Beyond wages: Why dual practice physicians discriminate care quality towards private patients in Ghana

There is sparse implicit evidence that Dual Practitioners (DPs), physicians holding public and private jobs concurrently discriminate care quality toward private patients to attract better wages. We examined this phenomenon drawing on literature to construct and test the hypotheses that beyond wages, differences in leadership and management, working conditions and psychological ownership between the private and public healthcare sectors influence DPs discriminatory care quality efforts. The study surveyed 121 DPs in four cities across Ghana. Data were collected using a structured questionnaire modelled on the three constructs and two outcome measures of care quality: patient-centeredness and patient satisfaction. Repeated t-measures and logistic regression models were used to analyse data. DPs rated private facilities higher than public facilities in all the domains of the three constructs. DPs patient-centeredness and commitment to patient satisfaction was highly influenced by effective leadership and management and good working conditions in the private than public facilities. Psychological ownership had statistically significant influence on DPs patient-centeredness in the private facilities but not the public. These findings provide explicit evidence toward understanding the causalities of DPs service quality fragmentation across practice settings and contribute to policy regulation of the medical labor market in Ghana and other countries.