Therefore, in order to inform policy, there is an urgent need for robust evidence to evaluate the quality and effectiveness of the health care provided through both systems. Although studies report that patients in the private sector experience better timeliness and hospitality, studies suggest that providers in the private sector more frequently violate accepted medical standards and have lower reported efficiency. Performed the experiments: SB JA. In Viet Nam, the private sector provides 60% of all outpatient contacts. In India, an analysis of over 120,000 households, adjusted for demographic and socioeconomic factors, found that children receiving private health services were less likely to receive measles vaccinations [65]. For example, in Botswana, private hospitals often receive cancer patients from public hospitals that are unable to provide radiation oncology services [78]. These conflicts of interest pose a potential threat to the validity of World Bank–sponsored studies and raise the need for independent scrutiny. Several related World Bank initiatives took the form of social franchises, in which private providers pay a fee and are provided training, managerial assistance, and certification in a provider network [20],[89],[90]. Poor patients were as likely as wealthier patients to seek care from private providers in Laos, but poorer patients received service from less qualified providers, with limited-quality services (no exam or advice, only medication dispensing) [35]. Public health care is usually provided by the government through national healthcare systems. One review of contracting experience in Madagascar and Senegal found that large expenditure from public sector ministries was necessary to manage and supervise private contracts, increasing overall costs in those two countries by 13% and 17%, respectively [102]. One review in Ghana indicated that the key public agency in charge of such regulation was unable to identify a large number of private providers in order to assess accreditation and quality: 2,612 of 11,430 drug shops were registered but had not received licenses [22]. See Figure A.15 in. Furthermore, we found further data gaps in health system performance around the issues of waiting times, financing changes (e.g., to further characterize the “competitive dynamics” we described), and outcomes of quality improvement efforts within each sector. No, Is the Subject Area "Death rates" applicable to this article? For example, the lack of data from private sector groups was similar to the situation in the UK, where the privately run Independent Sector Treatment Centres was unable to provide healthcare performance data when required [109]. However, significant conflicts of interest may apply to both groups [11], as large private international contractors, insurance firms, and non-governmental organizations may benefit from expanding the role of the private sector, while academics who rely on state-funded grant proposals may gain resources from a greater public sector role. ICMJE criteria for authorship read and met: SB JA DS SK RP. Understanding the patient of the future and their expectations are what has driven the development of delivery systems capable of meeting these demands. Both public and private sector systems had poor accountability and transparency. In recent years, disputes between the proponents of private and public systems have become particularly heated, as the global economic recession that began in 2007 has placed major constraints on government budgets—the major funding source for healthcare expenditures in most countries (Figure 1) [2].

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