Global Health Watch 1 in one file

These trends towards segmentation of a health care system, structured
through health care financing arrangements, appear to be driven by a policy to
institute health care systems that reflect and reinforce socio-economic inequities
rather than to mitigate them.
the commercialization of health care The growth of private sector
health care provision in developing countries has largely been a consequence
of ‘passive privatization’. The collapse of the public sector has led to the emergence
of a disorganized, unregulated and even chaotic provider market in
many developing countries, particularly at the primary level of health care.
The incapacity of public services has also resulted in governments and donors
relying upon NGOs, UN agencies, charities, religious groups and humanitarian
organizations to plug the gaps in public provision not only in primary
care but also in essential hospital services and in response to humanitarian
emergencies.
In middle- and high-income countries, the private provider market is also
heterogeneous and may include non-profit, charitable organizations; single,
stand-alone private hospitals or group practices; employer-based health maintenance
organizations; and large corporate or business entities with public
shareholders. Private providers also operate in more formal markets that include
intermediary agents such as insurance companies. Such provision may
emerge as a consequence of demand from consumers as well as from active encouragement
through policy-levers, such as tax subsidies to the private sector
or the use of public money to out-source functions, including to the for-profit,
income-maximizing private sector (see Box B1.4).
The heterogeneous group of private providers operate in many different
contexts. For millions of people, private providers provide a lifeline to health
care in the absence of any effective public alternative. At the same time, however,
private health care is clearly associated with profit, exploitation and preferential
service of higher income groups. What is at issue, therefore, is not
simply private provision, but a certain type or aspect of private health care
provision – that of market-and income-driven provision when payments for
health care are directly linked to provider income or shareholder profit.
What is relevant is the influence of such provision on provider behaviour
that results in inefficient, inequitable and poor quality care (Woolhandler and
Himmelstein 2004, Devereaux et al. 2002, Evans 1997). Such behaviour includes
pricing health care to maximize income rather than to maximize access
and benefit; ‘over-servicing’ (for example, conducting unnecessary and inappropriate
laboratory tests and diagnostic investigations); inducing demand
Approaches to health care
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