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Public vs Private: Does the Quality of Healthcare vary between the Public and Private Sectors?

By Nimrit Jodha

Over the past decade, there has been an increased emphasis on healthcare becoming a profit-maximising industry. However, healthcare is based on a factual science where patients must trust diagnoses regardless of price. In theory, having a division between public and private is useless because consumer sovereignty does not apply in healthcare, as the patient is not the best judge of their welfare. This article evaluates a comparison of healthcare quality and whether there is a clear distinction between the two.

Efficiency vs. Accountability

The private sector receives significantly more funding than the public sector due to the patients paying for the faculties and infrastructure. In addition to direct payments, there is also funding from private insurance and employer-sponsored plans. Meanwhile, in comparison, there are continuous reductions in budgets and staff in the public sector, leading to apparent differences in available resources. Absorptive capacity occurs in the private sector, where it recognises new patients’ value due to their financial position, attracting more funding from the government, shifting budgets away from the public sector, where they already struggle to maintain a human and physical infrastructure.

Many gravitate towards the private sector because it is ‘more efficient, accountable and medically effective’. However, it should be noted that studies have found the public sector to lack timeliness and hospitality towards patients. To make an informed judgement of the effectiveness and quality of both systems, a study was conducted on eight databases systematically on their performance. This was assessed against the World Health Organisation’s six essential themes of health- ‘accessibility and responsibility, quality, outcomes, accountability and transparency, regulation, efficiency, fairness and equity. A narrative review was conducted for each theme. The studies reinforced the idea that in the private sector, there is better hospitality but also found that the industry violates the accepted medical standards more frequently, where they have been reported to have lower efficiency. The systematic review also did not support the view that the private sector’s healthcare delivery is more accountable and effective. It showed that both sectors have strengths and weaknesses, but the main issues were the financial barriers to care, poor accountability and a lack of transparency.

The Advocates' Duel

Advocates for the private sector have advocated that it is the ‘main provider’ as impoverished patients would prefer care at private clinics where there is the belief that they would be more responsive to patient’s needs due to the market competition, which should, in theory, overcome government corruption and inefficiency. In comparison, advocates for the public sector have highlighted inequalities in accessioning healthcare as low-income patients cannot pay for private services. However, the private sector has been criticised for failing to deliver public health goods and preventative services as it lacks communication and coordination with the public sector.

It should be noted that there is also a bias when discussing the sectors as big private international contractors, insurance firms, and non-governmental organisations would benefit from expanding the private sector, whilst academics would be in favour of the public sector as they greatly rely on state-funded grants to gain more resources for their research.

The Path to Unity

The main issue is not the extent to which the sectors differ because they both have advantages and disadvantages. In theory, the public sector should be of higher quality. However, studies have shown that they lack accountability and are more likely to violate medical standards. Policies must reduce the divide between the two sectors to make a more integrated system. This could be done by creating one significant healthcare sector where all the funding and resources are pooled and contribute to one place rather than separating it into two separate distinctions. Patients who previously funded their private treatment should be encouraged and motivated by the fact that the services they will receive will also be improved from their current healthcare. There needs to be a greater emphasis on enhancing and integrating healthcare into one unitary service rather than the main focus being on the difference and quality of the two sectors. Integration could involve sharing resources so there is greater innovation of ideas and breakthroughs regarding medicine. This would also reduce the issues the public sector sees with staffing as they would have additional support from the private sector. The most impactful way to reduce the disparities and inequalities between the sectors is by having all doctors and nurses work together towards the same goal rather than splitting resources and funding.

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