Ravindra P Rannan-Eliya, Nilmini Wijemanne, Isurujith K Liyanage, Shanti Dalpatadu, Sanil de Alwis, Sarasi Amarasinghe, and Shivanthan Shanthikumar Objective To compare the quality of inpatient clinical care in public and private hospitals in Sri Lanka. Methods A retrospective, cross-sectional comparison was done of inpatient quality, in a sample of 11 public and 10 private hospitals in three of 25 districts. Data were collected for 55 quality indicators from medical records of 2523 public and 1815 private inpatient admissions. These covered treatment of asthma, acute myocardial infarction (AMI), childbirth and five other conditions, along with outcome indicators, and medicine prescribing indicators. Results Overall quality scores were better in the public sector than the private sector (77 vs 69%). Performance was similar for management of AMI and childbirth and somewhat better in the private sector for management of asthma. The public sector performed better in those indicators that are not constrained by resources (94 vs 81%), but worse in indicators that are highly resource intensive (10 vs 31%). Quality was comparable in assessment and investigation, but the public sector performed better in treatment and management (70 vs 62%) and drug prescribing (68 vs 60%), and modestly worse in terms of outcomes (92 vs 97%). Conclusions For a range
of indicators where comparisons were possible, quality of inpatient
clinical care in Sri Lanka was comparable
to levels reported from upper-middle income Asian
countries, and often approaches that in developed countries, although
the
findings cannot be generalized. Quality in the
public sector is better than in the private sector in many areas,
despite spending
being substantially less. Quality in public
hospitals is resource constrained, and needs greater government
investment for
improvement, but when resource limitations are not
critical, the public sector appears able to deliver equal or better
quality
than the private sector. Overall similarities in
quality between the two sectors suggest the importance of physician
training
and other factors. |