Utilization and expenditure at public and private facilities in 39 low-income countries.

To document the patterns of health service utilization and health payments at public and private facilities across countries. We used data from the World Health Surveys from 39 low- and low-middle income countries to examine differences between public and private sectors. Utilization of outpatient and inpatient services, out-of-pocket payments (OOP) at public and private facilities, and transportation costs were compared. Utilization and payments to public and private sectors differ widely. Public facilities dominated in most countries for both outpatient and inpatient services. But, whereas use of private facilities is more common among the rich, poor people also use them, to a considerable extent and in almost all the countries in the study. The majority of OOP were incurred at public providers for inpatient services. On average, this was not the case for outpatient services. Medicines accounted for the largest share of OOP for all services except inpatient services at private facilities, where consultation fees did. Transportation costs were considerable. Price competition is certainly not the only factor that guides choice of provider. The results support continued efforts by the governments to engage strategically with the private sector. However, they also highlight the importance of not generalizing conditions across countries. Governments may need to reconsider simplistic user-fee abolition strategies at public providers if they simply focus on consultation fees. Policies to make health services more accessible need to consider a comprehensive benefit package that includes a wider scope of costs related to care such as expenditures on medicines and transportation.

Saksena P ，Xu K ，Elovainio R ，Perrot J ... -  《-》

Out-of-pocket expenses for maternity care in rural Bangladesh: a public-private comparison.

Rahman M ，Rob U ，Noor FR ，Bellows B ... -  《-》

Who pays more for health services in middle-income countries: lessons from Mexico.

Arredondo A ，Nájera P 《-》

Hong Kong domestic health spending: financial years 1989/90 to 2008/09.

Tin KY ，Tsoi PK ，Lee YH ，Tsui EL ，Lam DW ，Chui AW ，Lo SV ... -  《HONG KONG MEDICAL JOURNAL》

Health insurance and the poor in low income countries.

Grant K ，Grant R 《-》