Grépin Karen A
Karen A. Grépin (
Health Aff (Millwood). 2016 Jul 1;35(7):1214-21. doi: 10.1377/hlthaff.2015.0862.
There is debate about the role of the private sector in providing services in the health systems of low- and middle-income countries and about how the private sector could help achieve the goal of universal health coverage. Yet the role that the private sector plays in the delivery of health services is poorly understood. Using data for the period 1990-2013 from 205 Demographic and Health Surveys in seventy low- and middle-income countries, I analyzed the use of the private sector for the treatment of diarrhea and of fever or cough in children, for antenatal care, for institutional deliveries, and as a source of modern contraception for women. I found that private providers were the dominant source of treatment for childhood illnesses but not for the other services. I also found no evidence of increased use of the private sector over time. There is tremendous variation in use of the private sector across countries and health services. Urban and wealthier women disproportionately use the private sector, compared to rural and poorer women. The private sector plays an important role in providing coverage, but strategies to further engage the sector, if they are to be effective, will need to take into consideration the variation in its use.
关于私营部门在低收入和中等收入国家卫生系统中提供服务的作用，以及私营部门如何有助于实现全民健康覆盖的目标，存在着争议。然而，人们对私营部门在提供卫生服务方面所起的作用了解甚少。利用1990年至2013年期间来自70个低收入和中等收入国家的205项人口与健康调查的数据，我分析了私营部门在治疗儿童腹泻、发烧或咳嗽、产前护理、机构分娩以及作为妇女现代避孕手段来源方面的使用情况。我发现，私营提供者是儿童疾病治疗的主要来源，但在其他服务方面并非如此。我还没有发现随着时间的推移私营部门使用增加的证据。各国和各项卫生服务在私营部门的使用上存在巨大差异。与农村和较贫困妇女相比，城市和较富裕妇女更多地使用私营部门。私营部门在提供覆盖方面发挥着重要作用，但如果要使进一步让该部门参与的战略有效，就需要考虑到其使用上的差异。
