The concept of 'managed competition' to improve efficiency has been common in health sector reform in wealthy countries. It has also been exported to health systems in the South, involving privatisation and marketisation. Research from the UK Institute of Development Studies questions whether this competitive approach is appropriate in a sector where ethical behaviour, altruism and co-operation are essential for good quality services.
Public-Private Mix
Patients or profits? Professional ethics, co-operation and competition in health systems
Perceptions of and support for national health insurance in South Africa's public and private healthcare sectors
Booysen F; Hongoro C: The Pan African Medical Journal 30(277), doi: doi:10.11604/pamj.2018.30.277.14147, 2018
For the purpose of effective implementation of a National Health Insurance (NHI) policy the authors argue that it is necessary to have an understanding of the awareness and perceptions of and support for such policy among clients using the healthcare system. The South African National Health and Nutrition Examination Survey asked household heads a series of questions on healthcare utilisation and access and collected information on knowledge and perceptions of and support for national health insurance. Comparisons are drawn between private sector healthcare users with medical aid and public sector healthcare users without medical aid, using descriptive and regression analysis. Inequalities in access to quality healthcare remain stark. Only 8.5% of private users had postponed seeking healthcare compared to 23.9% of public users. Only 11.9% of public users were very satisfied with the quality of healthcare services compared to 50.2% of private users. More than eighty percent of healthcare users however were of the opinion that NHI is a top priority. The findings suggest that this requires a national health insurance that provides better quality healthcare, increasing the probability of support for an NHI with lower cost and full coverage by 10.1%. The authors suggest that it is imperative to provide better quality healthcare services in the public sector for private sector users to be supportive of national health insurance. Concerted efforts are also required to develop a proper communication strategy to disseminate information on and garner support for national health insurance, both in the public and private healthcare sectors.
Performance of private sector health care: implications for universal health coverage
Morgan R; Ensor T; Waters H: The Lancet, June 2016, doi: http://dx.doi.org/10.1016/S0140-6736(16)00343-3
Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers—including their size, objectives, and technical competence—the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole.
Pharmaceutical pricing policies in a global market
OECD Health Policy Studies, Directorate for Employment, Labour and Social Affairs: September 2008
Pharmaceutical pricing policies are designed with national objectives in mind, but are the transnational implications always taken into account? This study notes that specific characteristics of the pharmaceutical market have given rise to current pharmaceutical prices. Market-based or ‘free’ pricing is common for products not subsidised by coverage schemes. Price regulation exists in most countries but does not necessarily result in lower prices because prices are determined by the respective market powers of the parties involved. Many other types of policies, other than those directly related to pricing, affect the pharmaceutical market and even if policy makers hold common objectives, they may weight them differently when trade-offs are required. More investment incentives for research and development are needed.
Philanthropy in a Recession
Gastrow S: Daily Maverick, South Africa, August 2017
The author raises that South Africa has limited data on what grant making takes place and on the size and scope of the civil society sector, despite a a dependency on international funding and support from private philanthropic foundations. According to Nedbank Private Wealth’s Giving Report III, however, only 5% of the high net worth individuals surveyed had actually established a giving trust or foundation. That meant that the balance were giving money on an ad hoc basis. The same report indicated that South African givers “demonstrated a long-term commitment to the causes they support. Nearly half had supported beneficiaries for longer than five years (and) 22% had been supporting them for their entire lives. The author suggests that in principle, philanthropy should be focusing on organisations that are involved in systemic change and government should be supporting those organisations that deal with basic human requirements. In that case, non-profits are unlikely to be greatly affected by recession. However, that does not apply in South Africa where philanthropy is being stretched to its limits by the high level of needs not being met by the state. The choice of where limited resources can go is a hard one, but it is argued that those donating funds will support those organisations that are aligned with their individual passions for specific causes and their values, combined with effective and efficient outcomes.
Policy and Regulatory Options for Private Participation in developing countries
Many developing countries face a critical gap between the demand for health care services and their supply. Public resources often fall short of what is needed to provide universal health care, and the typical incentive structure in the public sector may not always be conducive to expanding access, improving the quality of care, and ensuring efficient use of limited funding and expertise. This World Bank Note defines options for mobilizing private resources to achieve public health objectives.
Policy options to improve the economic access of low-income households to state-provided health care
The purpose of this paper is to review a set of key policy options that aim to improve access to state-provided health care for poor households in low and middle income countries. It has been developed as part of a broader initiative that seeks to improve understanding of how to tackle the cost-related burdens influencing low income households’ access and use of health care.
