Health Economics Unit, Aberystwyth Business School, Aberystwyth University, Aberystwyth, UK.
School of Economics, University of Nottingham Ningbo China, Ningbo, China.
Int J Health Econ Manag. 2024 Dec;24(4):571-593. doi: 10.1007/s10754-024-09385-0. Epub 2024 Sep 16.
Whether private healthcare providers should be encouraged over public providers remains unclear. On the one hand, because private providers are profit-driven, they are more motivated to compete for demand by enhancing quality if demand is elastic. However, because they are more motivated to maximize revenue, they may sacrifice quality to maximize profit. A crucial factor in determining whether private providers should be encouraged is the extent to which their quality exceeds or falls short of that of the public provider. This study, therefore, investigates whether the public and private differ in providing quality healthcare services using the 2014 Ghana Demographic and Health Survey. Our measure of healthcare quality is based on patient satisfaction level with nine healthcare services (cleanliness, waiting time, comfort and safety, consultation time, privacy, listening, explanation, treatment advice and confidentiality) provided by public and private healthcare facilities. We applied an instrumental variable approach to account for endogeneity issues related to the patient's choice of healthcare provider. We find that private facility users have a higher probability of being very satisfied with "waiting time", "consultation time", "listening", "cleanliness", "comfort and safety", "confidentiality", and "privacy" than public users, thus suggesting that private facilities provide better service than public. We thus recommend encouraging the private sector to enter the healthcare market. We also find that failing to account for endogeneity in provider choice when estimating the effect of healthcare facility ownership on healthcare service quality underestimates the effects.
是否应该鼓励私立医疗服务提供商而不是公立服务提供商仍然不清楚。一方面，由于私立提供者是受利润驱动的，如果需求具有弹性，他们更有动力通过提高质量来争夺需求。然而，由于他们更有动力最大化收入，他们可能会牺牲质量来最大化利润。决定是否应该鼓励私立提供者的一个关键因素是他们的质量超过或低于公共提供者的程度。因此，本研究使用 2014 年加纳人口与健康调查调查了公私医疗机构在提供优质医疗服务方面的差异。我们的医疗质量衡量标准基于患者对九项医疗服务（清洁度、等待时间、舒适度和安全性、咨询时间、隐私、倾听、解释、治疗建议和保密性）的满意度水平，这些服务由公立和私立医疗机构提供。我们应用工具变量方法来解决与患者选择医疗服务提供商相关的内生性问题。我们发现，与公共用户相比，私立医疗机构的用户更有可能对“等待时间”、“咨询时间”、“倾听”、“清洁度”、“舒适度和安全性”、“保密性”和“隐私”非常满意，这表明私立医疗机构提供的服务比公立医疗机构更好。因此，我们建议鼓励私营部门进入医疗市场。我们还发现，在估计医疗机构所有权对医疗服务质量的影响时，如果不考虑提供者选择的内生性，就会低估这些影响。
