The Quality of Outpatient Primary Care in Public and Private Sectors in Sri Lanka-How Well Do Patient Perceptions Match Reality and What Are the Implications

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.