Performance of private sector health care: implications for universal health coverage

Abstract

While the private sector is an important health care provider in many low and middle income countries (LMICs), its role in relation to progress towards Universal Health Coverage (UHC) varies. Drawing on a review of the published and grey literature, we explore the factors that affect private sector contribution to UHC: i.e. we are interested in the overall impact on system outcomes such as . Evidence on the performance of both the private and public healthcare sectors is used to examine the characteristics of private providers that are associated with their performance, and the implications for how these factors might interrelate to influence progress towards UHC. Studies of private sector performance have focused on three main dimensions: quality, equity of access, and efficiency. We found that the characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers including their size, objectives, and technical competence the interaction of these factors influences how the sector performs within different contexts. Changing the performance of the private sector will require interventions which target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector appears to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health sector requires a regulatory response focused on the health sector as a whole. Key messages The critical policy relevant question about the private sector is not its performance in isolation, or relative to the public sector, but the extent to which it supports or detracts from progress towards Universal Health Coverage  There is a dearth of evidence on factors affecting system level performance, reflecting the complexity and heterogeneity of the private health sector and the difficulty in exploring the inter-relationships of factors at the system level, and their effect on overall performance.  Deriving population benefit from the private health sector will require interventions which target the sector as a whole, rather than individual providers alone.

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“…For example, unnecessary interventions reduce the quality, efficiency, and accessibility of care, and increase OoP expenditure. 49 The private sector, furthermore, absorbs a disproportionate share of the health workforce, and is inaccessible to most of the population. 49 Two other points merit attention.…”

“…49 The private sector, furthermore, absorbs a disproportionate share of the health workforce, and is inaccessible to most of the population. 49 Two other points merit attention. Private procurement of drugs is the single largest component of high OoP healthcare expenses, signifying poor access to public facilities.…”

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