Abstract:
To compare the quality of clinical care and patient satisfnction in public and
private outpatient primary care services in Sri Lanka.
Methods A prospective, cross-sectional comparison was done by direct observation of
patient encounters and exit interviews of outpatients in 10 public hospital
general outpatient clinics and 66 private practitioner clinics in three districts of
Sri Lanka. A total of 1027 public sector patients and 944 private sector patients
were surveyed. Data were collected for 39 quality indicators covering diarrhoea,
cough, hypertension, diabetes, asthma. upper respiratory tract infections (URTl)
and five other conditions, along with prescribing indicators. The exit interviews
collected data for 10 patient satisfaction indicators.
Results The public sector performed better for some conditions (diarrhoea, cough and
asthma) and the private sector performed better for others (hypertension,
diabetes, URTl and tonsillitis). Overall quality was similar between the sectors in
the domains of history taking, examination and investigations and management.
but the private sector performed much better on patient education (57 vs 12%).
Overall patient satisfaction was high in both sectors (98%), although the private
sector performed much better in interpersonal satisfaction (94 vs 84%) and
system-related indicators (95 vs 84%). Comparisons with studies from other
countries suggest that both sectors perform considerably bcucr than India, and
similarly in many Indicators to high-income countries.
Conclusions Quality of outpatient primary care in Sri l.anka is generally high for a lowermiddle
income developing country. The public and private sectors perform
similarly, except that private sector patients have longer consultations, are more
likely to receive education and advice, and obtain better interpersonal satisfaction.
The public system, with its limited funding, is able to deliver care in
diagnosis and management that is similar to the private sector, while private
sector patients. who spend more on their hcalthcare receive better quality care in
non-clinical areas.
