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Lancet. 2016 Aug 6;388(10044):606-12. doi: 10.1016/S0140-6736(16)00343-3. Epub 2016 Jun 26.

Performance of private sector health care: implications for universal health coverage.

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Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address:
Institute of Health Sciences, University of Leeds, Leeds, UK.
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.


Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers-including their size, objectives, and technical competence-the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole.

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