Standard Survey Data: Insights Into Private Sector Utilization

Universal Health Coverage in Low- and Middle-Income Countries is increasingly expanding through incorporation of private clinics, pharmacies, and hospitals into an overall health system funded in whole or part through government-managed health insurance. This underscores the importance of policies on health provision which apply across the whole delivery system regardless of ownership status. To advance understanding of private-sector policies, and to facilitate sharing of lessons across countries with similar public-private distributions, we have analyzed data on the source of inpatient and outpatient care from 65 countries. While past studies have conducted similar analysis, ours advances the field in two ways. First, we limit our analysis to data sets from 2010 through 2019, making our study more up-to-date than past studies, while changing health seeking patterns for maternal health since 2010 means that our data set is more representative of overall inpatient care. Second, while past multi-country analysis of public-private ownership have been based on the Demographic Health Surveys, we have added to this data from the Multiple Indicator Cluster Surveys, significantly increasing the countries in our analysis. We have aggregated our analysis by WHO's regions. Outside of the EURO region, where the private sector delivers just 4% of all healthcare services, the private sector remains significant, and in many countries represents more than half of all care. The private sector provides nearly 40% of all healthcare in PAHO, AFRO, and WPRO regions, 57% in SEARO, and 62% in EMRO. While specific countries with two recent surveys show variation in the scale of both inpatient and outpatient private provision, we did not find regional or global trends toward or away from private care within LMICs. Private inpatient care is most important for the wealthy in many countries; public vs. private care varies less, by wealth, for outpatient services.

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Expenses and national insurance payments at a municipal-level hospital in rural Nepal: implications for strategic purchasing and universal health coverage

10.21203/rs.2.20326/v1 ◽

2020 ◽

Author(s):

Ryan Schwarz ◽

Prajwol Nepal ◽

Bibhav Acharya ◽

Shiva Raj Adhikari ◽

Anu Aryal ◽

...

Keyword(s):

Health Care ◽

Private Sector ◽

Hospital Costs ◽

Fee For Service ◽

Health Coverage ◽

Outpatient Services ◽

Strategic Purchasing ◽

Health Delivery ◽

Provider Payment ◽

Payment Mechanisms

Abstract Background: Strategic purchasing mechanisms, including national health insurance, provide opportunities to improve quality and progress towards universal health coverage. Nepal’s health insurance program (HIP), begun in 2016, is a national insurance platform aiming to improve financial risk protection, and efficiency, quality, and access to health services. HIP also further engages private-sector providers through strategic purchasing, potentially improving quality, regulation, and accountability. Bayalpata Hospital is a public-private partnership (PPP) hospital run jointly by the Ministry of Health and Population and Nyaya Health Nepal and is one of the first PPP hospitals enrolled in HIP. We evaluated Bayalpata Hospital costs and HIP guidelines to understand how HIP rates compare to health delivery costs incurred.Methods: We employed a top-down costing methodology to analyze costs for fiscal year 2017-2018. We compared costs to HIP reimbursement rates during the same period, and projected overall coverage for costs assuming full HIP enrollment given the compulsory nature of HIP.Results: Our data suggest HIP, as one payment mechanism in Nepal’s mixed provider payment system, would cover 57% of hospital costs with full enrollment, with variation across services. Among inpatient services, 64% of costs would be covered, including 105% reimbursement for fee-for-service, 87% reimbursement for bundled packages, but only 23% - 40% for certain surgical services. For outpatient services, 59% would be covered, and for emergency services, 32% would be covered. Conclusions: HIP is an important strategic purchasing foundation; however, payments may be insufficient to match provider costs and cover a larger percentage of inpatient-based and fee-for-service delivery than outpatient services. These dynamics may inappropriately incentivize fee-for-service health care utilization, in particular for private-sector providers without access to other public-sector payment mechanisms, while potentially disincentivizing outpatient or community-based approaches to health care, which are less well reimbursed through HIP. HIP policy revisions, and further expansion of mixed provider payment mechanisms, may more effectively incentivize primary health care approaches, while also deepening private-sector engagement. The data and experience of Bayalpata Hospital and HIP offer practical insights for Nepali policymakers and those in similar settings globally employing strategic purchasing to improve progress towards UHC and quality health delivery.

