• Ayman Al-Jazaeri, Lama Alshwairikh, Manar A Aljebreen, Nourah AlSwaidan, Tarfah Al-Obaidan, and Abdulrahman Alzahem.
• Dr. 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.
• Ann Saudi Med. 2017 Jul 1; 37 (4): 290296290-296.

BackgroundFaced 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.ObjectivesTo compare access to pediatric surgical services between two coexisting PB and PV.DesignRetrospective comparative study.SettingsA major teaching hospital and the largest PV group in Saudi Arabia.Patients And MethodsThe 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.ResultsOf 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).ConclusionWhen 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.LimitationsAlthough 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.

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