, participants, almost equally sought FP and NFP facilities, only 36.4% preferred nurses compared to MDs, while for non-severe cases 53.2% preferred FP facilities and only 29.2% patronized nurses. For non-severe conditions, university educated were more likely to use MDs-led FP compared to nurse-led FP facilities (Odds Ratio [OR] = 4.66, 95% confidence interval [CI] = 2.62-8.30) and MD-led FP over MD-led NFP facilities (OR = 1.03, 95%CI = 1.01-1.04), for severe health conditions. Having insurance predicted MD-led FP preference over nurse-led FP. Furthermore, insurance predicted the preference for MD-led FP over MD-led NFP facilities. Employment did not distinguish participants' choice of provider.
The findings suggest that, at different levels, MDs and nurses from FP and NFP facilities importantly contribute to health services delivery regardless of the severity of health conditions. The results offer some valuable evidence for policy orientation in the current rising tide of the private system, including workforce development, and practitioners' role definition. We suggested that health insurance mechanism would reinforce the private health services utilization and could enhance progress towards the attainment of Sustainable Development Goals.
医疗从业者的资质（医生[MD]或护士）和医疗机构的所有制类型（营利性[FP]或非营利性[NFP]）都可能影响个人的医疗服务寻求行为，因此值得进行实证评估，以便在当前私营医疗体系发展的背景下提供有价值的循证政策导向。先前的研究并未综合考察这些因素，特别是在撒哈拉以南非洲的城市背景下，私营部门正在迅速发展。本研究旨在探讨与城市居民在私营 MD 主导和私营护士主导的门诊护理之间的偏好相关的因素，以及这些因素如何因私营医疗机构的所有制类型（FP 和 NFP）和疾病严重程度（严重和非严重病例）而异。
2011 年 7 月至 11 月，我们对随机抽取的 2064 名成年人（646 户家庭）进行了一项横断面家庭调查。我们采用面对面访谈的方式，了解参与者对提供者的选择及其相关因素。我们应用多变量逻辑回归进行分析。
对于严重的疾病，参与者平等地选择 FP 和 NFP 医疗机构，只有 36.4%的人倾向于选择护士而不是 MD，而对于非严重的病例，53.2%的人倾向于选择 FP 医疗机构，只有 29.2%的人选择护士。对于非严重的疾病，与护士主导的 FP 医疗机构相比，受过大学教育的人更有可能选择 MD 主导的 FP 医疗机构（优势比[OR] = 4.66，95%置信区间[CI] = 2.62-8.30）和 MD 主导的 FP 医疗机构与 MD 主导的 NFP 医疗机构（OR = 1.03，95%CI = 1.01-1.04）；对于严重的健康状况，有保险的人预测会选择 MD 主导的 FP 医疗机构而非护士主导的 FP 医疗机构。此外，保险还预测了选择 MD 主导的 FP 医疗机构而非 MD 主导的 NFP 医疗机构。就业并不能区分参与者对提供者的选择。
研究结果表明，无论健康状况的严重程度如何，FP 和 NFP 医疗机构的 MD 和护士都在医疗服务提供方面做出了重要贡献。研究结果为当前私营医疗体系不断壮大的背景下的政策导向提供了一些有价值的证据，包括劳动力发展和从业者角色的定义。我们建议，医疗保险机制将加强对私营医疗服务的利用，并能促进实现可持续发展目标的进展。
