title: 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: OBJECTIVE
  To compare the quality of clinical care and patient satisfaction 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 (URTI) 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, URTI 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 better than India, and similarly in many indicators to high-income countries.
  
  
  CONCLUSIONS
  Quality of outpatient primary care in Sri Lanka is generally high for a lower-middle 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 healthcare receive better quality care in non-clinical areas.
authors.affiliation: Institute for Health Policy, Colombo, Sri Lanka raviofficelk@gmail.com.
authors.forename: Ravindra P
authors.initials: RP
authors.lastname: Rannan-Eliya
authors.affiliation: Institute for Health Policy, Colombo, Sri Lanka.
authors.forename: Nilmini
authors.initials: N
authors.lastname: Wijemanne
authors.affiliation: Institute for Health Policy, Colombo, Sri Lanka.
authors.forename: Isuru K
authors.initials: IK
authors.lastname: Liyanage
authors.affiliation: Institute for Health Policy, Colombo, Sri Lanka.
authors.forename: Janaki
authors.initials: J
authors.lastname: Jayanthan
authors.affiliation: Institute for Health Policy, Colombo, Sri Lanka.
authors.forename: Shanti
authors.initials: S
authors.lastname: Dalpatadu
authors.affiliation: Institute for Health Policy, Colombo, Sri Lanka.
authors.forename: Sarasi
authors.initials: S
authors.lastname: Amarasinghe
authors.affiliation: Institute for Health Policy, Colombo, Sri Lanka.
authors.forename: Chamara
authors.initials: C
authors.lastname: Anuranga
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards*; D017149:Private Sector / Q000592:standards*; D011446:Prospective Studies; D017150:Public Sector / Q000592:standards*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D013188:Sri Lanka
keywords: Asthma; Sri Lanka; hospitals; maternal care; outpatient care; patient satisfaction; private sector; quality measurement; quality of clinical care