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Association of SHI coverage and level of healthcare utilization and costs in the Philippines: a 10-year pooled analysis

Journal of Public Health ◽

10.1093/pubmed/fdz142 ◽

2019 ◽

Vol 42 (4) ◽

pp. e496-e505

Author(s):

Nel Jason L Haw ◽

Jhanna Uy ◽

Beverly Lorraine Ho

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Utilization ◽

Health Care Costs ◽

Inpatient Care ◽

The Philippines ◽

Care Utilization ◽

Health Coverage ◽

Outpatient Services ◽

Care Costs

Abstract Background The Philippine Health Insurance Corporation (PhilHealth), which manages the Philippine national health insurance program, is a critical actor in the country’s strategy for universal health coverage. Over the past decade, PhilHealth has passed significant coverage, benefits and payment reforms to contain costs and improve the affordability care for high-cost diseases, inpatient care and select outpatient services. Methods We studied the association of PhilHealth with health care utilization and health care costs using three rounds of the Philippine Demographic and Health Survey with data on individual outpatient and inpatient visits from 2008 to 2017. Results PhilHealth membership was associated with 42% greater odds of outpatient utilization and 47–100% greater odds inpatient utilization depending on survey year. Depending on facility type, use of PhilHealth to pay for care was associated with higher average health care costs of 244–865% for outpatient care and 135–206% for inpatient care. Conclusions PhilHealth has likely decreased barriers to health care utilization but may have inadvertently driven up health care costs in the country. Results align with past studies that suggest that reforms in the prior decade have done little to contain health care costs for Filipinos.

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Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study

Digital Health ◽

10.1177/20552076211033425 ◽

2021 ◽

Vol 7 ◽

pp. 205520762110334

Author(s):

Bronwyn Harris ◽

Motunrayo Ajisola ◽

Raisa Meher Alam ◽

Jocelyn Anstey Watkins ◽

Theodoros N Arvanitis ◽

...

Keyword(s):

Healthcare Workers ◽

Healthcare Services ◽

Care Seeking ◽

Health Coverage ◽

Policy Document ◽

Middle Income ◽

Middle Income Countries ◽

Consulting Services ◽

Urban Sites ◽

Low And Middle Income

Objective Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries. Methods We reviewed evidence published since 2018 about mobile consulting in low- and middle-income countries and undertook a scoping study (pre-coronavirus disease) in two rural settings (Pakistan and Tanzania) and five urban slums (Kenya, Nigeria and Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites) and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mobile consulting providers, and local and national decision-makers. Project advisory groups guided the study in each country. Results We reviewed four empirical studies and seven reviews, analysed data from 5322 urban slum households and engaged with 424 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. Mobile consulting services are operating through provider platforms ( n = 5–17) and, at the community level, some direct experience of mobile consulting with healthcare workers using their own phones was reported – for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. Mobile consulting can reduce affordability barriers and facilitate care-seeking practices. Conclusions There are indications of readiness for mobile consulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply chains to fully realise the continuity of care and responsiveness that mobile consulting services offer, particularly during/beyond coronavirus disease 2019.

