title: The Impact of Healthcare Privatization on Access to Surgical Care: Cholecystectomy as a Model.
abstract: Privatization is widely perceived as a tool to improve healthcare access; however, its impact on the access of surgical care has not been quantified. We used cholecystectomy as a model to assess the variation in access between coexisting public (PB) and private providers (PVs).
  
  
  
  We performed cross-sectional analysis of patients who underwent cholecystectomy at two major PB and PV groups serving Riyadh, Saudi Arabia. Representative sample sizes were estimated based on 95 % confidence level and ±5 confidence interval (CI). Exclusion criteria were major comorbidities, emergency cholecystectomies, age ≥60 and concurrent non-minor procedures. Data collected were patients' demographics, payer status, and durations of symptoms, diagnosis and hospitalization.
  
  
  
  Between 2012 and 2104, samples of 330 and 297 were randomly selected from the total of 2164 and 1315 cases performed at PV and PB, respectively. Seventy-eight PV and 73 PB cases were excluded. The distribution of publically funded/insured/self-paid was (3/179/70 PV) and (209/0/4 PB), respectively. Median durations between symptoms and surgery for PV and PB cases were 90 and 365 days (P < 0.001), respectively, while the wait times after ultrasound-based diagnosis were 125 and 11 days (P < 0.001), respectively. Median hospitalization time was significantly shorter in PV compared to PB (1 vs. 2 days, P = 0.001), and same-day admissions were more frequent in PV 94 % than PB 41 % (RR 2.3, CI 1.9-2.7).
  
  
  
  When coexist in a competitive environment, PV offers a remarkably better access to cholecystectomies compared to PB. Facilitating access to PV can be an effective strategy to improve patient's access to surgical care.
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Saudi Arabia. aaljazaeri@ksu.edu.sa.
authors.forename: Ayman
authors.identifier: 0000-0002-6853-0935
authors.initials: A
authors.lastname: Al-Jazaeri
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Saudi Arabia.
authors.forename: Firas
authors.initials: F
authors.lastname: Ghomraoui
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Saudi Arabia.
authors.forename: Wejdan
authors.initials: W
authors.lastname: Al-Muhanna
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Saudi Arabia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Saleem
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Saudi Arabia.
authors.forename: Hazem
authors.initials: H
authors.lastname: Jokhadar
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Saudi Arabia.
authors.forename: Tareq
authors.initials: T
authors.lastname: Aljurf
mesh_terms: D000328:Adult; D002763:Cholecystectomy; D003430:Cross-Sectional Studies; D004465:Economic Competition; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011332:Privatization; D012529:Saudi Arabia; D061665:Time-to-Treatment / Q000706:statistics & numerical data*