A new series of articles published in the Lancet serves as a timely warning to Australia about the perils of going further down the path of privatisation in health care.
The series draws on nearly a decade of analysis and considers the complex issues involved in ensuring an effective health system that is affordable for poor populations while managing a public-private mix that works for the public interest.
Overall, the articles found that health delivery in many low to middle income countries is being compromised by private operators offering poor service by unqualified practitioners at exorbitant cost. They also identified a pattern of market failure when private, for-profit providers dominated without effective public controls.
The series concludes that perhaps the best option available to governments is to identify incentives to encourage private health providers to change their behaviour, making equity and quality more important measures of success, while addressing the dangers of an often predatory corporate health sector.
Series co-editors, Professor Barbara McPake, Director of the Nossal Institute for Global Health at the University of Melbourne and Professor Kara Hanson from the London School of Hygiene & Tropical Medicine released the following statement about the series’ findings this morning.[divide]
Professor McPake and Professor Hanson write:
Robust frameworks and a holistic approach to healthcare are required to avoid the risks of price gouging, misuse of market power, and large gaps in coverage.
When we are talking about millions of people left behind, there are significant implications for a country’s economic growth, stability and wellbeing.
Policymakers need a clear and shared understanding of the private sector as a starting point for investment decisions. This situation highlights the need for intense investment in health by governments as well as rigorous oversight
Commitment to universal health care vital
For an effective private-public mix, policymakers need to embrace private sector agility and efficiency as well as an unwavering public commitment to Universal Health Care (UHC), in which access is dictated by need, not resources or power.
Believe it or not, this is as achievable in Eritrea and Somalia as it is in the UK and Japan.
Strong regulation and public funding needed
Affordable, effective private sector delivery could be fostered through strong regulation and strategic procurement.
Private healthcare in low and middle income countries (LMICs) is extensive and wildly heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners, unlicensed and licensed, to corporate hospital chains and large private insurers.
A strong commitment of public funds is needed to ensure that poor people have adequate services available to them when they are sick and don’t need to resort to untrained providers and low quality services.
