Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine ß The Author 2015; all rights reserved.
Health Policy and Planning 2015;30:i1 doi:10.1093/heapol/czv004
EDITORIAL
The role of the private sector in health systems David Bishai* and Karampreet Sachathep Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health *Corresponding author. 615 N. Wolfe St. Number E4622, Baltimore, MD 21205. E-mail: [email protected]
inpatient care quality in public and private hospitals in Sri Lanka comparative to other lower-middle income developing nations is quite high and that the public sector performs better than the private in many areas. The Cid et al. paper looks at health outcomes across public, private not-for-profit and private for-profit hospitals and finds important differences in significant clinical indicators across ownership. The Ghana mobile phone study by Chatterji et al. shows us that a mobile phone text message intervention sent to licensed drug sellers improved providers’ self-reported behaviour but not actual behaviour which requires further evaluation. The last theme of the papers shared at the Symposium involve governance and regulatory frameworks attached to private and public sector involvement in health systems. The two papers published under this theme are on regulatory frameworks for the private sector derived from East and Southern Africa as well as a geospatial mapping paper on the availability of health services in the slum settlements of Dhaka. The Doherty study conducted a thorough review of existing legislation in the South and Eastern African region. The author found that a regulatory framework is required for strengthening adequate legislation for private health care provision and insurance. The Adams et al. study displays the need for some level of coordination and cooperation between the public and private sectors as well as the importance of including the informal private sector in the effective coverage of health services for the urban poor in this setting. This vast array of papers as well as the many more which were shared at the Private Sector Symposium in 2013, brings to light the variety of issues and topics which are under research and consideration around the world. The private sector plays a vital role in health systems development, management and effectiveness and yet it is an area which remains to be very much under explored and uninformed. As academics and researchers, we must also question what the impact of this research will be and what are the next actionable steps and policy ramifications of the findings and results that we are sharing. Furthermore, including policy makers and practitioners’ in research and implementation is vital as no action will be possible without the support and commitment of these key players in the healthcare industry.
i1
Downloaded from http://heapol.oxfordjournals.org/ at EPFL Lausanne on September 29, 2015
There is a growing appreciation and recognition of the role of the private sector in the development of better health systems and the improvement of healthcare worldwide. We are witnessing a large increase in research dedicated to this topic and thus in July 2013, we brought together experts, healthcare providers and researchers from around the world for a symposium in Sydney to discuss and share findings and research on this very topic. The symposium was generously supported by Rockefeller Foundation, Gates Foundation, USAID, AusAID, and DFID. There were three pervasive themes which were represented at the Symposium; access, quality and governance. Access papers ranged from evaluations of private insurance programmes targeted at the poor in Georgia, to an assessment of the condom market in Myanmar, to the private sector’s role in tertiary care delivery in India. The paper by Gotsadze et al. involves an impact evaluation of private health Insurance for the Poor in Georgia, which shows us that insurance programmes targeted at the poor may not necessarily have a significant impact on service utilization however, that there is a sizable decrease in out-of-pocket healthcare expenditure, especially so amongst the poorest. The authors find however that new programmes such as insurance programmes for the poor often involve other factors affecting health seeking behaviour. The Htat et al. paper on access involves the evaluation of the condom market in Myanmar and the need for an integrated cross-sectoral approach to condom distribution for sustainability. Authors find that a total market approach involving the public and commercial sectors is required in order to grow and sustain the Myanmar market. The Katyal et al. paper focuses on two Indian states’ attempts to partner with the private sector in Government sponsored healthcare initiatives. This article shows us that results vary across the two states and that the Government sponsored programme resulted in mixed impact which seemed to be very context-driven. The second theme of these paper submissions was one on the quality of care. These papers ranged from dissecting inpatient and outpatient care issues in Sri Lanka, differences in clinical outcome amongst varied hospital ownership in Chile, to an Randomized Controlled Trial (RCT) on mobile phones and childhood diarrhoea in Ghana. The two Rannan-Eliya et al. papers on Sri Lanka display that the quality of outpatient and
