Determinants of private health sector utilisation in a universal public health care system

Abstract

This paper addresses the concern over high OOP expenditure in the Republic of Malta and identifies the factors that are motivating individuals to seek primary healthcare services in the private sector rather than from the universally publicly funded counterpart. This study researched the primary and ambulatory health services of the private and public sectors and collected data from a sample size of 384 individuals that fit the inclusion criteria requiring respondents to be 18 years of age or older and being residents in Malta. An online questionnaire was used that primarily collected quantitative data; however, it was also equipped with open-ended questions that yielded additional qualitative input. The findings of this study suggest that Malta residents view the private sector as being more satisfactory and convenient. However, the private sector was not identified by the literature as well as this study as being inherently superior in the delivery of care, and the professionalism of its professionals since practitioners in both the public and private sectors were regarded as excelling in their work. The main motivating factors that were prompting such a high rate of OOP expenditure in Malta were therefore found to be logistical and operational and included: the ability to choose the care provider to be seen by; an appointment system over a walk-in system; accessibility of the centre in terms of geographical proximity as well as the availability of parking space; the possibility of home visits; the amount of time spent waiting to be seen; the physical environment; the duration of the session; and in certain situations, the professionalism and mannerism of the practitioner. This study, therefore, suggests enhancing continuity of care by allowing patients to choose and keep their practitioner and also institute an appointment-based system. An additional recommendation would be to offer nursing staff more advanced roles in the primary care setting which might help alleviate the burden from the heavy workload experienced in primary care centres. Furthermore, it might also prove beneficial to increase investment in telehealth since this could also aid in lessening the pressure from the existing public health centres and, therefore, improving the current service delivery.