A letter to Oxfam: Reframing the questions around private-sector health care

Jishnu Das, Lead Economist at the Development Research Group at the World Bank, recently wrote a letter to Oxfam encouraging a reframing of the questions about quality of PHC services in the private sector. Motivated by a 2009 Oxfam briefing pointing to poorer quality of care in the private sector, Das presents answers to the questions: “What do we know about private sector primary care?” and “Should we rely on the private sector to scale up care to the poor?”. He unpacks the methodology and content of some of the available evidence, including two contradicting systematic reviews which motivated a manuscript he co-authored earlier this year. The manuscript presents four methodological criteria for studies comparing quality of care between the public and private sector. Das additionally includes insights from his extensive experience in global health and concludes that “the private sector provides comparable or higher quality care than the public sector, but even with public subsidies, it will be extremely hard to use this advantage to provide care for the poor.”