Pooled funds: Assessing new models for global health R&D financing
Grace C and Pearson M: Centre for Global Health R&D Policy Assessment, 30 November 2010
Product development partnerships, non-profit research institutes and private sector groups have come together over the past years to conduct research and development (R&D) in the areas of the development of drugs, vaccines and diagnostics for neglected diseases, including tropical diseases and other major infectious diseases like HIV and AIDS, tuberculosis and malaria. However, arguments have been put forward that their efforts are disjointed and that funding flows inefficiently to individual research projects resulting in insufficient resources, funding volatility, poor resource allocation, and duplicated and unnecessary efforts. In response, several pooled funding mechanisms have been proposed to address what proponents see as the key problem(s) in the current system: the Industry R&D Facilitation Fund (IRFF) originally proposed by the George Institute; the Fund for Research in Neglected Diseases (FRIND) proposed by Novartis; and the Product Development Partnership Financing Facility (PDP-FF) proposed by the International AIDS Vaccine Initiative (IAVI). The goal of this paper is to provide insight into the extent to which these three proposed mechanisms would have a positive effect on accelerating R&D for neglected diseases. It considers how these proposals are likely to perform against two criteria: their capacity to raise additional money for neglected disease R&D and their capacity to improve the efficient allocation of those funds. The authors of the paper use a literature review, interviews with key stakeholders and illustrative modelling to assess the proposals against these two criteria. Most interviewees expressed doubts that common ground could be found with regard to the metrics on resource allocation if the fund were covering a large and diverse part of the R&D space. However, stakeholders overwhelmingly agreed that a pooled fund focused on late stage work only would be a more feasible and useful proposition.
Pooled funds: assessing new models for global health R&D financing
Grace C and Pearson M: Centre For Global Health R&D Policy Assessment, 30 November 2010
Product development partnerships, non-profit research institutes and private sector groups have come together over the past years to conduct research and development (R&D) in the areas of the development of drugs, vaccines and diagnostics for neglected diseases, including tropical diseases and other major infectious diseases like HIV and AIDS, tuberculosis and malaria. However, arguments have been put forward that their efforts are disjointed and that funding flows inefficiently to individual research projects resulting in insufficient resources, funding volatility, poor resource allocation, and duplicated and unnecessary efforts. In response, several pooled funding mechanisms have been proposed to address what proponents see as the key problem(s) in the current system: the Industry R&D Facilitation Fund (IRFF) originally proposed by the George Institute; the Fund for Research in Neglected Diseases (FRIND) proposed by Novartis; and the Product Development Partnership Financing Facility (PDP-FF) proposed by the International AIDS Vaccine Initiative (IAVI). The goal of this paper is to provide insight into the extent to which these three proposed mechanisms would have a positive effect on accelerating R&D for neglected diseases. It considers how these proposals are likely to perform against two criteria: their capacity to raise additional money for neglected disease R&D and their capacity to improve the efficient allocation of those funds. The authors of the paper use a literature review, interviews with key stakeholders and illustrative modelling to assess the proposals against these two criteria. Most interviewees expressed doubts that common ground could be found with regard to the metrics on resource allocation if the fund were covering a large and diverse part of the R&D space. However, stakeholders overwhelmingly agreed that a pooled fund focused on late stage work only would be a more feasible and useful proposition.
Pooled funds: Assessing new models for global health R&D financing
Grace C And Pearson M: Centre For Global Health R&D Policy Assessment, 30 November 2010
Product development partnerships, non-profit research institutes and private sector groups have come together over the past years to conduct research and development (R&D) in the areas of the development of drugs, vaccines and diagnostics for neglected diseases, including tropical diseases and other major infectious diseases like HIV and AIDS, tuberculosis and malaria. However, arguments have been put forward that their efforts are disjointed and that funding flows inefficiently to individual research projects resulting in insufficient resources, funding volatility, poor resource allocation, and duplicated and unnecessary efforts. In response, several pooled funding mechanisms have been proposed to address what proponents see as the key problem(s) in the current system: the Industry R&D Facilitation Fund (IRFF) originally proposed by the George Institute; the Fund for Research in Neglected Diseases (FRIND) proposed by Novartis; and the Product Development Partnership Financing Facility (PDP-FF) proposed by the International AIDS Vaccine Initiative (IAVI). The goal of this paper is to provide insight into the extent to which these three proposed mechanisms would have a positive effect on accelerating R&D for neglected diseases. It considers how these proposals are likely to perform against two criteria: their capacity to raise additional money for neglected disease R&D and their capacity to improve the efficient allocation of those funds. The authors of the paper use a literature review, interviews with key stakeholders and illustrative modelling to assess the proposals against these two criteria. Most interviewees expressed doubts that common ground could be found with regard to the metrics on resource allocation if the fund were covering a large and diverse part of the R&D space. However, stakeholders overwhelmingly agreed that a pooled fund focused on late stage work only would be a more feasible and useful proposition.