Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries Systematic Review of Comparative Studies 英文参考文献.docVIP

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Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries Systematic Review of Comparative Studies 英文参考文献.doc

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Quality of Private and Public Ambulatory Health Care in Low and Middle Income Countries Systematic Review of Comparative Studies 英文参考文献

QualityofPrivateandPublicAmbulatoryHealthCarein LowandMiddleIncomeCountries:SystematicReviewof ComparativeStudies SimaBerendes1,PeterHeywood2,SandyOliver3,PaulGarner1* 1LiverpoolSchoolofTropicalMedicine,Liverpool,UnitedKingdom,2MenziesCenterforHealthPolicy,UniversityofSydney,Sydney,Australia,3InstituteofEducation, UniversityofLondon,London,UnitedKingdom Abstract Background: Indevelopingcountries, theprivatesector providesasubstantial proportionof primaryhealth caretolow income groups for communicable and non-communicable diseases. These providers are therefore central to improving healthoutcomes.Weneedtoknowhowtheirservicescomparetothoseofthepublicsectortoinformpolicyoptions. MethodsandFindings:Wesummarisedreliableresearchcomparingthequalityofformalprivateversuspublicambulatory healthcareinlowandmiddleincomecountries.Weselectedstudiesagainstinclusioncriteriafollowingacomprehensive search, yielding 80 studies. We compared quality under standard categories, converted values to a linear 100% scale, calculateddifferencesbetweenproviderswithinstudies,andsummarisedmedianvaluesofthedifferencesacrossstudies. Astheresultsforfor-profitandnot-for-profitprovidersweresimilar,wecombinedthem.Overall,medianvaluesindicated thatmanyservices,irrespectiveofwhetherpublicorprivate,scoredlowoninfrastructure,clinicalcompetence,andpractice. Overall,theprivatesectorperformedbetterinrelationtodrugsupply,responsiveness,andeffort.Nodifferencebetween provider groups was detected for patient satisfaction or competence. Synthesis of qualitative components indicates the privatesectorismoreclientcentred. Conclusions: Althoughdataarelimited,qualityinbothprovider groupsseemspoor,withtheprivatesectorperforming better in drug availability and aspects of delivery of care, including responsiveness and effort, and possibly being more clientorientated.Strategiesseekingtoinfluencequalityinbothgroupsareneededtoimprovecaredeliveryandoutcomes forthepoor,includingmanagingtheincreasingburdenofnon-communica