Physicians in private practice: reasons for being a social franchise member

Health Research Policy and Systems

Tin Aung¹  Qingfeng Li²  Nang Mo Hom¹  Gary Mundy³  Dale Huntington⁴ 

[1] PSI/Myanmar, 16 West Shwe Gone Dine 4th Street,, Bahan Township, Yangon, Myanmar;3101 Huntingdon Ave., Baltimore, MD, 21211, USA;Population Services international, 273 Kim Ma Street, Ba Dinh District, Ha Noi, Vietnam;Reproductive Health and Research Department, World Health Organization, Geneva, Switzerland

关键词: Myanmar;    Reproductive health;    Social franchising;   

Others  :  809939
DOI  :  10.1186/1478-4505-10-25

 received in 2012-04-13, accepted in 2012-07-03,  发布年份 2012

【 摘 要 】

Background

Evidence is emerging on the cost-effectiveness, quality and health coverage of social franchises. But little is known about the motivations of providers to join or remain within a social franchise network, or the impact that franchise membership has on client volumes or revenue earnings.

Methods

(i) Uncontrolled facility based of a random sample of 230 franchise members to assess self-reported motivations; (ii) A 24 month prospective cohort study of 3 cohorts of physicians who had been in the franchise for 4 years, 2 years and new members to track monthly case load and revenue generated.

Results

The most common reasons for joining the franchise were access to high quality and cheap drugs (96.1%) and feelings of social responsibility, (95.2%). The effects of joining the franchise on the volume of family planning services is shown in the 2009 cohort where the average monthly service volume increased from 18.5 per physician to 70.6 per physician during their first 2 years in the franchise, (p<0.01). These gains are sustained during the 3^rd and 4^th year of franchise membership, as the 2007 cohort reported increases of monthly average family planning service volume from 71.2 per physician to 102.8 per physician (p<0.01). The net income of cohort 2009 increased significantly (p=0.024) during their first two years in the franchise. The results for cohorts 2007 and 2005 also show a generalized trend in increasing income.

Conclusions

The findings show how franchise membership impacts the volume of franchise and non-franchised services. The increases in client volumes translated directly into increases in earnings among the franchise members, an unanticipated effect for providers who joined in order to better serve the poor. This finding has implications for the social franchise business model that relies upon subsidized medical products to reduce financial barriers for the poor. The increases in out of pocket payments for health care services that were not price controlled by the franchise is a concern. As the field of social franchises continues to mature its business models towards more sustainable and cost recovery management practices, attention should be given towards avoiding commercialization of services.

【 授权许可】

   
2012 Huntington et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 .

Figure 2 .

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