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What is the 'private sector' anyway? A review of the 2013 symposium

posted Jul 8, 2013, 1:37 PM by Jeff Knezovich   [ updated Jul 8, 2013, 1:49 PM ]

Symposium Storify

On Saturday, 6 July, over 100 participants gathered in the Sydney Convention Centre for the one-day Private Sector in Health Symposium. This is the third time the event has been held before the International Health Economics Association World Congress, and was one of the largest sessions yet.

The day started off with a thoughtful welcome to the country by Millie Ingram, followed by a keynote from Bruce Bonyhady on the recent introduction of the National Disability Insurance Scheme in Australia. In his inspiring keynote, Bruce noted the strong role that the private sector had in reframing the debate around disability in Australia. Instead of focusing on disability solely as a rights issue, he worked with others to reframe it as an economic -- one focused on insurance and risk. He said it sprang from a recognition that: "there are only two types of people in this world, those with a disability, and those who have yet to get a disability". He also noted the reality of changing demographics: disabled children often rely heavily on their parents for care, but are starting to outlive their own parents. From an economic standpoint, he noted that a 1% decrease in informal care from friends and relatives led to a 4% increase in seeking formal care supported by the government, which he argued as unsustainable in the longterm. And so, after being reframed as an economic issue, it quickly became a political one. The government introduced the scheme at the beginning of July, and it is funded by a mill levy on health services that is likely one of the most popular tax rises in Australian history, with over 80% supporting the move. The keynote was a good reminder to us that the role of the private sector in health can be diverse -- it's not always about service provision or financing, but can also be about shifting the discourse and reframing policy debates.

Following the opening keynote, the participants broke out into three rounds of parallel sessions covering a diverse range of issues, such as regulation, influencing quality of care, health financing and a focus on equity. Many of the presentations from the day are already available.

In the afternoon, a closing plenary session was delivered by Mushtaque Chowdhury from BRAC, an NGO from Bangladesh that has quickly become one of the world's largest. Mushtaque attempted to explain the Bangladesh health 'miracle' -- that the country has strong health indicators despite limited investment in health from the government. He noted that Bangladesh has the highest life expectancy in the region, as the lowest infant and maternal mortality, but it also spends the least per capita on health. He attributed this 'miracle' to the strong innovation in the non-state sector in Bangladesh. He also focused on the role of entities like BRAC, which view poverty as a complex issue that must be tackled through a number of different initiatives. For example, BRAC runs micro-credit schemes, education programmes, health promotion schemes, and agricultural extension work. His presentation challenged those present at the symposium to rethink the nature of the private sector. BRAC is nearly impossible to categorise -- is it an NGO, a social enterprise, a business, a bank? -- and yet we understand that it has a critical role to play in the Bangladesh health market system and it's not the public sector.

Following Mushtaque's presentation, participants had a constructive discussion to share their reflections from the day as well as chart a way forward. Many were struck by the diversity of the participants, but noted that there were not many representatives of the for-profit private sector at the meeting, and they felt that their contribution would have added significantly to the day. There were also calls to have a clearer definition of what is understood by the term 'the private sector', and to focus on a few core themes in future research. In particular, there was a feeling that not enough was being done on assuring quality of private sector providers and on regulating health markets. There was also a call to separate out two distinct potential roles for the private sector: health service delivery and health financing.

The event concluded with a drinks reception sponsored by HANSHEP and CHMI, who will soon be re-launching its website cataloguing health market innovations -- a valuable resource for all those working on the private sector in health in low- and middle-income countries.