Implications of Dual Practice among Health Workers: A Systematic Review
Background: Mixed health care systems to work simultaneously on both public and private facilities, is common today. This phenomenon referred to as dual practice (DP), has potential implications for access, quality, cost and equity of health services. This paper aimed to review systematically studies that assess the implications of DP among health workers.
Methods: MEDLINE, EMBASE, and The Cochrane library were searched for obtaining published literature between Feb 1990 and May 2014. Google and Google Scholars, organizational websites, and reference lists of relevant papers searched to get grey literature. Only studies concentrated on consequences and impacts of DP among health professionals and conducted using "randomized controlled trials", "non-randomized controlled trials", "controlled before and after studies", or "interrupted time series" were eligible for inclusion.
Results: From 3242 records, we focused on 19 studies, which aimed to assess effects and impacts of dual practice. After that, the current understanding of DP positive and negative implications was categorized and discussed based on two perspectives.
Conclusion: There has been a propensity to over-reliance on theoretical methods in predicting the implications of this phenomenon. Almost all of the mentioned implications are based on theoretical predictions undermined in the broader literature. Furthermore, assessing the current literature showed positive and negative impacts of DP on different parts of the health system and various dimensions of service delivery. These implications are contexted specific and may vary from system to system.
Ferrinho P, Van Lerberghe W, Fronteira I, Hipolito F, Biscaia A (2004). Dual practice in the health sector: review of the evidence. Hum Resour Health, 2:14.
Jumpa M, Jan S, Mills A (2007). The role of regulation in influencing income-generating activities among public sector doctors in Peru. Hum Resour Health, 5:5.
García-Prado A, González P (2007). Policy and regulatory responses to dual practice in the health sector. Health Policy, 84:142-152.
Gonzalez P, Macho-Stadler I (2013). A theoretical approach to dual practice regulations in the health sector. J Health Econ, 32:66-87.
Socha KZ, Bech M (2011). Physician dual practice: A review of literature. Health Policy, 102:1-7.
Ashmore J (2013). 'Going private': a qualitative comparison of medical specialists' job satisfaction in the public and private sectors of South Africa. Hum Resour Health, 11:1.
Kiwanuka SN, Rutebemberwa E, Nalwadda C, Okui O, Ssengooba F, Kinengyere AA, Pariyo GW (2011). Interventions to manage dual practice among health workers. Cochrane Database Syst Rev:CD008405.
Eggleston K, Bir A (2006). Physician dual practice. Health Policy, 78:157-166.
Garcia-Prado A, Gonzalez P (2011). Whom do physicians work for? An analysis of dual practice in the health sector. J Health Polit Policy Law, 36:265-94.
Bian Y, Sun Q, Jan S, Yu J, Meng Q (2003). Dual practice by public health providers in Shandong and Sichuan Province, China. London: Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine.
Socha K, Bech M (2011). The relationship between dual practice and physicians’ work behaviour in the public hospitals: Results from the Danish survey. Health Economics Papers University of Southern Denmark. Syddansk Universitet. Disponible en: static. sdu. dk/.../% 7BCEC651C1-3E52-429A-836E-A16658A7237C% 7D20111. pdf.
Berman P, Cuizon D (2004). Multiple public-private jobholding of health care providers in developing countries. Issues Paper–Private Sector, London: DFID Health Systems Resource Centre.
Roenen C, Ferrinho P, Van Dormael M, Conceição MC, Van Lerberghe W (1997). How African doctors make ends meet: An exploration. Trop Med Int Health, 2:127-135.
Jan S, Bian Y, Jumpa M, Meng Q, Nyazema N, Prakongsai P, Mills A (2005). Dual job holding by public sector health professionals in highly resource-constrained settings: problem or solution? Bull World Health Organ, 83:771-776.
Biglaiser G, Ma C-tA (2007). Moonlighting: public service and private practice. RAND Journal of Economics, 38:1113-1133.
Askildsen JE, Holmas TH (2013). Wages and work conditions as determinants for physicians' work decisions. Appl Eco, 45:397-406.
Gruen R, Anwar R, Begum T, Killingsworth JR, Normand C (2002). Dual job holding practitioners in Bangladesh: an exploration. Soc Sci Med, 54:267-279.
Bir A, Eggleston K (2003). Physician Dual Practice: Access Enhancement or Demand Inducement? http://ase.tufts.edu/econ/papers/200311.pdf.
Garcia-Prado A, Gonzalez P (2007). Policy and regulatory responses to dual practice in the health sector. Health Policy, 84:142-52.
Ranson MK, Chopra M, Atkins S, Dal Poz MR, Bennett S (2010). Priorities for research into human resources for health in low-and middle-income countries. Bull World Health Organ, 88:435-443.
Barros PP, Olivella P (2005). Waiting lists and patient selection. Journal of Economics & Management Strategy, 14:623-646.
Brekke KR, Sorgard L (2007). Public versus private health care in a national health service. Health Econ, 16:579-601.
Gonzalez P (2004). Should physicians' dual practice be limited? An incentive approach. Health Econ, 13(6):505-24.
Iversen T (1997). The effect of a private sector on the waiting time in a National Health Service. J Health Econ, 381–96.
Jiwei Q (2010). Financing health in China: Theory & institutions. National university of Singapore.
