PHM-Exch> Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org


** ** ** **

*Comparative Performance of Private and Public Healthcare Systems in Low-
and Middle-Income Countries:
A Systematic Review

*

*“…reevaluates the evidence relating to comparative performance of public
versus private sector healthcare delivery in low- and middle-income
countries….”*


Sanjay Basu 1,2,3*, Jason Andrews 4, Sandeep Kishore 5, Rajesh Panjabi 6,
David Stuckler 3,7****


1 Department of Medicine, University of California, San Francisco,
California, United States of America, 2 Division of General Internal
Medicine, San Francisco General Hospital, San Francisco, California, United
States of America, 3 Department of Public Health and Policy, London School
of Hygiene & Tropical Medicine, London, United Kingdom, 4 Division of
Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts,
United States of America, 5 Tri-Institutional MD-PhD Program, Weill Cornell
Medical College/Rockefeller University/Sloan-Kettering Institute, New York,
New York, United States of America, 6 Division of Global Health Equity,
Brigham and Women's Hospital, Harvard Medical School, Boston,
Massachusetts, United States of America, 7 Department of Sociology,
Cambridge University, Cambridge, United Kingdom
Academic Editor: Rachel Jenkins, King's College ****London**, **United
Kingdom********


*PLoS Medicine – 19 June 2012 - Volume 9 -| Issue 6 - e1001244

***

Available online at: http://bit.ly/N6hOQM <http://t.co/CM3o6H3h>
            ****

“……Private sector healthcare delivery in low- and middle-income countries
is sometimes argued to be more efficient, accountable, and sustainable than
public sector delivery. Conversely, the public sector is often regarded as
providing more equitable and evidence-based care. We performed a systematic
review of research studies investigating the performance of private and
public sector delivery in low- and middle-income countries.

****

*Methods and Findings

*

Peer-reviewed studies including case studies, meta-analyses, reviews, and
case-control analyses, as well as reports published by non-governmental
organizations and international agencies, were systematically collected
through large database searches, filtered through methodological inclusion
criteria, and organized into six World Health Organization health system
themes:
accessibility and responsiveness; quality; outcomes; accountability,
transparency, and regulation; fairness and equity; and efficiency.

Of 1,178 potentially relevant unique citations, data were obtained from 102
articles describing studies conducted in low- and middle-income countries.

****

Comparative cohort and cross-sectional studies suggested that providers in
the private sector more frequently violated medical standards of practice
and had poorer patient outcomes, but had greater reported timeliness and
hospitality to patients. Reported efficiency tended to be lower in the
private than in the public sector, resulting in part from perverse
incentives for unnecessary testing and treatment. Public sector services
experienced more limited availability of equipment, medications, and
trained healthcare workers.

****

When the definition of “*private sector*” included unlicensed and
uncertified providers such as drug shop owners, most patients appeared to
access care in the private sector; however, when unlicensed healthcare
providers were excluded from the analysis, the majority of people accessed
public sector care.
*“Competitive dynamics*” for funding appeared between the two sectors, such
that public funds and personnel were redirected to private sector
development, followed by reductions in public sector service budgets and
staff.

****

Conclusions****

Studies evaluated in this systematic review do not support the claim that
the private sector is usually more efficient, accountable, or medically
effective than the public sector; however, the public sector appears
frequently to lack timeliness and hospitality towards patients….”

****
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