Utilization and expenditure at public and private facilities in 39 low-income countries.
OBJECTIVE
To document the patterns of health service utilization and health payments at public and private facilities across countries.


METHODS
We used data from the World Health Surveys from 39 low- and low-middle income countries to examine differences between public and private sectors. Utilization of outpatient and inpatient services, out-of-pocket payments (OOP) at public and private facilities, and transportation costs were compared.


RESULTS
Utilization and payments to public and private sectors differ widely. Public facilities dominated in most countries for both outpatient and inpatient services. But, whereas use of private facilities is more common among the rich, poor people also use them, to a considerable extent and in almost all the countries in the study. The majority of OOP were incurred at public providers for inpatient services. On average, this was not the case for outpatient services. Medicines accounted for the largest share of OOP for all services except inpatient services at private facilities, where consultation fees did. Transportation costs were considerable. Price competition is certainly not the only factor that guides choice of provider.


CONCLUSIONS
The results support continued efforts by the governments to engage strategically with the private sector. However, they also highlight the importance of not generalizing conditions across countries. Governments may need to reconsider simplistic user-fee abolition strategies at public providers if they simply focus on consultation fees. Policies to make health services more accessible need to consider a comprehensive benefit package that includes a wider scope of costs related to care such as expenditures on medicines and transportation.
Department of Health Systems Financing, World Health Organization, Geneva, Switzerland. saksenap@who.int
Priyanka
P
Saksena
Ke
K
Xu
Riku
R
Elovainio
Jean
J
Perrot
D002755:Choice Behavior; D003365:Costs and Cost Analysis; D003906:Developing Countries; D005260:Female; D014943:Global Health; D019538:Health Care Surveys; D005102:Health Expenditures; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D010045:Outpatients; D010342:Patient Acceptance of Health Care; D004364:Pharmaceutical Preparations / Q000191:economics; D011203:Poverty; D017149:Private Sector / Q000191:economics / Q000706:statistics & numerical data; D017150:Public Sector / Q000191:economics / Q000706:statistics & numerical data; D014186:Transportation / Q000191:economics
D004364:Pharmaceutical Preparations