Morga A, Xavier A (2001). Hospital specialists’ private practice and its impact on the number of NHS patients treated and on the delay for elective surgery. The University of York, Discussion Papers in Economics 2001/01.
Hanvoravongchai P, Letiendumrong J, Teerawattananon Y, Tangcharoensathien V (2000). Implications of Private Practice in Public Hospitals on the Cesarean Section Rate in Thailand. Human Resources for Health Development, 4:1-2.
Bloor K, Maynard A, Freemantle N (2004). Variation in activity rates of consultant surgeons and the influence of reward structures in the English. J Health Serv Res Policy,76–84.
Johannessen KA, Hagen TP (2014). Physicians' engagement in dual practices and the effects on labor supply in public hospitals: results from a register-based study. BMC Health Serv Res, 14:299.
Hipgrave DB, Hort K (2014). Dual practice by doctors working in South and East Asia: a review of its origins, scope and impact, and the options for regulation. Health Policy Plan, 29:703-16.
García-Prado A, González P (2006). Moonlighting physicians: Analysis of its causes and consequences. El pluriempleo entre los profesionales sanitarios: Un análisis de sus causas e implicaciones, 20:29-40.
Mossialos E, Allin S, Davaki K (2005). Analysing the Greek health system: A tale of fragmentation and inertia. Health Econ, 14:S151-168.
Ensor T, Duran-Moreno A (2002). Corruption as a challenge to effective regulation in health sector. In R. Saltman, R. Busse, & E. Mossialos (Eds.), Regulating Entrepreneurial Behaviour in European Health Care Systems. Maidenhead: Open University Press:106-124.
Chaudhury N, Hammer J, Kremer M, Muralidharan K, Rogers FH (2006). Missing in action: teacher and health worker absence in developing countries. J Econ Perspect, 20:91-116.
France G, Taroni F, Donatini A (2005). The Italian health-care system. Health Econ, 14:S187-S202.
Armstrong W (2000). The Consumer Experience with Cataract Surgery and Private Clinics in Alberta: Canada’s Canary in the Mineshaft. Calgary, AB: The Alberta Chapter of Consumers Association of Canada.
Van Lerberghe W, Conceicao C, Van Damme W, Ferrinho P (2002). When staff is underpaid: dealing with the individual coping strategies of health personnel. Bull World Health Organ, 80:581-584.
Asiimwe D, McPake B, Mwesigye F, Ofoumbi M, Oertenblad L, Streefland P, Turinde A (1997). The private sector activities of public-sector health workers in Uganda. In In Private Health Providers in Developing Countries. Serving the Public Interest? Edited by: Bennet S, McPake B, Mills A. London and New Jersey. Zed Books:140-157.
Palmer N, Mills A (2003). Classical versus relational approaches to understanding controls on a contract with independent GPs in South Africa. Health Econ, 12:1005-1020.
Rokx C, Giles J, Satriawan E, Marzoeki P, Harimurti H, Yavuz E (2012). New Insights into Provision of Health Services in Indonesia: A Health Workforce Study. (ed), The World Bank, Washington.
World Health Organization (2000). The effects of economic and policy incentives on provider practice. World Health Organization, Geneva.
Damasceno A, Van Lerberghe W, Ferrinho P (2000). Coping through private practice: a cardiologist in Maputo, , Mozambique. In: P. Ferrinho, & W. van Lerberghe (Eds.): Providing health care under adverse conditions: health personnel performance & individual coping strategies. (pp. 157-161). (Studies in Health Services Organisation & Policy; 16). Antwerpen: ITGPress.
Peters DH, Yazbeck RR, Sharma GM, Ramana V, Pritchett LH, Wagstaff A (2002). Better health systems for India’s poor: findings, analysis and options. World Bank, Washington.
Israr SM, Razum O, Ndiforchu V, Martiny P (2000). Coping strategies of health personnel during economic crisis: A case study from Cameroon. Trop Med Int Health, 5:288-292.
Tussing A, Wojtowycz M (1992). The caesarean section decision in New York State, 1986. Economic and noneconomic aspects. Med Care, 30:529-540.
Moghri J, Arab M, Rashidian A, Akbari Sari (2016) . Physician dual practice: A descriptive mapping review of literature. Iran J Public Health, 45 (3): 278-288.
Pocock N, Phua K (2011). Medical tourism and policy implications for health systems: a conceptual framework from a comparative study of Thailand, Singapore and Malaysia. Global Health, 7:12.
Noree T, Chockchaichan H, Mongkolporn V. Thailand’s country paper. Abundant for the few, shortage for the majority: The inequitable distribution of doctors in Thailand. International health policy program. August 1st, 2005.
Meliala A, Hort K, Trisnantoro L (2013). Addressing the unequal geographic distribution of specialist doctors in Indonesia: The role of the private sector and effectiveness of current regulations. Soc Sci Med, 82:30-4.
McPake B, Asiimwe D, Mwesigye F, Ofumbi M, Streefland P, Turinde A (2000). In: Ferrinho P, Van Lerberghe W (eds.): Providing health care under adverse circumstances: Health personnel performance & individual coping strategies. Belgium: ITGPress, pp 135-155.
Socha K, Bech M (2012). Dual practitioners are as engaged in their primary job as their senior colleagues. Dan Med J, 59:A4375.