Physician dual practice: a review of literature

Abstract

Objectives: A combination of public and private practice by physicians, referred to as physician dual practice, has been receiving attention in connection with arguments about its negative impact for the public health care. This paper aims to review and critically discuss findings on the subject of dual practice effects for the public health care.

Methods: A systematic literature review identified 23 positions on the subject consisting of journal articles, academic working papers, book chapter, and publications of the WHO.

Results: The subject is short on evidence. Theoretical analyses indicate both positive and negative effects of dual practice. Some of the effects depend, however, on assumptions that are undermined in the broader literature. The analyses assume that the dual practitioners' objective is to maximise income. Yet, while physicians seem to engage in a private practice on top of the public one mainly to increase income, it remains uncertain whether dual practice is an income-maximising combination of jobs. Moreover, costs of enforcing restrictions on dual practice are rarely considered.

Conclusions: Further research is needed that compares dual practitioners and other physicians in uniform settings, investigates how the dual practitioners divide labour between the two jobs, and analyses the costs of enforcing restrictions on dual practice.