Assessing the financial impact of physician self-referral on patients and how they cope with payment in Southeast Nigeria

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BACKGROUND: Dual practice occurs where healthcare professionals, particularly medical doctors, engage in concurrent public and private clinical work for remuneration. This practice can impact financial burden on patients when they are transferred from the public sector to private practice. OBJECTIVE: This study investigated the impact of physician self-referral on patient’s finances and how they coped with paying for private bills when diverted to private practice. STUDY SETTING: This study was carried out in Enugu Urban Southeast Nigeria. METHODS: A cross-sectional multistage sampling design was used to elicit information from 407 households who had first visited a public hospital and then gone to a private hospital/clinic in the last 12 months of the study. FINDINGS: The total mean expenditure for treatment in private hospital for the patient group who were referred from public hospitals was higher at a cash figure of N32,104($105), whereas the estimated cost of treatment in the public sector was found to be comparatively low at N9960 ($33). The total median costs were compared using a Wilcoxon signed rank test (p < 0.0001). Nearly half of the referred patient group saw themselves as having “serious and very serious” financial impact as a result of the transfer from the public sector to private practice. The major coping mechanism for paying for private bills was out-of-pocket followed by borrowing and sale of household’s assets. CONCLUSIONS: Public hospital administrations/managers could strengthen measures against transfer of public patients to the private sector. Regulatory measures are needed to reduce patient’s financial burden associated with diversion from the public sector to private practice.

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