Public stewardship of private providers in mixed health systems
Synthesis report from the Rockefeller Foundation—sponsored initiative on the role of the private sector in health systems
Lagomarsino Gina, Stefan Nachuk, and Sapna Singh Kundra. 2009.
Available online PDF [74p.] at: http://bit.ly/1gpmsq
“……..This report summarizes the findings from research commissioned in 2008 by the Rockefeller Foundation, in collaboration with the Results for Development Institute and the Thai Ministry of Public Health’s International Health Policy Program. This research—resulting in 14 papers by various institutions, examining the role of the private sector in health systems in developing countries— draws on multiple data sources, including, a global survey of countries’ regulatory models, a scan of innovative private sector financing and delivery models, a survey of attitudes toward the private health sector, and evidence on where people receive health services.
The Foundation sponsored this work as part of broader repositioning of its health strategy to address the emerging challenges of the 21st century. The repositioning led, in late 2008, to adoption of a new Foundation initiative on Transforming Health Systems to achieve high-quality, accessible, and affordable health coverage for all.
One key theme emerging from this analysis is the importance of public stewardship of the nonstate sector (that is, the private sector, broadly defined). Effective government stewardship is crucial for achieving broader health objectives, given the reality that many countries already have large, complex markets for healthcare, presenting major challenges and significant opportunities.
A second key theme is that many governments are not performing that stewardship role particularly well at present. Policy dialogue and decisionmaking—within government and with donors— are often not well informed about the huge scale and diversity of health services that exist beyond government-run facilities. Those in the public sector who should be overseeing the entire health system—state and nonstate—are not monitoring what is happening in the nonstate sector and have imperfect understanding of the forces at work in the health system in its entirety. Nor is there adequate appreciation of the fact that private out-of-pocket payments by households account for a large proportion of total health spending.
Compounding these problems are severe limitations in the data available on the nonstate sector. Basic information on what kinds of services the private sector provides, to whom, and with what results is not readily at hand for policymakers…..”
Table of contents
Chapter 1 The context: Country health systems include much more than government-run services
A varied mix of service providers
Is the private sector growing or shrinking?
Complexity of mixed public-private systems
Why do health markets persist?
Challenges for health markets
Chapter 2 The challenge: Developing effective stewardship
The regulatory mechanism
The financing mechanism
The purchasing mechanism
Limited stewardship of health markets in the developing world
Systemic barriers to stewardship in mixed health systems
Chapter 3 Ideas for accelerating progress toward better stewardship of mixed health systems
Invest in information about health markets
Support innovative models that can serve as “stepping stones” to broader reforms
Develop a roadmap for mixed health system stewardship
Partner papers and references
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