Public and private healthcare services: what drives the choice?

TitlePublic and private healthcare services: what drives the choice?
Publication TypeJournal Article
Year of Publication2020
AuthorsMeleddu, M, Pulina, M, Scuderi, R

This paper has explored patients’ propensity to consume private healthcare services. We based our analysis on the typical tangible and intangible (for instance, responsiveness, reliability, assurance and staff empathy) domains of the SERVQUAL and SERVPERF methods. These variables may influence patients’ decision-making when they choose between the public and private sectors. We combined factor analysis (to obtain a set of latent factors related to perceived quality) and a partial proportional ordered logit model to estimate the probability that a patient would access private healthcare services. To test the main hypotheses, we used data from a stratified sample in Sardinia, a peripheral region of Italy. Findings revealed that private and public healthcare are substitutes, especially for primary/specialised services. Patients who used public healthcare frequently and had a low income were unlikely to change to private healthcare or to recommend private services. ‘Responsiveness’ and perceptions on ‘tangibles’ were key in determining the probability that a patient would choose and recommend private services. This paper offers a multifaceted framework that can be used in future research to generalise these findings, especially in insular regions that are constrained by mobility.

Keywordsfactor analysis, Out-of-pocket spending, Partial proportional ordered logit, Private healthcare, Public healthcare, quality