title: Quality of inpatient care in public and private hospitals in Sri Lanka.
abstract: 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.
authors.affiliation: Institute for Health Policy, 72 Park Street, Colombo, Sri Lanka raviofficelk@gmail.com.
authors.forename: Ravindra P
authors.initials: RP
authors.lastname: Rannan-Eliya
authors.affiliation: Institute for Health Policy, 72 Park Street, Colombo, Sri Lanka.
authors.forename: Nilmini
authors.initials: N
authors.lastname: Wijemanne
authors.affiliation: Institute for Health Policy, 72 Park Street, Colombo, Sri Lanka.
authors.forename: Isurujith K
authors.initials: IK
authors.lastname: Liyanage
authors.affiliation: Institute for Health Policy, 72 Park Street, Colombo, Sri Lanka.
authors.forename: Shanti
authors.initials: S
authors.lastname: Dalpatadu
authors.affiliation: Institute for Health Policy, 72 Park Street, Colombo, Sri Lanka.
authors.forename: Sanil
authors.initials: S
authors.lastname: de Alwis
authors.affiliation: Institute for Health Policy, 72 Park Street, Colombo, Sri Lanka.
authors.forename: Sarasi
authors.initials: S
authors.lastname: Amarasinghe
authors.affiliation: Institute for Health Policy, 72 Park Street, Colombo, Sri Lanka.
authors.forename: Shivanthan
authors.initials: S
authors.lastname: Shanthikumar
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D016304:Hospitals, Private / Q000592:standards*; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D008297:Male; D011247:Pregnancy; D017149:Private Sector / Q000592:standards; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013188:Sri Lanka
keywords: Asthma; Sri Lanka; heart disease; hospitals; inpatient care; maternal care; private sector; quality measurement; quality of clinical care