Private health care

During the last decade there has been considerable international mobilisati on around shrinking the role of States in health care. The World Bank repor ts that, in many low and middle-income countries, private sources of financ e comprise the largest share of total national health expenditures. Private sector health care is ubiquitous, reaches throughout the population, prefe rred by the people and is significant from both economic as well as health perspective. Resources are limited, governments are weak, and a new approac h is needed. This paper provides a broad overview and raises key issues wit h regard to private health care. The focus is on provision of health care b y private medical providers. On the background of the world's common health problems and interventions available to tackle them, the place of private health care in the overall context is first discussed. The concept of priva tisation within the various forms of health care systems is then explained. The paper then describes the genesis and key elements of rapidly enhancing role of the private sector in health care and points to the paucity of lit erature from low and middle-income countries. Common concerns about private health care are outlined. Two illustrative examples - tuberculosis, the to p infectious killer among the poor and coronary heart disease, the top noni nfectious killer among the I ich - are presented to understand the current and possible role of private sector in provision of health care. Highlighti ng the need to distinguish between health care as a public good or a market commodity, the paper leaves it to the reader to draw conclusions. (C) 2000 Elsevier Science Ltd. All rights reserved.