The failure of private health services: COVID-19 induced crises in low- and middle-income country (LMIC) health systems
The failure of private health services: COVID-19 induced crises in low- and middle-income country (LMIC) health systems
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DOI：
10.1080/17441692.2021.1874470
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发表时间：
2021-01-19
影响因子：
3.3
通讯作者：
Grepin, Karen A.
中科院分区：
文献类型：
--
作者：
David Williams, Owain;Yung, Ka Chun;Grepin, Karen A.
几十年来，许多中低收入国家的政府和发展伙伴在卫生部门推行新自由主义政策，其主要动机是认为这些国家的政府太弱，无法提供满足人口需求所需的所有卫生服务。私营卫生市场成为改善卫生服务提供的治理和政策解决方案，这使得这些国家持续存在内在形式的市场失灵，并在2019冠状病毒病大流行期间暴露出来。在本文中，我们使用来自全球事件、语言和语气数据库的COVID-19相关新闻项目汇编数据库中的数据来分析这些市场失灵的表现形式。具体而言，我们确定了先前存在的市场失灵和再分配失灵是如何导致中低收入国家出现三种紧急危机的：私人供应商之间的金融和流动性危机，服务提供和定价危机，以及随之而来的国家供应商关系危机。因此，2019冠状病毒病大流行暴露了公共-私营部门卫生系统模式的重大失败，并为重新思考国家卫生系统的未来方向和对全民健康覆盖的承诺提供了机会。
For decades, governments and development partners promoted neoliberal policies in the health sector in many LMICs, largely motivated by the belief that governments in these countries were too weak to provide all the health services necessary to meet population needs. Private health markets became the governance and policy solution to improve the delivery of health services which allowed embedded forms of market failure to persist in these countries and which were exposed during the COVID-19 pandemic. In this article, we analyse the manifestations of these market failures using data from an assembled database of COVID-19 related news items sourced from the Global Database of Events, Language, and Tone. Specifically, we identify how pre-existing market failure and failures of redistribution have led to the rise of three urgent crises in LMICs: a financial and liquidity crisis among private providers, a crisis of service provision and pricing, and an attendant crisis in state-provider relations. The COVID-19 pandemic has therfore exposed important failures of the public-private models of health systems and provides an opportunity to rethink the future orientation of national health systems and commitments towards Universal Health Coverage.