The role of the private sector in healthcare systems
This week I attended a meeting of the European Health Policy Group (EHPG) at the London School of Economics.
EHPG describes itself as “a multidisciplinary network that aims to stimulate international collaboration and learning through comparative analysis of changes to health care systems in Europe”. It meets twice a year to discuss academic research and ideas to improve health policy.
At this week’s meeting there was a decent amount of discussion on what the private sector’s role should be in healthcare systems. There was a panel entitled ‘Private sector in health care – opportunity or fallacy?’ on which Max Hotopf, HBI’s founder and former chairman, who is now retired, spoke.
A variety of different opinions were voiced, ranging from firmly-anti-private to almost-whole-hearted endorsement.
Earlier in the day Max had asked keynote speaker Dr Jennifer Dixon (CEO of UK think tank The Health Foundation) what role the private sector will play in the UK with the new Labour government. She said she thinks it will (and should) take on an increasing amount of outsourced elective care, as the government has said it will, but cautioned that there is a limit to how much capacity it can take on given how small the private hospital sector is compared to the public sector.
She also said she is more sceptical about the private sector getting involved in emergency care or primary care, because the need to coordinate care delivery with the rest of the system is critical. She was particularly wary of private equity involvement in the sector, and alluded to evidence that private equity owned care operators have worse quality.
This appeared at odds with what a health economist on Max’s panel said later on — that researchers have failed to prove empirically the notion that private providers in general skimp on quality for the sake of improving margins.
Dixon’s view also struck me as quite UK-centric. For a meeting that is seeking to compare and share ideas from health policy experts across Europe, I would have liked to have seen more discussion of the fact that the role the private sector takes on varies quite a lot across Europe’s various healthcare systems, and whether there are lessons to be learnt about the role it can play from this.
Max spent his presenting time highlighting a few of his favourite examples of where the private sector really has been able to achieve something the public sector hasn’t, by being laser focused on productivity. One example being cataract surgeries: a UK NHS surgeon typically does 12-14 a day, but the same surgeon will do double working for a private ophtha company like Spa Medica, whilst in India they’re able to do 40-60 a day. Or the way certain private groups have found ways to train medics for a fraction of the cost of the public sector. He also mentioned that private groups have managed to heavily rationalise diagnostic labs.
He ended his presentation by suggesting that health policy experts should do what Lyra and Tom do in Philip Pullman’s His Dark Materials fantasy trilogy: take the knife and cut through into the other world of for-profit healthcare and see how people are doing things and what can be learnt from them (one of the audience members was quick to remind him that in Pullman’s book this leads to the end of the universe!).
We would welcome your thoughts on this story. Email your views to Martin De Benito Gellner or call 0207 183 3779.
