The role of private practitioners in a rural district of Malaysia and their interactions with public health services.

A study was carried out to examine the role of private practitioners in a rural district in Malaysia and to identify the nature of their interactions with public health services. Underlying null hypotheses were that there is no difference in the nature of the services, the characteristics of the health workers or the clientele of public and private sector facilities and that the interactions between both types of providers were mutually beneficial. Five sub-studies were conducted among 15 private clinics and six public health facilities in Kuala Selangor district. Quantitative and qualitative techniques were used and efforts made to triangulate and validate findings. The nature of services in private clinics is influenced by competition with other facilities, the demand for the services by users and the attempt to maximise profits by the providers. Most private clinics offered a wider range of curative services, operated for longer and had more flexible hours than public facilities. However, private practitioners had a limited role in providing preventive services. Private clinics were mostly run by older doctors supported by younger and untrained staff while public facilities were run by younger doctors supported by older and more experienced staff. Users of private facilities were more likely to be non-Malays, of higher socio-economic status, seeking curative care for acute illnesses and financed by third party cover. Users of private facilities were prescribed more drugs and expensive investigations than those using public facilities. Weak and inappropriate policies, lack of incentives, poor inter and intra-agency collaboration and negative attitudes between the providers were among the problems identified in public-private interactions. Malaysian policy makers need to engage in a consultative process in order to define the best mix of regulations, incentives and other methods aimed at improving the services offered by the providers and improving their interactions.