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The Provision of Private Healthcare Services in European Countries: Recent Data and Lessons for Universal Health Coverage in Other Settings

Frontiers in Public Health ◽

10.3389/fpubh.2021.636750 ◽

2021 ◽

Vol 9 ◽

Author(s):

Dominic Montagu

Keyword(s):

Private Sector ◽

Universal Health Coverage ◽

Large Scale ◽

Healthcare Services ◽

Health Coverage ◽

Health Delivery ◽

Care Services ◽

Primary Care Services ◽

Minimal Importance ◽

Universal Health

Universal Health Coverage (UHC) exists in all of the countries of Europe, despite variation on the ownership structure of health delivery systems. As countries around the world seek to advance UHC and manage the private sector within their health systems, the European experiences can offer useful insights. We found four different models for the provision of healthcare, with the private sector predominant in some countries, and of minimal importance in others. The European experiences indicate that UHC can be effectively provided with, or without, large-scale private sector provision in hospital, specialty, and primary care services, and that moreover it can be provided with high levels of patient satisfaction. These findings offer regulatory models for countries in other regions to review as they advance UHC.

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Accelerated fragility: exploring the supply–demand nexus in health facilities in rural Burkina Faso

Africa ◽

10.1017/s0001972020000662 ◽

2020 ◽

Vol 90 (5) ◽

pp. 934-951

Author(s):

Helle Samuelsen

Keyword(s):

Burkina Faso ◽

Diagnostic Procedures ◽

Healthcare Services ◽

The State ◽

Local Health ◽

Health Seeking ◽

Global Trends ◽

Research Engagement ◽

Global Pandemic ◽

Political Turmoil

AbstractIn Burkina Faso, political turmoil, escalating insecurity and a looming pandemic challenge the population's trust in the state. This article contributes to the debates about state–citizen relationships in fragile countries by connecting local health-seeking practices with the global trends of datafication and a strong focus on the fight against malaria in this part of Africa. Drawing on long-term research engagement in Burkina Faso, I examine the health-seeking practices of rural citizens and look into diagnostic routines and reporting in two rural dispensaries. I show how the routinization of diagnostic procedures combined with a strong national and global political focus on the fight against malaria create what I term a ‘supply–demand nexus’ in which rural citizens selectively ask for the health services that they know the system can supply. I argue that the routinized diagnostic practices that mainly focus on malaria serve as a ‘technology of invisibility’ by not capturing other important diseases among the rural population. Finally, I ask whether the limited healthcare services in the current context of political insecurity, instability and a global pandemic spur a process of further fragilization of the social contract between rural citizens and the state.

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Access of older people to primary healthcare services in low- and middle-income countries: a systematic scoping review protocol

HRB Open Research ◽

10.12688/hrbopenres.13271.1 ◽

2021 ◽

Vol 4 ◽

pp. 57

Author(s):

Saydeh Dableh ◽

Kate Frazer ◽

Thilo Kroll

Keyword(s):

Older People ◽

Scoping Review ◽

Healthcare Services ◽

Health Coverage ◽

Theoretical Frameworks ◽

Middle Income ◽

Middle Income Countries ◽

Healthcare Needs ◽

Health System Efficiency ◽

Low And Middle Income

Background: People across the world are living longer. This advantageous trend is escorted by an increased prevalence of chronic diseases, making healthcare needs more complex. Non-communicable diseases induce a sharply rising economic and societal cost, particularly in low- and middle-income countries (LMIC), where most older people reside. In this context, the access of older people to primary health care (PHC) is vital because it brings solutions to the aforementioned issues. Furthermore, evidence strongly suggests that this approach to health ensures universal health coverage and enables health systems to adapt to rapid economic, technologic, and demographic changes. PHC improves health outcomes, health system efficiency, and health equity. Given their distinctive needs, older people face financial, geographical, social, cultural, structural, and organisational barriers, affecting their equitable access to PHC services. Therefore, many interventions have been implemented to maximise their access to PHC. This paper outlines the protocol for a scoping review that addresses the central question: What is the scope and nature of available evidence on older peoples’ access to PHC in LMICs? This includes the experience of older people having access to PHC, enabling and hindering access, outcomes of the lack of access, interventions implemented to improve access, and related theoretical frameworks. Methods: This scoping review will follow the theoretical framework proposed by Arksey and O’Malley. The five databases that will be searched are CINAHL, PubMed, LILACS, Embase, and Cochrane Libraries. Studies will be selected according to a set of inclusion/exclusion criteria. Data will then be mapped, extracted, and presented graphically along with a narrative report. Conclusions: The scoping review is a first step to synthesise and disseminate the literature on older people’s access to PHC. This will provide information for researchers to reorient their studies, and intel for decision-makers, enabling them to enact policies that meet older people’s needs.

