BMJ September, 2001 )
Three objectives are recommended in relation to the private provision of care for conditions of public health importance: widening access, improving quality, and ensuring non-exploitative prices. None of these will be simple to achieve; and multifaceted interventions, involving policymakers, providers, and users will be required. Increasingly service users (or "consumers") are being highlighted as the key to driving improvements to achieve these goals. Their role has, however, been little evaluated in developing countries.
Public-Private Mix
Private health care in developing countries
If it is to work, it must start from what users need
Public–private partnerships for health:
their main targets, their diversity, and their future directions
Roy Widdus, Public–Private Partnerships for Health, Global Forum for Health Research
Bulletin of the World Health Organization, August 2001, 79 (8)
A large variety of public–private partnerships, combining the skills and resources of a wide range of collaborators, have arisen for product development, disease control through product donation and distribution, or the general strengthening or coordination of health services. Administratively, such partnerships may either involve affiliation with international organizations, i.e. they are essentially public-sector programmes with private-sector participation, or they may be legally independent not-for-profit bodies. These partnerships should be regarded as social experiments; they show promise but are not a panacea. New ventures should be built on need, appropriateness, and lessons on good practice learnt from experience. Suggestions are made for public, private, and joint activities that could help to improve the access of poor populations to the pharmaceuticals and health services they need.
MALAWI SUSPENDS PRIVATIZATION PROGRAMME
Malawian authorities said Monday the countrys privatisation programme had been suspended for review following a cabinet decision early this month. "It's a moment of soul searching. We want to look back at what we have done and see whether we are in the right direction," Charles Msosa, principal secretary for privatisation, told AFP. Malawi has privatised 36 of its 100 loss-making parastatals since the program begun in 1995.
Public-private partnerships: illustrative examples
This background paper by Adetokunbo Lucas describes how collaboration between the public and private sectors can be productive and successful, providing opportunities to achieve goals that could not be achieved by either sector working alone.
Putting policy into practice: can local government cope?
Increasingly, the debate over private sector involvement in the delivery of urban water services is addressing pro-poor policies and transactions. Yet, improvements in policy are not being accompanied by support for implementation and little emphasis is being placed on how local governments will cope with such complex processes. What capacity do municipalities need to make policy frameworks work in practice? How do municipalities change from 'providers' to 'enablers' and 'promoters'? How do municipalities focus partnerships on the poor?
Why should governments serve the poor?
Is government responsible for ensuring public health? Is it necessary for public entities to deliver this public good? Who else might serve the unprofitable urban poor?
New Prepayment Schemes for Health in Rwanda
by Pia Schneider and Miriam Schneidman (August, 2000. Rwanda's prepayment schemes with large membership pools have become important interest groups. Besides improving members' access to quality care, in a post-genocide society, where the social fabric was seriously destroyed, the introduction of the mutual health schemes has the potential to rebuild trust and democratic processes.
WORK IT OUT OR WATCH IT DIE
Drastic change is needed to save SA\'s system of health care
The cost of private health care is rising so rapidly that it is in danger of becoming unaffordable to all but the wealthy. The punch-drunk public health sector is, however, failing to provide an alternative for the average salaried person. Everyone, from blue-collar workers to senior executives, is clamouring for more affordable, quality health care. A radical new deal is needed for the private and public sectors. New ways of delivering and funding health care must be created. Both sectors are on the ropes and are being forced to act.
Social Capital, Disorganized Communities, and the Third Way:
Understanding the Retreat from Structural Inequalities in Epidemiology and Public Health
Carles Muntaner, John Lynch, and George Davey Smith, International Journal of Health Services Volume: 31 Issue: 2, May 2001
The construct of social capital has recently captured the interest of researchers in social epidemiology and public health. The authors review current hypotheses on the social capital and health link, and examine the empirical evidence and its implications for health policy.
The construct of social capital employed in the public health literature lacks depth compared with its uses in social science. It presents itself as an alternative to materialist structural inequalities (class, gender, and race) and invokes a romanticized view of communities without social conflict that favors an idealist psychology over a psychology connected to material resources and social structure. The evidence on social capital as a determinant of better health is scant or ambiguous. Even if confirmed, such hypotheses call for attention to social determinants beyond the proximal realm of individualized sociopsychological infrastructure. Social capital is used in public health as an alternative to both state-centered economic redistribution and party politics, and represents a potential privatization of both economics and politics. Such uses of social capital mirror recent "third way" policies in Germany, the United Kingdom, and United States. If third way policies lose support in Europe, the prominence of social capital there might be short lived. In the United States, where the working class is less likely to influence social policy, interest in social capital could be longer lived or could drift into academic limbo like other psychosocial constructs once heralded as the next big idea.
SA: Employees face skyrocketing healthcare costs -
shock report
Healthcare costs are likely to skyrocket and employers are becoming less and less prepared to carry the burden, according to the fifth in a series of surveys done by Old Mutual and released in Johannesburg on Wednesday. With findings based on in-depth interviews with 60 leading SA companies, representing close to 600 000 medical scheme lives, and focus group discussions with members of medical schemes, Old Mutual's bi-annual survey provides valuable insight into the challenges facing SA's private healthcare industry.