Private sector failures in transitioning economies highlight need for public stewardship of health care
Health delivery in many low to middle-income countries is being compromised by private operators offering poor service by unqualified practitioners at exorbitant cost, according to a new Lancet series co-edited by the University of Melbourne and the London School of Hygiene and Tropical Medicine.
The series, which draws on nearly a decade of analysis, found private operators were essential in responding to relentless demand for health services from populations experiencing significant ageing and increases in non-communicable diseases such as diabetes and heart disease.
Yet there was a pattern of market failure when private, for-profit providers dominated without effective public controls, said series co-editor Barbara McPake, Director of the Nossal Institute for Global Health at the University of Melbourne.
“Robust frameworks and a holistic approach to healthcare are required to avoid the risks of price gouging, misuse of market power, and large gaps in coverage,” Professor McPake said.
“When we are talking about millions of people left behind, there are significant implications for a country’s economic growth, stability and wellbeing.”
Professor McPake said policymakers needed a clear and shared understanding of the private sector as a starting point for investment decisions. The situation highlighted the need for intense investment in health by governments as well as rigorous oversight.
“For an effective private-public mix, policymakers need to embrace private sector agility and efficiency as well as an unwavering public commitment to Universal Health Care (UHC), in which access is dictated by need, not resources or power,” she said.
“Believe it or not, this is as achievable in Eritrea and Somalia as it is in the UK and Japan.”
Series co-editor Kara Hanson, from the London School of Hygiene and Tropical Medicine, said affordable, effective private sector delivery could be fostered through strong regulation and strategic procurement.
Private healthcare in low and middle income countries (LMICs) is extensive and wildly heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners, unlicensed and licensed, to corporate hospital chains and large private insurers.
“A strong commitment of public funds is needed to ensure that poor people have adequate services available to them when they are sick and don't need to resort to untrained providers and low quality services,” Professor Hanson said.