In PLoS Medicine Basu et al report on a systematic meta-analytic comparison of private and public health care systems in low- and middle-income countries such as Viet Nam, Namibia, Tanzania, Sri Lanka, Bangladesh, India and Peru. They extracted data from 102 publications and divided their findings into six health care-system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency.
Yes, meta-analyses are fraught with all sorts of hazards and require all sorts of caveats. But what did the authors find? Private health care systems were less likely to publish data reflecting their performance and tended to serve people in higher socioeconomic classes. Public sector health care systems were less likely to be responsive to patients and more likely to lack equipment, medications, and trained health care workers. Both public and private sector systems lacked accountability and transparency. Duh.
Private health care systems were more apt to deliver low-quality care, to be less efficient (!), to pose greater risks of complications and to incentivize (yeah that’s a word) unnecessary testing and treatment. Sound familiar? Providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes…but they were more timely and hospitable. Yeah baby!
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