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Experiences of private sector quality care amongst mothers, newborns, and children in low- and middle-income countries: a systematic review

BMC Health Services Research ◽

10.1186/s12913-021-06905-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Joe Strong ◽

Samantha R. Lattof ◽

Blerta Maliqi ◽

Nuhu Yaqub

Keyword(s):

Systematic Review ◽

Health Care ◽

Private Sector ◽

Quality Care ◽

Middle Income ◽

Private Care ◽

Middle Income Countries ◽

Experience Of Care ◽

Positive Experiences

Abstract Background Experience of care is a pillar of quality care; positive experiences are essential during health care encounters and integral to quality health service delivery. Yet, we lack synthesised knowledge of how private sector delivery of quality care affects experiences of care amongst mothers, newborns, and children. To fill this gap, we conducted a systematic review that examined quantitative, qualitative, and mixed-methods studies on the provision of maternal, newborn, and child health (MNCH) care by private providers in low- and middle-income countries (LMICs). This manuscript focuses on experience of care, including respectful care, and satisfaction with care. Methods Our protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Searches were conducted in eight electronic databases (Cumulative Index to Nursing and Allied Health, EconLit, Excerpta Medica Database, International Bibliography of the Social Sciences, Popline, PubMed, ScienceDirect, and Web of Science) and two websites and supplemented with hand-searches and expert recommendations. For inclusion, studies examining private sector delivery of quality care amongst mothers, newborns, and children in LMICs must have examined maternal, newborn, and/or child morbidity or mortality; quality of care; experience of care; and/or service utilisation. Data were extracted for descriptive statistics and thematic analysis. Results Of the 139 studies included, 45 studies reported data on experience of care. Most studies reporting experience of care were conducted in India, Bangladesh, and Uganda. Experiences of private care amongst mothers, newborns, and children aligned with four components of quality of care: patient-centeredness, timeliness, effectiveness, and equity. Interpersonal relationships with health care workers were essential to experience of care, in particular staff friendliness, positive attitudes, and time spent with health care providers. Experience of care can be a stronger determining factor in MNCH-related decision-making than the quality of services provided. Conclusion Positive experiences of care in private facilities can be linked more broadly to privileges of private care that allow for shorter waiting times and more provider time spent with mothers, newborns, and children. Little is known about experiences of private sector care amongst children. Trial registration This systematic review was registered with the PROSPERO international prospective register of systematic reviews (registration number CRD42019143383).

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Equity lessons from a large scale private-sector healthcare intervention in Ghana and Kenya: Results for a multi-year qualitative study

Gates Open Research ◽

10.12688/gatesopenres.13142.1 ◽

2020 ◽

Vol 4 ◽

pp. 129

Author(s):

Dominic Montagu ◽

Lauren Suchman ◽

Charlotte Avery Seefeld

Keyword(s):

