Jane E Doherty International evidence shows that, if poorly regulated, the private
health sector may lead to distortions in the type, quantity,
distribution, quality and price of health services,
as well as anti-competitive behaviour. This article provides an
overview
of legislation governing the for-profit private
health sector in East and Southern Africa. It identifies major
implementation
problems and suggests strategies Ministries of
Health could adopt to regulate the private sector more effectively and
in line
with key public health objectives. This qualitative
study was based on a document review of existing legislation in the
region,
and seven semi-structured interviews with
individuals selected purposively on the basis of their experience in
policymaking
and legislation. Legislation was categorized
according to its objectives and the level at which it operates. A
thematic content
analysis was conducted on interview transcripts.
Most legislation focuses on controlling the entry of health
professionals
and organizations into the market. Most countries
have not developed adequate legislation around behaviour following
entry.
Generally the type and quality of services provided
by private practitioners and facilities are not well-regulated or
monitored.
Even where there is specific health insurance
regulation, provisions seldom address open enrolment, community rating
and comprehensive
benefit packages (except in South Africa). There is
minimal control of prices. Several countries are updating and improving
legislation although, in most cases, this is
without the benefit of an overarching policy on the private sector, or
reference
to wider public health objectives. Policymakers in
the East and Southern African region need to embark on a programme of
action
to strengthen regulatory frameworks and instruments
in relation to private health care provision and insurance. They should
not underestimate the power of the private health
sector to undermine efforts for increased regulation. Consequently they
should conduct careful stakeholder analyses and
build alliances to help drive through reform. Full Text (HTML)
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