A systematic review conducted by Sanjay Basu of the University of California, San Francisco and colleagues re-evaluated the evidence relating to comparative performance of public versus private sector healthcare delivery in low- and middle-income countries (LMICs). Reporting in this week's PLoS Medicine, the authors found that the studies they evaluated do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector; however, the public sector appears frequently to lack timeliness and hospitality towards patients.
There is considerable debate around whether LMICs should strengthen public versus private healthcare services, and this study reviewed the existing evidence on performance of private and public sector delivery of care.
Using databases and a comprehensive key word search, Basu and colleagues identified and reviewed published data, assessing selected studies against the World Health Organization's six essential themes of health systems -- accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency -- and conducted a narrative review of each theme.
The researchers found that each system has its strengths and weaknesses. In both the public and the private sector there were financial barriers to care, such as user fees. Although patients in the private sector experienced better timeliness and hospitality, providers in the private sector more frequently violated accepted medical standards and have lower reported efficiency.
The authors highlight that "private sector healthcare systems tended to lack published data by which to evaluate their performance, have greater risks of low-quality care, and serve higher socio-economic groups, whereas the public sector tended to be less responsive to patients and lack availability of supplies…. Both public and private sector systems had poor accountability and transparency."
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