Large Scale ◽

Qualitative Evaluation ◽

Wealth Quintile ◽

Healthcare Intervention ◽

Health Coverage ◽

Outpatient Services ◽

Middle Income ◽

Policy Makers ◽

Private Providers ◽

The Poor

Background: The poor fall sick more frequently than the wealthy, and are less likely to seek care when they do. Private provision in many Low- and Middle-Income Countries makes up half or more of all outpatient care, including among poor paitents. Understanding the preferences of poor patients which impel them to choose private providers, and how 3rd party payment influences these preferences, is important for policy makers considering expansion of national health insurance financing to advance Universal Health Coverage. This paper reports on the results of a qualitative evaluation of the African Health Markets for Equity intiative (AHME), a multi-year initiative in Ghana and Kenya to increase options and improve quality for outpatient services, especially for the poor. Methods: Interviews with patients from private clinics were conducted annually between 2013 and 2018. Field staff recruited women for exit interviews as they were leaving these clinics. In the final round of data collection (2018), interviewers screened patients for wealth quintile and selected one third of the sample (approximately 10 patients per country) that fell into the two lowest wealth quintiles (Q1 and Q2). Transcripts were coded using Atlas.ti and coded for analysis using an inductive, thematic approach. Results: We found four primary drivers of patient preferences for private clinics: convenience; efficiency and predictability, perceived higher quality, and empowerment which was derived from greater choice in where to go. Conclusions: Our findings indicate that more options will lead to more opportunities for treatment, and decrease the percentage of those, mostly poor, who become ill and go without care of any kind. This should be considered as a priority by policy makers seeking to make the best use of existing national infrastructure and expertise to assure equal health for all. In this way, private providers offer an opportunity to advance national goals.

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Public-Private Partnership Policy in Primary Health Care: A Scoping Review Protocol

10.21203/rs.3.rs-23561/v1 ◽

2020 ◽

Author(s):

Hojatolah Gharaee ◽

Saber Azami Aghdash ◽

Jafar Sadegh Tabrizi

Keyword(s):

Health Care ◽

Primary Health Care ◽

Private Sector ◽

Scoping Review ◽

Health Coverage ◽

Middle Income ◽

Private Partnership ◽

Middle Income Countries ◽

Primary Health ◽

Universal Health

Abstract Background Achieving universal health coverage requires health systems oriented to primary health care (PHC). The private sector may be a crucial resource for countries’ work on universal health coverage. One of the most effective ways to engage the private sector in health system is Public-Private Partnership (PPP). Since, published experiences about PPP implementation in PHC in different countries have provided various and sometimes contradictory results, there is a need to examine the results of using PPP in PHC worldwide. Thus, the main objective of this scoping review is to perform an inclusive search for studies that report the experiences of implementation PPP in PHC worldwide. Methods This scoping review study will be conducted using the framework proposed by Arkesy and O'Malley. An extensive search of the literature will be done in five databases including PubMed, Embase, Scopus, Web of Science and Science Direct, and two Persian databases using a comprehensive search strategy to identify studies on PPP implementation in PHC. The search will be done from January 2000 to the end of 2019, completed by reference tracking, author tracking and expert consultation. Any study, which focuses on the results of PPP in PHC, will be included in the study. Two reviewers will screen the articles based on the title, abstract and full text, and extract data. Potential disagreements will be resolved by consulting a third author. Discussion Given the problems and shortcomings in the providing PHC services in different countries, specially low and middle income countries, the use of private sector capacities and capabilities in the form of PPP, can be effective and useful solution. The results along with recommendations will be published in order to the authorities of the health system in different countries, especially low and middle income countries, use it to make better evidence-based decisions about using PPP in PHC in the future.

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Doctor Retention in Ireland - What it may mean for the Global Health Workforce Reform Agenda Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.126 ◽

2020 ◽

Author(s):

Bernard Hope Taderera

Keyword(s):

Global Health ◽

Health Workforce ◽

Cross Sectional Study ◽

Early Career ◽

Healthcare Personnel ◽

Health Coverage ◽

Cross Sectional ◽

Middle Income ◽

Reform Agenda ◽

Medical Graduates

The study of healthcare personnel migration in Ireland reports that most medical graduates plan to leave the country’s health system. It may be possible to address this challenge by understanding and addressing the reasons why young doctors plan to leave. Future studies should contribute to the retention of early career doctors in highincome countries such as Ireland. This will help reduce the migration of doctors from low- and middle-income countries in order to address the global health workforce crisis and its impact on the attainment of universal health coverage in all health systems.

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