What is the role of the private sector in health care across developing countries? How do these health professionals interact with public sector health care providers? What areas require further examination to appraise the value of the private sector in health care? In health care, the private sector provides a wide range of services across developing countries. These private providers may have different motives to be part of the health system, be it for profit, or for non-profit humanitarian or charitable reasons, but nonetheless form a critical part of health care provision in many countries.
This Health Policy and Planning Journal article provides a literature review of papers that consider the role of the private sector across a large number of developing countries, from India, to Mexico, to Papua New Guinea, but focussing mainly on the East Asian region. The significance of private health care in Asian countries, factors influencing utilisation of health services, and the interaction between public and private providers across countries are included.
While there is limited information published on private practitioners in Asian countries, available literature suggests that the private sector makes up a large proportion of health care services and plays an important role alongside the government and indigenous healers. In some studies it was found that private practitioners were utilised more frequently than government services. Other key findings include:
- Factors including characteristics of the subjects (socio- economic status, ethnicity), characteristics of the disorder (acute, minor or chronic), and characteristics of the service (geographical accessibility, quality of care, price of care) affect the type of treatment sought
- Regulation of the private health care industry in many developing countries is weak through lack of resources, poor decentralised government services and lack of information on activities of private providers
- Health professionals trained at public expense often end up in the private sector. In order to reduce the impact of this, governments enforce mandatory public service, or provide incentives for health care professionals to remain in the public sector, with varying levels of success.
The findings revealed by the body of literature demonstrate a need for further research to document and analyse existing interactions if policies are to be developed which identify the appropriate role for private practitioners and encourage good quality, cost-effective care in the private sector. Key policy implications include:
- Identifying the factors affecting health service utilisation assists in identifying barriers faced by users of the services. These barriers need to be considered by policy makers when promoting private or public sector services
- Given that many health care programmes affect both private and public providers, understanding the kinds of interactions and problems faced by them provides valuable feedback to health planners seeking to improve the effectiveness and efficiency of such programmes.
