Evaluation of patient care provided by both public and private institutions
Patient care is a crucial aspect of health systems, especially in low- and middle-income countries where access to quality services is often limited. However, there is an ongoing debate about whether public or private institutions provide better patient care in terms of quality, outcomes, efficiency, and equity. This paper aims to compare and contrast the performance of public and private healthcare systems in low- and middle-income countries, based on a systematic review of the literature and relevant data.
According to Basu et al. (2012), who conducted a systematic review of 102 studies comparing public and private healthcare delivery in low- and middle-income countries, there is no clear evidence that the private sector is more efficient, accountable, or medically effective than the public sector. On the contrary, they found that private providers often violated medical standards of practice, had poorer patient outcomes, and charged higher fees for unnecessary tests and treatments. However, they also acknowledged that public sector services faced challenges such as limited availability of equipment, medications, and trained staff, as well as lack of timeliness and hospitality towards patients. Therefore, they suggested that both sectors need to improve their performance and accountability, and that collaboration and regulation are essential to ensure quality and equity in patient care.
Other studies have also highlighted the advantages and disadvantages of public and private healthcare systems in low- and middle-income countries. For instance, Velocity Global (n.d.) noted that public health insurance is often less expensive than private health insurance, thanks to government subsidies, but it also imposes more restrictions on the types of services covered and the frequency of use. Conversely, private health insurance offers more flexibility and choice for patients, but it also requires higher premiums and out-of-pocket payments. Moreover, Peoplecare (n.d.) pointed out that having private hospital cover allows patients to choose whether they want to be treated as private or public patients in public hospitals, which can affect their waiting times, costs, and preferences for doctors. However, they also warned that some public hospitals may not have agreements with private health insurers, which can result in additional fees for patients.
A scoping review by Hockenberry et al. (2018) compared public and private providers in terms of hospital quality indicators such as mortality rates, length of stay, readmission rates, adverse events, patient satisfaction, and costs. They found that most studies reported lower mortality rates and shorter lengths of stay for private hospitals than for public hospitals, but they also noted that these differences may be influenced by factors such as patient characteristics, case mix, severity of illness, and selection bias. They indicated that public hospitals tend to treat patients who are slightly older and have lower socioeconomic status, riskier lifestyles and higher levels of co-morbidity and complications than patients treated in private hospitals. Therefore, they suggested that more rigorous methods are needed to adjust for these confounding variables and to measure the causal effects of ownership type on hospital quality.
In conclusion, this paper has compared and contrasted the performance of public and private healthcare systems in low- and middle-income countries, based on a systematic review of the literature and relevant data. The main findings are that both sectors have strengths and weaknesses in terms of quality, outcomes, efficiency, and equity of patient care, and that there is no clear evidence that one sector is superior to the other. However, there is room for improvement in both sectors, as well as potential for collaboration and regulation to ensure optimal patient care.
Works Cited
Basu S., Andrews J., Kishore S., Panjabi R., Stuckler D. (2012). Comparative Performance of Private
and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review.
PLOS Medicine 9(6): e1001244. https://doi.org/10.1371/journal.pmed.1001244
Hockenberry J.M., Mutter R.L., Barrett A., Parlato J., Ross D., Stocks C., Thompson D.A., Wilson L.
(2018). Comparing public and private providers: a scoping review of hospital quality indicators.
BMC Health Services Research 18: 141. https://doi.org/10.1186/s12913-018-2953-9
Peoplecare (n.d.). Public vs Private – what’s the difference? Retrieved from
https://www.peoplecare.com.au/help-centre/health-insurance-a-to-z/public-vs-private/
Velocity Global (n.d.). Private vs. Public Healthcare: What’s the Difference? Retrieved from
https://velocityglobal.com/resources/blog/private-vs-public-healthcare/
