Globalization and Health Open Collection

The future of health markets

posted Jul 18, 2014, 9:12 AM by Jeff Knezovich   [ updated Jul 18, 2014, 9:13 AM ]

Sara Bennett, Gerald Bloom, Jeffrey Knezovich, David H Peters

This editorial introduces a new open collection in Globalization and Health on the topic of the future of health markets. In 2012, we undertook work for the Rockefeller Foundation that sought to inform their future investments in health markets. Whereas health markets are sometimes viewed solely through the lens of private health care providers, our approach was broader, viewing such providers as one of many inter-connected actors who work within a market system. We were interested in better understanding the interactions between these many actors, including public and private health care providers, payors, regulators, and civil society organizations, and the rules and regulations that govern the market. Our starting point was that poor people in low- and middle-income countries (LMICs) frequently depend on care from private health care providers, particularly informal private providers, and so, to expand access to high quality services for the poor, we need to think more strategically about how to influence health markets.

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Private sector, for-profit health providers in low and middle income countries: can they reach the poor at scale?

posted Jul 18, 2014, 9:11 AM by Jeff Knezovich

Elizabeth Tung, Sara Bennett

The bottom of the pyramid concept suggests that profit can be made in providing goods and services to poor people, when high volume is combined with low margins. To-date there has been very limited empirical evidence from the health sector concerning the scope and potential for such bottom of the pyramid models. This paper analyzes private for-profit (PFP) providers currently offering services to the poor on a large scale, and assesses the future prospects of bottom of the pyramid models in health.

We searched published and grey literature and databases to identify PFP companies that provided more than 40,000 outpatient visits per year, or who covered 15% or more of a particular type of service in their country. For each included provider, we searched for additional information on location, target market, business model and performance, including quality of care.

Only 10 large scale PFP providers were identified. The majority of these were in South Asia and most provided specialized services such as eye care. The characteristics of the business models of these firms were found to be similar to non-profit providers studied by other analysts (such as Bhattacharya 2010). They pursued social rather than traditional marketing, partnerships with government, low cost/high volume services and cross-subsidization between different market segments. There was a lack of reliable data concerning these providers.

There is very limited evidence to support the notion that large scale bottom of the pyramid models in health offer good prospects for extending services to the poor in the future. In order to be successful PFP providers often require partnerships with government or support from social health insurance schemes. Nonetheless, more reliable and independent data on such schemes is needed.

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Innovation in regulation of rapidly changing health markets

posted Jul 18, 2014, 9:09 AM by Jeff Knezovich   [ updated Jul 18, 2014, 9:09 AM ]

Gerald Bloom, Spencer Henson, David H Peters

The rapid evolution and spread of health markets across low and middle-income countries (LMICs) has contributed to a significant increase in the availability of health-related goods and services around the world. The support institutions needed to regulate these markets have lagged behind, with regulatory systems that are weak and under-resourced. This paper explores the key issues associated with regulation of health markets in LMICs, and the different goals of regulation, namely quality and safety of care, value for money, social agreement over fair access and financing, and accountability. Licensing, price controls, and other traditional approaches to the regulation of markets for health products and services have played an important role, but they have been of questionable effectiveness in ensuring safety and efficacy at the point of the user in LMICs. The paper proposes a health market systems conceptual framework, using the value chain for the production, distribution and retail of health goods and services, to examine regulation of health markets in the LMIC context. We conclude by exploring the changing context going forwards, laying out implications for future heath market regulation. We argue that the case for new approaches to the regulation of markets for health products and services in LMICs is compelling. Although traditional "command and control" approaches will have a place in the toolkit of regulators, a broader bundle of approaches is needed that is adapted to the national and market-level context of particular LMICs. The implication is that it is not possible to apply standard or single interventions across countries, as approaches proven to work well in one context will not necessarily work well elsewhere.

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Accelerating learning for pro-poor health markets

posted Jul 18, 2014, 9:07 AM by Jeff Knezovich   [ updated Jul 18, 2014, 9:07 AM ]

Sara Bennett, Gina Lagomarsino, Jeff Knezovich, Henry Lucas


Given the rapid evolution of health markets, learning is key to promoting the identification and uptake of health market policies and practices that better serve the needs of the poor. However there are significant challenges to learning about health markets. We discuss the different forms that learning takes, from the development of codified scientific knowledge, through to experience-based learning, all in relationship to health markets.


Notable challenges to learning in health markets include the difficulty of acquiring data from private health care providers, designing evaluations that capture the complex dynamics present within health markets and developing communities of practice that encompass the diverse actors present within health markets, and building trust and mutual understanding across these groups.

The paper proposes experimentation with country-specific market data platforms that can integrate relevant evidence from different data sources, and simultaneously exploring strategies to secure better information on private providers and health markets. Possible approaches to adapting evaluation designs so that they are better able to take account of different and changing contexts as well as producing real time findings are discussed. Finally capturing informal knowledge about health markets is key. Communities of practice that bridge different health market actors can help to share such experience-based knowledge and in so doing, may help to formalize it. More geographically-focused communities of practice are needed, and such communities may be supported by innovation brokers and/or be built around member-based organizations.


Strategic investments in and support to learning about health markets can address some of the challenges experienced to-date, and accelerate learning that supports health markets that serve the poor.

Roundtable discussion: what is the future role of the private sector in health?

posted Jul 18, 2014, 8:47 AM by Jeff Knezovich   [ updated Jul 18, 2014, 9:05 AM ]

Guy Stallworthy, Kwasi Boahene, Kelechi Ohiri, Allan Pamba and Jeffrey Knezovich


The role for the private sector in health remains subject to much debate, especially within the context of achieving universal health coverage.

This roundtable discussion offers diverse perspectives from a range of stakeholders – a health funder, a representative from an implementing organization, a national-level policy-maker, and an expert working in a large multi-national company – on what the future may hold for the private sector in health.


The first perspective comes from a health funder, who argues that the discussion about the future role of the private sector has been bogged down in language. He argues for a ‘both/and’ approach rather than an ‘either/or’ when it comes to talking about health service provision in low- and middle-income countries.

The second perspective is offered by an implementer of health insurance in sub-Saharan Africa. The piece examines the comparative roles of public sector actors, private sector actors and funding agencies, suggesting that they must work together to mobilize domestic resources to fund and deliver health services in the longer term.

Thirdly, a special advisor working in the federal government of Nigeria considers the situation in that country. He notes that the private sector plays a significant role in funding and delivering health services there, and that the government must engage the private sector or forever be left behind.

Finally, a representative from a multi-national pharmaceutical corporation gives an overview of global shifts that are creating opportunities for the private sector in health markets.


Overall, the roundtable discussants agree that the private sector will play an important role in future health systems. But we must agree a common language, work together, and identify key issues and gaps that might be more effectively filled by the private sector.

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