Faculty of Social Sciences, Economics Department, The Open University, Walton Hall, Milton Keynes, UK.
Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
Lancet. 2016 Aug 6;388(10044):596-605. doi: 10.1016/S0140-6736(16)00342-1. Epub 2016 Jun 26.
Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners-both unlicensed and licensed-to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa.
中低收入国家的私人医疗保健非常广泛且多样化，范围从流动药品销售商，到数以百万计的无证和有证的独立从业者，再到连锁企业医院和大型私人保险公司。全民健康覆盖（UHC）政策必须解决这个复杂的私营部门问题。然而，目前还没有商定的措施来评估这些国家私营医疗部门的规模和范围，负责管理和监管混合卫生系统的政策制定者也难以确定私营部门的关键特征。在本报告中，我们提出了一套指标，这些指标来自现有数据，可以为政策制定者提供一个起点，以确定其特定混合卫生系统中私人供应的结构和动态；也就是说，确定特定结构的后果、变革的驱动因素，以及提高效率和结果的可用杠杆。核心信息是，除非在混合卫生系统的背景下，否则无法理解私营部门，因为私营部门和公共部门相互作用。我们使用这些指标和其他国家信息，制定了一个说明性的、部分国家的典型分类法，来说明公共部门的规模和运作如何塑造私营部门的结构和行为，反之亦然。
