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dc.contributor.authorRusso, Giuliano
dc.contributor.authorMcPake, Barbara
dc.contributor.authorFronteira, Ins
dc.contributor.authorFerrinho, P.
dc.date.accessioned2018-06-29T22:02:58Z
dc.date.available2018-06-29T22:02:58Z
dc.date.issued2014-09
dc.identifierER3273
dc.identifier.citationRusso, G., McPake, B., Fronteira, I. & Ferrinho, P. (2014) Negotiating markets for health: An exploration of physicians' engagement in dual practice in three African capital cities. Health Policy and Planning, 29 (6), pp. 774-783.
dc.identifier.issn0268-1080
dc.identifier.urihttp://dx.doi.org/10.1093/heapol/czt071
dc.identifier.urihttps://eresearch.qmu.ac.uk/handle/20.500.12289/3273
dc.description.abstractScarce evidence exists on the features, determinants and implications of physicians' dual practice, especially in resource-poor settings. This study considered dual practice patterns in three African cities and the respective markets for physician services, with the objective of understanding the influence of local determinants on the practice. Forty-eight semi-structured qualitative interviews were conducted in the three cities to understand features of the practice and the respective markets. A survey was carried out in a sample of 331 physicians to explore their characteristics and decisions to work in public and private sectors. Descriptive analysis and inferential statistics were employed to explore differences in physicians' engagement in dual practice across the three locations. Different forms of dual practice were found to exist in the three cities, with public physicians engaging in private practice outside but also inside public facilities, in regulated as well as unregulated ways. Thirty-four per cent of the respondents indicated that they worked in public practice only, and 11% that they engaged exclusively in private practice. The remaining 55% indicated that they engaged in some form of dual practice, 31% 'outside' public facilities, 8% 'inside' and 16% both 'outside' and 'inside'. Local health system governance and the structure of the markets for physician services were linked to the forms of dual practice found in each location, and to their prevalence. Our analysis suggests that physicians' decisions to engage in dual practice are influenced by supply and demand factors, but also by how clearly separated public and private markets are. Where it is possible to provide little-regulated services within public infrastructure, less incentive seems to exist to engage in the formal private sector, with equity and efficiency implications for service provision. The study shows the value of analysing health markets to understand physicians' engagement in professional activities, and contributes to an evidence base for its regulation.
dc.format.extent774-783
dc.publisherOxford University Press
dc.relation.ispartofHealth Policy and Planning
dc.subjectDual Practice
dc.subjectMultiple Job-Holding
dc.subjectHuman Resources For Health
dc.subjectPhysicians In Africa
dc.subjectCape Verde
dc.subjectGuinea Bissau
dc.subjectMozambique
dc.subjectHealth System Research In Lowincome Countries
dc.titleNegotiating markets for health: An exploration of physicians' engagement in dual practice in three African capital cities
dc.typearticle
dcterms.accessRightspublic
dc.description.facultysch_iih
dc.description.volume29
dc.identifier.doihttp://10.1093/heapol/czt071
dc.description.ispublishedpub
dc.description.eprintid3273
rioxxterms.typearticle
qmu.authorMcPake, Barbara
qmu.centreInstitute for Global Health and Development
dc.description.statuspub
dc.description.number6


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