Factors associated with use of private sector care among attendees at public primary care clinics

ABSTRACT

OBJECTIVE: To evaluate associations of health status and social inequalities with consultation at a private doctor among public primary care clinic attendees. DESIGN AND METHODS: The sample included 2,117 randomly selected subjects with clinical diabetes attending 35 government health centres in Trinidad and Tobago. Measures included attendance at a private doctor, the type 2 Diabetes Symptom Checklist, the SF36 questionnaire and indicators of social and economic status. RESULTS: Of the sample, 1,256 (59 percent) reported attending a private doctor, 577 (27 percent) attended a private doctor for diabetes, and 378 (18 percent) attended a private doctor regularly. Attendance at a private doctor was associated with lower SF36 score. The odds ratio for a 10 unit increase in SF36 physical component score was 0.81 (95 percent confidence interval 0.72 to 0.91). After adjusting for demographic and social factors, the relative odds were 0.89 (0.80 to 1.00). After allowing for differences in health status, those without pipe-borne water supply in the home were less likely to attend a private doctor than those with (odds ratio 0.77, 0.63 to 0.94). Those living alone were less likely to attend a private doctor than those living with their children and partner (odds ratio 0.60, 0.43 to 0.83). CONCLUSIONS: Persons consulting doctors in the private sector had worse health status than those relying only on public care. Household rather than individual measures of lower social or economic status were associated with less access to private care in relation to need, even among those who use public sector care.(Au)