Health Policy and Planning 2015;30:i1 doi:10.1093/heapol/czv004
EDITORIAL
The role of the private sector in health systems David Bishai* and Karampreet Sachathep Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health *Corresponding author. 615 N. Wolfe St. Number E4622, Baltimore, MD 21205. E-mail: [email protected]
inpatient care quality in public and private hospitals in Sri Lanka comparative to other lower-middle income developing nations is quite high and that the public sector performs better than the private in many areas. The Cid et al. paper looks at health outcomes across public, private not-for-profit and private for-profit hospitals and finds important differences in significant clinical indicators across ownership. The Ghana mobile phone study by Chatterji et al. shows us that a mobile phone text message intervention sent to licensed drug sellers improved providers’ self-reported behaviour but not actual behaviour which requires further evaluation. The last theme of the papers shared at the Symposium involve governance and regulatory frameworks attached to private and public sector involvement in health systems. The two papers published under this theme are on regulatory frameworks for the private sector derived from East and Southern Africa as well as a geospatial mapping paper on the availability of health services in the slum settlements of Dhaka. The Doherty study conducted a thorough review of existing legislation in the South and Eastern African region. The author found that a regulatory framework is required for strengthening adequate legislation for private health care provision and insurance. The Adams et al. study displays the need for some level of coordination and cooperation between the public and private sectors as well as the importance of including the informal private sector in the effective coverage of health services for the urban poor in this setting. This vast array of papers as well as the many more which were shared at the Private Sector Symposium in 2013, brings to light the variety of issues and topics which are under research and consideration around the world. The private sector plays a vital role in health systems development, management and effectiveness and yet it is an area which remains to be very much under explored and uninformed. As academics and researchers, we must also question what the impact of this research will be and what are the next actionable steps and policy ramifications of the findings and results that we are sharing. Furthermore, including policy makers and practitioners’ in research and implementation is vital as no action will be possible without the support and commitment of these key players in the healthcare industry.
i1
Downloaded from http://heapol.oxfordjournals.org/ at EPFL Lausanne on September 29, 2015
There is a growing appreciation and recognition of the role of the private sector in the development of better health systems and the improvement of healthcare worldwide. We are witnessing a large increase in research dedicated to this topic and thus in July 2013, we brought together experts, healthcare providers and researchers from around the world for a symposium in Sydney to discuss and share findings and research on this very topic. The symposium was generously supported by Rockefeller Foundation, Gates Foundation, USAID, AusAID, and DFID. There were three pervasive themes which were represented at the Symposium; access, quality and governance. Access papers ranged from evaluations of private insurance programmes targeted at the poor in Georgia, to an assessment of the condom market in Myanmar, to the private sector’s role in tertiary care delivery in India. The paper by Gotsadze et al. involves an impact evaluation of private health Insurance for the Poor in Georgia, which shows us that insurance programmes targeted at the poor may not necessarily have a significant impact on service utilization however, that there is a sizable decrease in out-of-pocket healthcare expenditure, especially so amongst the poorest. The authors find however that new programmes such as insurance programmes for the poor often involve other factors affecting health seeking behaviour. The Htat et al. paper on access involves the evaluation of the condom market in Myanmar and the need for an integrated cross-sectoral approach to condom distribution for sustainability. Authors find that a total market approach involving the public and commercial sectors is required in order to grow and sustain the Myanmar market. The Katyal et al. paper focuses on two Indian states’ attempts to partner with the private sector in Government sponsored healthcare initiatives. This article shows us that results vary across the two states and that the Government sponsored programme resulted in mixed impact which seemed to be very context-driven. The second theme of these paper submissions was one on the quality of care. These papers ranged from dissecting inpatient and outpatient care issues in Sri Lanka, differences in clinical outcome amongst varied hospital ownership in Chile, to an Randomized Controlled Trial (RCT) on mobile phones and childhood diarrhoea in Ghana. The two Rannan-Eliya et al. papers on Sri Lanka display that the quality of outpatient and
