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Variation in access to pediatric surgical care among coexisting public and private providers: inguinal hernia as a
Ayman Al-Jazaeri1, Lama Alshwairikh, Manar A Aljebreen
1Dr. Ayman Al-Jazaeri, Division of Pediatrc Surgery,, Department of Surgery,, King Saud University,, Riyadh 1355, Saudi Arabia, aljazaeri@yahoo.com, ORCID: http://orcid.org/0000-0002-6853-0935.
Insights
Private pediatric surgical care offers better access than public options in Saudi Arabia. This study found shorter wait times and symptom durations for children receiving private surgical services.
Area of Science:
- Healthcare policy
- Pediatric surgery
- Health services research
Background:
- Saudi Arabia's healthcare system increasingly uses privatization to meet rising demand.
- Previous analyses of children's surgical care access disparities between public and private providers are lacking.
Purpose of the Study:
- To compare access to pediatric surgical services between public and private providers in Saudi Arabia.
Main Methods:
- A retrospective comparative study analyzed outcomes for pediatric inguinal herniotomy (IH) between May 2010 and December 2014.
- Data included patient demographics, insurance, referral patterns, and access metrics: time-to-surgery (TTS), surgery wait time (SWT), and duration of symptoms (DOS).
Main Results:
- Private provider (PV) patients were younger, more likely male, expatriates, and insured compared to public provider (PB) patients.
- PV had significantly better access parameters: shorter TTS (21 vs. 66 days), SWT (4 vs. 31 days), and DOS (33 vs. 114 days).
- Referral sources differed, with more PB patients coming from emergency departments and PV patients being self-referred.
Conclusions:
- Private pediatric surgical services provide superior access compared to public services in Saudi Arabia.
- Consideration of public funding for private pediatric surgical care expansion may improve overall access, provided outcomes are comparable.
- The study's focus on a single condition limits generalizability to all pediatric surgical services.
Background:
Faced with growing healthcare demand, the Saudi government is increasingly relying on privatization as a tool to improve patient access to care. Variation in children's access to surgical care between public (PB) and private providers (PV) has not been previously analyzed.
Objectives:
To compare access to pediatric surgical services between two coexisting PB and PV.
Design:
Retrospective comparative study.
Settings:
A major teaching hospital and the largest PV group in Saudi Arabia.
Patients And Methods:
The outcomes for children who underwent inguinal herniotomy (IH) between May 2010 and December 2014 at both providers were with IH serving as the model. Data collected included patient demographics, insurance coverage, referral pattern and access parameters including time-to-surgery (TTS), surgery wait time (SWT) and duration of symptoms (DOS).
Main Outcome Measure(S):
TTS, SWT and DOS.
Results:
Of 574 IH cases, 56 cases of in-hospital referrals were excluded leaving 290 PB and 228 PV cases. PV patients were younger (12.0 vs 16.4 months, P=.043) and more likely to be male (81.6% vs 72.8%, P=.019), expatriates (18% vs 3.4%, P < .001) and insured (47.4% vs 0%, P < .001). The emergency department was more frequently the source for PB referrals (35.2% vs 12.7%, P < .001) while most PV patients were self-referred (72.8% vs 16.7%, P < .001). Access parameters were remarkably better at PV: TTS (21 vs 66 days, P < .001), SWT (4 vs 31 days, P < .001) and DOS (33 vs 114 days, P < .001).
Conclusion:
When coexisting, PV offers significantly better access to pediatric surgical services compared to PB. Diverting public funds to expand children's access to PV can be a valid choice to improve access to care in case when outcomes with the two providers are similar.
Limitations:
Although it is the first and largest comparison in the pediatric population, the sample may not represent the whole population since it is confined to a single selected surgical condition.
