Dual job holding, practising in both public and private sectors at the same time, is a commonly reported income generating activity amongst public sector doctors world-wide. It is often associated with various forms of corruption or unethical behaviour such as the misappropriation of public sector resources and the channelling of patients from public to private services. The problem in Peru, as in many other settings, is that such activities are not well recognised in health sector regulation. The aim of this study is to examine the nature of dual practice in Peru, the factors that influence individuals' decisions to undertake it and the conditions faced when doing so. Rather than being a study of the rights and wrongs of dual practice, the focus is on understanding the appropriate institutional settings for effective regulation in this area. The study entailed a questionnaire survey of 1173 physicians in different parts of Peru, and qualitative interviews with a sample of twenty medical practitioners representing a cross-section of those primarily employed in either the private or public sectors and those primarily in clinical practice or policy making. The results confirm that dual practice is an activity that is widespread and well-accepted; and that the prime personal motivation is financial. However, there are also a number of important broad macroeconomic and regulatory influences on such activity. These suggest measures involving tighter controls on the supply of medical practitioners; alleviation of financial pressures brought by macro-economic conditions; and closer regulation of such activities to ensure some degree of collective action over quality and the maintenance of professional reputations.
Jumpa, M.; Jan, S.; Mills, A. Dual practice of public sector health care providers in Peru. London School of Hygiene and Tropical Medicine, London, UK (2003) 31 pp. [HEFP working paper 06/03]