Public-Private Partnership in Healthcare: An Analysis of Parents' Perceived Care Quality in Pakistan's Twin Cities Hospitals, Islamabad and Rawalpindi – A Comparative Cross-Sectional Study

Abstract

Introduction: Pakistanis belonging to lower socioeconomic backgrounds are attracted to higher-cost private healthcare facilities because they believe that the quality of service is superior. This creates a cycle of poverty and illness. Urgent measures must be implemented to enhance the quality of public hospitals perceived by population. This study investigates how parents of pediatric patients admitted to two government hospitals evaluate the varying quality of care.

Materials and Methods: Between October 2022 and February 2023, a comparative, cross-sectional, questionnaire-based study (based on HEALTHQUAL model) was conducted at two government medical college hospitals in the twin cities of Islamabad and Rawalpindi: one operated directly by the government under the Public Hospital model (PH-model), and the other under the Private-Public Partnership (PPP) model. The eligible inpatients were 115 from the hospital using PH model and 145 from the hospital using PPP model. Patients who died (6 in PH and 15 in PPP) or left against medical advice (LAMA) (11 in PH and 5 in PPP) were excluded. Three forms from the PPP model hospital and four incomplete forms from the PH were also rejected. Respondents rated the following domains on a scale of 1 to 5 (Likert scale): Empathy, tangibility, safety, efficiency, and improvement of care services. Additionally, respondents rated their overall satisfaction on a scale of 1 to 10. On a scale of 1 to 5, a rating of more than 4 in each domain was considered good. An 8 or higher on a scale of 1 to 10 indicated enjoyment.

Results: The responders from the hospital using the PPP-model were much more satisfied compared to those from the hospital using the PH-model. The satisfaction rate was 91% (n=132) for the PPP-model hospital, whereas it was only 30% (n=35) for the PH-model hospital. This difference was statistically significant with a p-value of less than .001. Even after accounting for sex, age-group, family type, maternal education, socioeconomic status and days of hospital-stay, the relationship remained significant (O.R.(CI) = 23.59 (16.12-34.47); p < .001) according to the binary logistic regression model. PPP-model was superior to PH-model in all dimensions of HEALTHQUAL based questionnaire. It reported (mean ± SD, p-value for PPP vs PH) for empathy (4.09 ± 0.48 vs 3.20 ± 0.49, p < 0.0001), tangibility (4.20 ± 0.51 vs 3.01 ± 0.52, p < 0.0001), safety (4.30 ± 0.48 vs 3.11 ± 0.50, p < 0.0001), efficiency (4.41 ± 0.51 vs 2.90 ± 0.53, p< 0.0001), and improvement of care services 4.50 ± 0.52 vs 3.02 ± 0.53, p < 0.0001).

Conclusion: Based on the satisfaction and perception ratings of the respondents, hospitals that implemented the PPP model were shown to have a higher perceived quality of care. This strategy could be repeated in developing nations to bring patients from lower socioeconomic backgrounds to more affordable tertiary-care public facilities.