Global Health Watch 1 in one file

Health care systems | B1
HALE 2000
Private health care expenditure as a percentage of total expenditure
Figure B1.4 Association between healthy life expectancy and private health
care expenditure as a percentage of total health care expenditure, 2000
(Source: Mackintosh and Koivusalo forthcoming 2005)
cial health expenditure relative to GDP. Conversely, countries that apportion
more of their GDP to private health expenditure do not display better health
outcomes in terms of HALE or child mortality, after allowing for the effect of
higher incomes on health outcomes. In fact, there is a mild (non-significant)
association with worse outcomes (Mackintosh and Koivusalo 2004).
These observations are corroborated by Demographic and Health Survey
(DHS) data from 44 low- and middle-income countries (Mackintosh and Koivusalo
2004) suggesting that:
• The proportion of deliveries with a skilled birth attendant is positively associated
with higher government health expenditure as a share of GDP.
• Countries with a high proportion of children with acute respiratory infections
(ARI) or diarrhoea who are treated privately generally have a lower
proportion of children who are treated for these conditions at all, suggesting
that higher levels of private provision are associated with higher levels
of exclusion from health care.
• The percentage of children from the poorest 20% of households who were
treated for ARI was more comparable (more equitable) to the percentage
of children treated for ARI from the richest 20% of households in countries
with a lower level of private primary care provision, suggesting that a greater
privatization of primary care is associated with greater inequality.
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