March 2003 Insights Health
Issue #3
Who profits?
Private healthcare - opportunity or risk?
As evidence about the importance of the private sector in healthcare
delivery accumulates, emphasis is being placed on better understanding
the opportunities and risks it creates. Private providers are often key
sources of treatment for diseases of public health importance, such as
malaria, sexually transmitted infections (STIs) and tuberculosis (TB).
They are also an important source of care for poor people, who may use
private providers nearly as much as better-off groups. But there are
concerns about their quality and affordability.
More...
Other articles in this issue:
The characteristics of healthcare providers, the demands of users and
the policy environment can all influence the quality of private healthcare
provision.
It is common for doctors working in the public sector to hold second
jobs in private practice. Dual medical practice occurs in virtually all
countries regardless of income.
In Asia the majority of tuberculosis (TB) patients get their diagnosis
and treatment from private medical practitioners - yet private doctors
are notoriously bad at providing adequate TB services. At the same time,
public services find it difficult to provide services that are easily
accessible to patients. Surprisingly, one approach - public-private partnerships
(PPPs) - may address both of these problems.
Until very recently, the healthcare sector in developed industrialised
countries consisted largely of public services for curative and preventive
care provided by governments and the regulated private sector. These
services were organised into different levels from primary care facilities
up to tertiary hospitals providing specialist care, with a referral mechanism
from one level to the next. But in many low and middle income countries
healthcare has moved away from this model.
In many areas where malaria is endemic, people will buy drugs first
from a local seller and treat themselves at home. Almost all home-based
treatments are undertaken on a 'trial and error' basis.
Competitive voucher schemes are a relatively new way of organising healthcare
provision. They may well help solve some of the difficult problems faced
by conventional health programmes.
Some experts argue that private healthcare providers are preferred by
service-users, or are more efficient or accessible than the public sector,
and hence that government should contract out services to them. However,
factors such as institutional capacity to write and manage contracts
and market competition affect how contracts with private providers function.
This has major implications for contracting in low and middle-income
countries (LMICs).
Further web resources.
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