261017 Factors influencing patient contact time at public health clinics in developing countries: Evidence from Bangladesh

Tuesday, October 30, 2012 : 10:30 AM - 10:45 AM

Dennis Chao, PhD , Global Health Group, RTI International, Research Triangle Park, NC
The main objective of this study is to investigate factors that determine the patient contact time (PCT), with data from a nationally representative sample of non-governmental organization (NGO) clinics in Bangladesh that provided essential health services to poor and non-poor patients. One provider from 138 randomly selected clinics was surveyed and each provider was followed on a randomly selected day using time-and-motion study techniques. This resulted in a total of 2,850 patient records. Results of the regression analysis yielded new evidence on the factors from both the supply and demand sides that contributed to the variations of PCT among health providers with comparable competence. On the supply side, both the time available for direct services and the number of patients influenced PCT. On the demand side, we found whether or not patients paid for care was significant in determining PCT: paying patients received more time than nonpaying patients. A simulation suggests that there are policy and program interventions that can effectively increase the PCT for essential health services. On the supply side, it is important to reinforce the regulations that require providers to spend their full working hours in the clinics and to raise providers' awareness of the standard service protocol. On the demand side, an alternative financing approach is required to further improve the quality of services to the poor. Instead of using a supply-side grant to provide free services to the poor, it would be better to use demand-side financing to enable the poor to pay for services.

Learning Areas:
Biostatistics, economics
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
1. Identify key factors which affect patient contact time in primary health clinics 2. Design effective program interventions to improve patient contact time and quality of service

Keywords: Health Care Quality, Public Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a senior health economist with over 30 years of experience working on health sector issues in developing countries. I have expertise on issues and options for recovering the costs of primary health services, ranging from conducting marketing segmentation and willingness-to-pay studies to designing appropriate user fee systems for clinics and hospitals to improve efficiency and equity.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.