is health care a public sector?

According to the non-profit organisation Trust for America's Health, the private sector is expected to step up and help alongside public health organisations when needed. Public sector groups typically provide benefits such as health coverage to regular employees, retirees and their eligible family members. The first choice is between operating the medical system publicly or contracting care from private providers. They have noted that private markets often fail to deliver public health goods, including preventive services (a "market failure"), and lack the coordinated planning with public health systems needed to curb epidemics.

The World Bank responded that it seeks "more pragmatic approaches that build on what is available through engagement with the private sector in countries where public sector services are performing poorly; the Center for Global Development similarly argued that the Oxfam report "ignored the informal sector, and that the poor "want to go to private providers and will "persist in doing so". We conducted a systematic review of research studies on the performance of private and public sector service delivery in low- and middle-income countries. There is considerable ideological debate about whether low- and middle-income countries should strengthen public versus private health services, but in reality, most low- and middle-income countries use both types of health provision. US healthcare has a strong component of private provision, with private insurance supplemented by government programmes such as Medicaid and Medicare.

For example, treatment of infectious diseases in public facilities may be more efficient than in private facilities because of the higher volume and greater use of systematised protocols due to the higher volume. Studies comparing outcomes before and after privatisation tend to find worse health system performance associated with rapid and extensive health care privatisation initiatives. The review has several limitations, reflecting the existing data and literature that purports to compare public and private sector health performance. An example of a public-private partnership in the health sector is the sale of a publicly owned facility.

Public sector groups can work with UnitedHealthcare to help find healthcare solutions for their employees. These hospitals then have a greater "absorptive capacity for future funding, and a larger number of healthcare staff, which attracts more funding from government institutions, crowding out the budgets of public sector facilities that struggle to maintain human and physical infrastructure. These differences limit the ability of existing work to fairly compare the public and private sectors for different disease categories and in different social and economic contexts of health care provision. Private contracting and social franchising showed potential for extending private sector coverage to impoverished groups, although the findings are tentative because comparisons with the public sector are not available.

Samuel Krejsa
Samuel Krejsa

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