Rapid privatisation has worsened health care services in poor and middle-income nations: study

But public sector, too. needs quality improvement, say researchers from University of California

By Salma Rehman
Published: Friday 22 June 2012

What should cash strapped low- and middle-income countries do to improve access to health care? Should they strengthen the public health sector or the private sector? The question remains unresolved, but often funds are redirected from the public exchequer to the private health sector, even though, there is not enough data to guide policy. Recently, the International Monetary Fund suggested that countries should increase private sector provision in health care as part of loan conditions to reduce government debt.

To assess if such moves would be judicious, researchers led by Sanjay Basu of department of medicine at University of California in San Francisco used existing published data of private and public sector performance in low- and middle-income countries and assessed them against World Health Organization's six criteria for good health systems: accessibility and responsiveness, quality outcomes, accountability, transparency and regulation, fairness and equity, and efficiency.

The results showed that the private sector is no more efficient, accountable or medically effective than the public sector. The risks ranged from low-quality care to discrimination based on socio-economic status of patients and from higher drug costs to lack of transparency in health services. For one, though a significant proportion of out-patient services in low- and middle-income countries appeared to be provided by the private sector, they provided it only to the affluent classes. For diagnostic accuracy and adherence to medical management standards, the team found that these norms were worse among private sector care providers. There was a higher rates of potentially unnecessary procedures, such as cesarean sections, reported at private than in public facilities.

Women and children suffer more

The study also compared the pre and post-privatisation outcomes and found that that the rapid phase of privatisation initiatives has worsened health care performances. For example, in Brazil, the privatisation of fertility control services led to increased abortions, sterilization, and improper use of oral contraceptives, ultimately linked to higher mortality rates among young women. The study also reveals that privatisation has led to inequalities in distribution system, increase in disparities in health care coverage and infant mortality between urban and rural areas. Moreover, poor reporting of diseases in the private sector impeded public sector control of communicable diseases.

But the researchers found that even the public sector is not without fault. Considerable  deficiencies in drug availability and technical inefficiency were found in the sector. The analysis underscores the fact that competition between public and private sector tended to decrease drug prices—the availability of drugs in the public sector decreased prices in the private sector. The researchers recommend that in the private sector, benefits may accrue from enhancing medical knowledge for appropriate diagnosis and disease management. On the other hand, the public sector needs quality improvement, suggests the team in the study published in PloS Medicine. The study says that there is limited and poor-quality evidence base regarding the comparative performance of the two systems to favour one over the other.


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