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Lancet. 2016 Aug 6;388(10044):596-605. doi: 10.1016/S0140-6736(16)00342-1. Epub 2016 Jun 26.

What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries.

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Faculty of Social Sciences, Economics Department, The Open University, Walton Hall, Milton Keynes, UK. Electronic address:
Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
Public Health Foundation of India, New Delhi, India.
World Bank, Health Nutrition and Population Global Practice, Washington, DC, USA.


Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners-both unlicensed and licensed-to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa.

[Indexed for MEDLINE]

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