While the importance of the private sector in providing health services in developing countries is now widely acknowledged, the paucity of data on numbers and types of providers has prevented systematic cross-country comparisons. Using available published and unpublished sources, we have assembled data on the number of public and private health care providers for approximately 40 countries. This paper presents some results of the analysis of this database, looking particularly at the determinants of the size and structure of the private health sector. We consider two different types of dependent variable: the absolute number of private providers (measured here as physicians and hospital beds), and the public-private composition of provision. We examine the relationship between these variables and income and other socioeconomic characteristics, at the national level. We find that while income level is related to the absolute size of the private sector, the public-private mix does not seem to be related to income. After controlling for income, certain socioeconomic characteristics, such as education, population density, and health status are associated with the size of the private sector, though no causal relationship is posited. Further analysis will require more complete data about the size of the private sector, including the extent of dual practice by government-employed physicians. A richer story of the determinants of private sector growth would incorporate more information about the institutional structure of health systems, including provider payment mechanisms, the level and quality of public services, the regulatory structure, and labour and capital market characteristics. Finally, a normative analysis of the size and growth of the private sector will require a better understanding of its impact on key social welfare outcomes.
[1]
Estelle James,et al.
Why is there proportionately more enrollment in private schools in some countries
,
1993
.
[2]
C. Ham.
Paying for health services.
,
1992,
BMJ.
[3]
P. Berman.
Kenya: Non-Governmental Health Care Provision
,
1998
.
[4]
S. Bennett.
Promoting the private sector: a review of developing country trends
,
1992
.
[5]
P. Musgrove.
Public and private roles in health
,
1996
.
[6]
C. Murray,et al.
National health expenditures: a global analysis.
,
1994,
Bulletin of the World Health Organization.
[7]
S. Desai,et al.
Health Care in Asia: A Comparative Study of Cost and Financing.
,
1993
.
[8]
T. Getzen,et al.
An income-weighted international average for comparative analysis of health expenditures.
,
1991,
The International journal of health planning and management.
[9]
P. Berman,et al.
The role of private providers in maternal and child health and family planning services in developing countries.
,
1996,
Health policy and planning.
[10]
J. Newhouse.
Medical-care expenditure: a cross-national survey.
,
1977,
The Journal of human resources.