Standard Survey Data: Insights into Private Sector Utilization

Authors Dominic Montagu and Nirali Chakraborty explore who uses the private sector and for what in this chapter. Universal health coverage in LMICs is increasingly expanding through the incorporation of private clinics, pharmacies, and hospitals into an overall health system funded in whole or in part through government-managed health insurance. This underscores the importance of policies on health provision, which apply across the whole delivery system regardless of ownership status. In this chapter, we summarize current knowledge on the scale and scope of private provision in LMICs. To accomplish this, we have analyzed data on the source of inpatient and outpatient care from 65 countries. While past studies have conducted similar analyses, ours advances the field in two ways. First, we limit our analysis to data sets from 2010 to 2019, making our study more up-to-date than past studies, while changing health-seeking patterns for maternal health since 2010 means that our data set is more representative of overall inpatient care. Second, while past multi-country analyses of public–private ownership have been based on the Demographic Health Surveys, we have added to this data from the Multiple Indicator Cluster Surveys, significantly increasing the number of countries in our analysis.Key findings from our analysis, according to the World Health Organization regions, are as follows: outside of the EURO region, where the private sector delivers just 4% of all healthcare services, the private sector remains significant and, in many countries, represents more than half of all care. The private sector provides nearly 40% of all healthcare in PAHO, AFRO, and WPRO regions, 57% in SEARO, and 62% in EMRO. While specific countries with two recent surveys show variation in the scale of both inpatient and outpatient private provision, we did not find regional or global trends toward or away from private care within LMICs. Private inpatient care is most important for the wealthy in many countries; public versus private care varies less, by wealth, for outpatient services.