[PDF] Dual Practice By Health Workers In South And East Asia eBook
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Dual practice usually refers to government-employed workers providing the same or similar services in the private sector. The private work may be undertaken in a regulated environment or may be uncontrolled. Dual practice is not isolated to the health sector but with the high profile of donor-funded and publicly funded efforts to improve individual and population health outcomes in recent years more attention has been paid to dual practice by public sector health workers doctors in particular.
Managing dual practice of health workers has often proved to be challenging, especially in emerging countries characterized by weak monitoring and low motivation. This paper exploits an exogenous variation in the initiation of private practice among heads of local public facilities (known as puskesmas) providing primary health care after the introduction of a 1997 health regulation in Indonesia. This regulation required health professionals to apply for a license for private practice at least three years after their graduation. Exploiting the exogenous variation in private practice after the 1997 regulation, we provide estimates of causal effects of dual practice on provision of public health services, distinguishing between the effects when private practice is located at or away from the public hospital. The estimates suggest that dual practitioners (relative to those engaged in public service only) work significantly less hours per week while they see significantly more patients in their public facilities. These adverse effects of dual practice are most pronounced when private practice is held away from the puskesmas. These results have important bearings on human resource management of universal health care provision.
Using a simple theoretical model we conjecture that dual practice may increase the number of patients seen but reduce hours spent at public facilities, if public physicians lack motivation and/or if their opportunity costs are very large. Using data from Indonesia, we then test these theoretical conjectures. Our identification strategy relies on a 1997 legislation necessitating health professionals to apply for license for private practice only after three years of graduation. Results using a difference-in-difference regression discontinuity design provides support to our conjectures, identifying the role of weak work discipline, lack of motivation and opportunity costs of public service provision.
Over the past decade, Indonesia has implemented significant health sector reforms that include decentralizing responsibilities for service delivery, designing incentives for health providers, increasing the supply of midwives in remote areas, and analyzing demographic and epidemiological transitions causing changes in the patterns of disease prevalence. Financial protection against catastrophic expenditures has improved substantially, and legislation has been enacted to improve the quality of physician training and patient care.Despite the progress, substantial challenges remain and include comparatively low resources for the health sector, limitations in the supply of providers at the primary and hospital levels, inefficient payment systems, shortcomings in the quality of maternal and child and adult care, lack of oversight and effective licensing in an expanding private health sector, and ineffective planning for and recruitment and retention of health workers.Given the slow pace in improving health outcomes and limited evidence linking health performance and the health workforce, the need to make more information available about past experiences to inform future policy changes is pressing. Few studies have been undertaken to measure the actual impact of the reforms and the remaining challenges. 'New Insights into the Provision of Health Services in Indonesia: A Health Workforce Study' begins the process, providing real time evidence-based inputs to facilitate the Government of Indonesia's comprehensive health sector review. The authors' analysis of panel data from households and health providers will assist the government's assessment of the impact of past health work force policies and its consideration of policy changes.
"In 2019, a child born in Japan will live to the age of 84, whereas a child born in Sierra Leone will only live until the age of 54.1 Similar disparities exist between rich and poor communities within countries.2 These differences in life expectancy are not caused by genetics, biology, or culture. Health inequities are caused by poverty, racism, a lack of medical care, and other social forces that influence health. A critical analysis of the historical roots of this gross and systemic inequality and of the political economy that continues inequality is a fundamental part of the study of global health"--
Author : Susan B. Rifkin Publisher : Taylor & Francis Page : 184 pages File Size : 17,35 MB Release : 1985-01-01 Category : Social Science ISBN : 9780709922766
This book provides a comprehensive understanding of public hospital reform in China, which is a hot topic for China’s new round of health sector reform. The authors use rich data from both health provider side and service user side and conduct a cross-sectional study in China with some comparative analysis between different locations. It provides the audience with a big picture of China’s public hospital and other components of health system as well. The book reviews the main policy measurements in the public hospital reforms and evaluates how these policies influence public hospitals' practices, especially on hospital governance and internal management.
Author : Dr Murallitharan M, MD MCommHSc MSc PhD Publisher : National Cancer Society Malaysia Page : 187 pages File Size : 38,36 MB Release : Category : Health & Fitness ISBN : 9671102883
NCD and The Healthcare Worker: An Introspective Look into the Malaysian Landscape for Non-Communicable Diseases Report is a report based on the investigation of health care workers and their experiences, concerns and suggestions for the improvement of the healthcare landscape in Malaysia. This comprehensive report spans data collected from three different studies, to understand the current problems and challenges in the Malaysian healthcare system. This insightful report can be utilized when making policy decisions and to improve the overall healthcare landscape in Malaysia.
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