Feasibility study of Public-Private Mix in Health Care in Bangladesh

Abstract

Bangladesh has good physical structure for health care in rural area called Thana Health Complex, the first referral level of health care institution. But unfortunately Thana Health Complex are under utilized especially the inpatient department. Therefore, the study has intended to search possible causes for that and to find measure for improving the under utilization problems. It is clear that the government can not do some thing better alone when the health care system is tax financed and tax collection system is very weak. Therefore, involvement of patients as well as private providers and NGOs are needed to do something better than present. Private/Public mix in health care is the solution. There are many types of p/p mix in health care but for Thana Health Complex contracting out is one of the suitable ways to solve some problems of under utilization. Cataract care is chosen for contracting out as visual disability is the highest cause of disability in Bangladesh and cataract is the number one cause for visual disability. The objectives of the study are to explore contracting out as a remedial measure of P/P mix to improve the problem of under utilization of Thana Health Complex of Bangladesh and assess the additional cost and potential benefit of contracting out models for cataract surgery and to explore possible design of contracting out for Thana Health Complex. To assess additional cost for contracting out the study considers capital cost and recurrent cost and to assess potential benefit it considers equity, efficiency, quality of care as well as patient's satisfaction. Finally, the study has chalked two designs for contracting out for cataract surgery at Thana Health Complex; one is Purchasing model to buy service from private providers and share the finance with patient and the other one the Leasing model to give lease the Operation Theater of Thana Health Complex for cataract surgery to NGO or private provider. Compare and contrast between two models has placed in terms of additional cost and potential benefit. Enforcement of government regulation and consumer education is recommended for proper for proper utilization of Thana Health Complex and changing health seeking behavior of people.