2010-04-06-世界卫生组织-Health_services_utilization_and_out-of-pocket_expenditure_at_public_and_private_facilities_in_low-income_countries_20页_1mb

Background: The study examines health services utilization and out-of-pocket (OOP) expenditure at public and private facilities in low-income countries, based on data from the World Health Survey 2003 across 39 countries. It highlights debates on the role of the private sector, noting that while it can improve efficiency and choice, public provision is crucial for equitable access. Public funding varies widely, with governments often unable to ensure universal coverage due to limited resources.

Methodology: Utilizes a descriptive approach, analyzing outpatient and inpatient utilization, OOP payments, and transportation costs. OOP is categorized into consultation fees, medicines, tests, and other costs. Transportation costs are separate from per-visit charges.

Key Findings: Public facilities dominate inpatient services in most countries, while outpatient use is mixed, with wealthier groups more likely to use private providers. Price differences exist, but factors like quality and access influence utilization. OOP expenditures are substantial, with medicines being the largest component in both public and private sectors. Transportation costs add significantly to the burden, especially for the poor.

Implications: The private sector's role is heterogeneous and context-specific. Policies should address comprehensive OOP costs beyond user fees, regulate private providers, and improve access through mechanisms like social health insurance. Equitable access requires integrating public and private actors, ensuring quality, and reducing indirect costs.

Recommendations: Governments should engage with the private sector through contracts, monitor services, and implement strategies to lower OOP expenditures and transportation costs for vulnerable populations to achieve universal health coverage.