Health System Factors Affecting Private Sector Performance: An Overview
Several health system factors affect the functioning of the
private sector as a whole: the structure and performance of the public
health-care sector, the structure of the private sector, the characteristics of
patient demand for health care, and regulation of the private health-care
sector. Individual factors are then linked to these system factors. We will
discuss these based on a 2016 Lancet article as follows:
Poor performance and lack of availability in the public
sector create significant service provision gaps that the private sector often
fills. This is particularly evident in low-income areas where public health
expenditure is insufficient or inefficient. For example, in Bangladesh, a
shortage of qualified healthcare professionals in rural areas drives the
population to seek care from unqualified providers. Similarly, in Tanzania,
when public sector facilities run out of drugs, the private sector sees increased
usage.
Expansion of Small, Poor-Quality Facilities
The expansion of the private sector has enabled the growth
of small, cheap, and poor-quality facilities in many regions, particularly in
sub-Saharan Africa. This growth is often linked to high user charges in the
public sector and deregulation of private provision. Conversely, countries like
Sri Lanka and Thailand have shown that targeted public spending can enhance
public sector quality and accessibility, limiting the private sector’s role to
serving higher-income populations.
Influence of Public Sector Policies
Public sector policies can significantly shape the space
available for private sector provision. For instance, in urban Mozambique,
adequate drug availability in public hospitals and parastatal pharmacies limits
private sector involvement to high-quality services for wealthier individuals.
Impact of Dual Practice
Dual practice, where healthcare practitioners work in both
public and private sectors, is common in many low- and middle-income countries.
This practice can lead to increased patient referrals to the private sector,
higher patient costs, increased absenteeism, and lower quality of care in the
public sector. However, it can also help retain health workers within the
overall health system.
Patient Characteristics
Patient characteristics such as education, economic
capacity, and community preferences significantly shape private sector
performance. Better-informed patients are more likely to seek qualified
providers. In Bangladesh, educated patients tend to switch from unqualified to
qualified providers. Economic constraints, however, often push impoverished
patients towards unqualified private providers.
Economic Conditions and Service Quality
Improving economic conditions can spur better quality in
both public and private medical services. Increased purchasing power,
especially in urban areas, can lead to larger, more specialized private
hospitals. This growth can reduce unit costs and improve service quality
through a more qualified workforce and better facilities.
Regulation and Quality Control
Regulation is crucial for ensuring private providers offer
acceptable and quality services. ack of regulation can lead to the
proliferation of small, poor-quality facilities, as seen in Ghana, Malawi,
Tanzania, and Zambia. Conversely, effective regulation, including certification
and accreditation, can enhance service quality. For instance, accreditation has
improved patient satisfaction and health outcomes in Thailand and reduced
surgical infections in India. However, effective regulation is often lacking in
low-income countries due to limited governmental capacity.
In conclusion, the interplay between public and private
healthcare sectors, patient characteristics, economic conditions, and
regulatory frameworks significantly affects the performance and quality of
private healthcare provision. Addressing these factors holistically is
essential for improving healthcare outcomes in diverse settings.
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