Global Problem of Physician Dual Practices: A Literature Review.

BACKGROUND

Physician dual practices (PDP) is a term used to describe physicians who combine work in public and private health-care sector. This study aimed to find evidence of PDP worldwide, investigate its reasons and consequences, and compare high-income (HIC) versus low and middle-income countries (LMIC).

METHODS

In this literature review, the search for PDP evidence was conducted in the English language. PubMed and Google were searched for relevant publications up to Sep 30, 2020.

RESULTS

Of 195 countries, PDP-reports were found in 157 countries (81%). No significant difference in prevalence of PDP was found between HIC (77%) and LMIC (82%). Most common reason for working in private sector was low government salaries in public hospitals (55%). This was more reported in LMIC (65%) than HIC (30%; <0.001). Most common reason for working in public sector was patient recruitment for private practice (25%). This was more reported in HIC (45%) than LMIC (16%; <0.001). PDP were described as detrimental to public health-sector in 58% of country-reports. Most common adverse consequence was lower quality-of-care in public hospitals (27%). LMIC with PDP-reports had more severe corruption (<0.001), lower current health-expenditure (<0.001), and higher out-of-pocket expenditure (<0.001) than HIC. Scale of PDP was common in more LMIC (92%) than HIC (60%; <0.001). Government policies to address PDP did not differ significantly between HIC and LMIC.

CONCLUSION

PDP were present in most HIC and LMIC. In majority of reports a detrimental effect of PDP on public health-care was described.