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Dual practice of medical professionals in public hospitals in south-eastern Nigeria: An economic and policy analysis / Bartholomew S. Eze

Swansea University Author: Bartholomew S. Eze

DOI (Published version): 10.23889/Suthesis.51641

Abstract

Dual practice (DP) occurs when doctors employed in the public sector work concurrently in private practice. This study examines the perceived effects of DP on the public healthcare system in Enugu Urban area, Nigeria and the burden on patient finances. The study comprises a survey of 407 service use...

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Published: 2019
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
URI: https://cronfa.swan.ac.uk/Record/cronfa51641
first_indexed 2019-09-02T14:49:54Z
last_indexed 2025-03-27T06:35:35Z
id cronfa51641
recordtype RisThesis
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spelling 2025-03-26T12:24:54.7985360 v2 51641 2019-09-02 Dual practice of medical professionals in public hospitals in south-eastern Nigeria: An economic and policy analysis 399803275c4e2ba052c4de4ed885af3c NULL Bartholomew S. Eze Bartholomew S. Eze true true 2019-09-02 Dual practice (DP) occurs when doctors employed in the public sector work concurrently in private practice. This study examines the perceived effects of DP on the public healthcare system in Enugu Urban area, Nigeria and the burden on patient finances. The study comprises a survey of 407 service users who had visited both public and private health facilities in the last year, focus groups exploring service users’ perceptions of benefits and disbenefits, interviews with DP and non-DP doctors exploring why they engaged in DP or refrained from doing so, and interviews with policy makers and senior administrators on their views of DP. Additionally, sensitivity analysis was used to calculate doctors’ hourly pay in the public sector and to create hypothetical estimates of the value of hours lost due to absences associated with DP. The estimated annual value of hours lost from DP to a single public tertiary care hospital was US$16,013 (best case scenario) and US$63,399 (worst case scenario). Benefits of DP were identified as speedier attention, reduced bureaucracy in private practice and reduction of pressure in public hospitals among others. Reported disbenefits included low commitment to public patients, late reporting and absence of doctors from work, and sharp practices. The public system was ranked higher in respect of the structure element of healthcare quality, whereas private practice performed better in the process and outcome elements of quality. The main motives for DP were seen as income enhancement followed by prestige and fringe benefits enjoyed in the public system. Reasons given by non-DPs for working exclusively in the public sector included the stress of private practice, family issues and career development. Among the different mechanisms and options proposed for managing the issue of DP in Nigeria, intramural practice appeared to command most support from policy makers and other senior stakeholders. E-Thesis Public healthcare, dual practice, Nigeria 31 12 2019 2019-12-31 10.23889/Suthesis.51641 COLLEGE NANME Public Health and Policy Studies COLLEGE CODE Swansea University Doctoral Ph.D Not Required 2025-03-26T12:24:54.7985360 2019-09-02T10:13:49.8766233 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Bartholomew S. Eze NULL 1 0051641-02092019103029.pdf Eze.B. PhD THESIS.pdf 2019-09-02T10:30:29.5630000 Output 3931107 application/pdf E-Thesis – open access true 2021-12-28T00:00:00.0000000 true
title Dual practice of medical professionals in public hospitals in south-eastern Nigeria: An economic and policy analysis
spellingShingle Dual practice of medical professionals in public hospitals in south-eastern Nigeria: An economic and policy analysis
Bartholomew S. Eze
title_short Dual practice of medical professionals in public hospitals in south-eastern Nigeria: An economic and policy analysis
title_full Dual practice of medical professionals in public hospitals in south-eastern Nigeria: An economic and policy analysis
title_fullStr Dual practice of medical professionals in public hospitals in south-eastern Nigeria: An economic and policy analysis
title_full_unstemmed Dual practice of medical professionals in public hospitals in south-eastern Nigeria: An economic and policy analysis
title_sort Dual practice of medical professionals in public hospitals in south-eastern Nigeria: An economic and policy analysis
author_id_str_mv 399803275c4e2ba052c4de4ed885af3c
author_id_fullname_str_mv 399803275c4e2ba052c4de4ed885af3c_***_Bartholomew S. Eze
author Bartholomew S. Eze
author2 Bartholomew S. Eze
format E-Thesis
publishDate 2019
institution Swansea University
doi_str_mv 10.23889/Suthesis.51641
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
document_store_str 1
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description Dual practice (DP) occurs when doctors employed in the public sector work concurrently in private practice. This study examines the perceived effects of DP on the public healthcare system in Enugu Urban area, Nigeria and the burden on patient finances. The study comprises a survey of 407 service users who had visited both public and private health facilities in the last year, focus groups exploring service users’ perceptions of benefits and disbenefits, interviews with DP and non-DP doctors exploring why they engaged in DP or refrained from doing so, and interviews with policy makers and senior administrators on their views of DP. Additionally, sensitivity analysis was used to calculate doctors’ hourly pay in the public sector and to create hypothetical estimates of the value of hours lost due to absences associated with DP. The estimated annual value of hours lost from DP to a single public tertiary care hospital was US$16,013 (best case scenario) and US$63,399 (worst case scenario). Benefits of DP were identified as speedier attention, reduced bureaucracy in private practice and reduction of pressure in public hospitals among others. Reported disbenefits included low commitment to public patients, late reporting and absence of doctors from work, and sharp practices. The public system was ranked higher in respect of the structure element of healthcare quality, whereas private practice performed better in the process and outcome elements of quality. The main motives for DP were seen as income enhancement followed by prestige and fringe benefits enjoyed in the public system. Reasons given by non-DPs for working exclusively in the public sector included the stress of private practice, family issues and career development. Among the different mechanisms and options proposed for managing the issue of DP in Nigeria, intramural practice appeared to command most support from policy makers and other senior stakeholders.
published_date 2019-12-31T07:54:01Z
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score 11.059486

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