Private Sector An Important But Not Dominant Provider Of Key Health Services In Low- And Middle-Income Countries
Private Sector An Important But Not Dominant Provider Of Key Health Services In Low- And Middle-Income Countries
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DOI：
10.1377/hlthaff.2015.0862
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发表时间：
2016-07-01
期刊：
影响因子：
9.7
通讯作者：
Grepin, Karen A.
中科院分区：
文献类型：
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作者：
Grepin, Karen A.
关于私营部门在低收入和中等收入国家保健系统中提供服务的作用以及私营部门如何帮助实现全民医保的目标，存在着辩论。然而，人们对私营部门在提供保健服务方面的作用了解甚少。利用1990年至2013年期间70个中低收入国家205项人口与健康调查的数据，我分析了私营部门在治疗儿童腹泻、发烧或咳嗽、产前护理、机构分娩以及作为现代妇女避孕手段的使用情况。我发现，私人提供者是儿童疾病治疗的主要来源，而不是其他服务。我也没有发现随着时间的推移越来越多地使用私营部门的证据。各国在利用私营部门和保健服务方面存在巨大差异。与农村和贫困妇女相比，城市和富裕妇女更多地利用私营部门。私营部门在提供覆盖面方面发挥着重要作用，但进一步让该部门参与的战略若要有效，就需要考虑到其使用的多样性。
There is debate about the role of the private sector in providing services in the health systems of low- and middle-income countries and about how the private sector could help achieve the goal of universal health coverage. Yet the role that the private sector plays in the delivery of health services is poorly understood. Using data for the period 1990-2013 from 205 Demographic and Health Surveys in seventy low- and middle-income countries, I analyzed the use of the private sector for the treatment of diarrhea and of fever or cough in children, for antenatal care, for institutional deliveries, and as a source of modern contraception for women. I found that private providers were the dominant source of treatment for childhood illnesses but not for the other services. I also found no evidence of increased use of the private sector over time. There is tremendous variation in use of the private sector across countries and health services. Urban and wealthier women disproportionately use the private sector, compared to rural and poorer women. The private sector plays an important role in providing coverage, but strategies to further engage the sector, if they are to be effective, will need to take into consideration the variation in its use.