Public or non-public family medicine--patients perspective of the quality of primary care in Białystok, Poland.
OBJECTIVE
Privatisation of primary healthcare is believed to raise the efficiency and quality of care. Poland offers a good opportunity to study relationships between ownership status and quality of provided services. The aim of our study was to compare patients' opinions concerning family physicians working in a public healthcare centre (owned and managed by local administrative authorities) with those in a non-public practice (property of family physicians). Both institutions work within the obligatory insurance scheme (the National Health Fund) with open and free access for patients.


METHODS
A cross-sectional study of patients using mail questionnaires was conducted in Białystok, Poland. Overall 1000 subjects aged 18 and over were randomly selected out of all the patients in two primary healthcare centres distinguished by ownership status (non-public and public health centre). The main measures were physician-patient relations and overall satisfaction with physician care.


RESULTS
The response rate was 58% and 560 questionnaires were used for analysis. Respondents from the non-public centre rated family physician care as very good twice as often (21.6%) as those from the public centre (10.6%). Patients from the non-public centre were significantly more frequently informed by doctors about their disease, ways of prevention and therapeutic management, and were also given significantly more support and consolation during visits. The major cause of dissatisfaction with family physicians in het non-public centre was the problem of being referred to a specialist or accessory investigations.


CONCLUSIONS
From the patients perspective, the quality of family physician care in non-public practice is better than in public institutions, especially with regard to communication and work time management. However, the cost-containment enforced by the capitation method of payment may present a threat to doctor-patient relationship.
Chlabicz
Slavomir
S
Department of Family Medicine and Community Nursing, Medical University of Białystok, Mieszka I 4B 15-054 Bialystok, Poland. schlabicz@poczta.onet.pl
Marcinowicz
Ludmila
L
D000328:Adult; D000368:Aged; D003151:Community Health Centers / Q000592:standards*; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010821:Physicians, Family; D011044:Poland; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011331:Private Practice / Q000592:standards*; D011332:Privatization; D011787:Quality of Health Care; D011795:Surveys and Questionnaires