This report, produced in partnership with the Engelberg Center for Health Care Reform at the Brookings Institution, explores lessons learned for the stewardship of mixed health system based on health care experiences in the United States. The report considers the role of professional associations, policy consultation and analysis mechanisms, health information collection, and accreditation. The report and accompanying issue brief examine how the lessons from this analysis of the US public/private health system interaction might inform the development of improved stewardship mechanisms in the developing world, with an emphasis on what works and does not work well in the United States.
The basic goal of any health system is to ensure access to quality care. However, in mixed health systems, where public and private providers operate side-by-side to provide health services, this goal can be challenging to achieve, particularly when health care regulation and delivery are not coordinated between the public and private sectors. These challenges are particularly acute in low- and middle-income countries, where historically, governments have prioritized the public provision of health care services over stewardship over the entire, broader health system. This is true for a number of reasons, including a negative perception of the private sector, lack of resources, and lack of a simple interface to engage the fragmented and disorganized landscape of health care providers.
Like many mixed health systems in the developing world, the U.S. health system includes a complex mix of public and private stakeholders who contribute to the financing, delivery, and regulation of health care. Yet, while it faces a number of significant and well-documented challenges – including high costs, variable quality, and uneven access – the U.S also excels in several areas – including innovation, public-private sector collaboration, quality regulation, and stakeholder engagement in the policy process.
As a result, the U.S. can serve as a valuable case study for developing countries with mixed health systems – especially those encountering some of the same challenges that the U.S. faces now and has faced in the past. Private or public-private stewardship and regulatory mechanisms used in the U.S. may be particularly appropriate for countries that lack government resources, capacity, and transparency, or countries that are grappling with how to engender more cooperation across sectors.
