Document Type : Original Article
Authors
Department of Medical Library and Information Science, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
Abstract
There is a lack of conceptual clarity about the role of delivering private hospital services
(DPHS) accompanied by major gaps in evidence. The purpose of this systematic scoping
review was to identify and map the available evidence regarding the developing countries
to scrutinize the participation of DPHS exclusively in the universal health coverage (UHC)
through providing graphical/tabular classifications of the bibliometric information, sources
of the records, frequent location, contribution of the private hospital services in the health
system, and roles of DPHS in UHC. This study was performed following the published
methodological guidance of the Joanna Briggs Institute for the conduct of scoping review,
applying some major databases and search engines. In addition, a narrative-thematic
synthesis integrated with the systematic analysis using the policy framework of the World
Health Organization was employed. The 28 included records in English which met the
inclusion criteria were found between 2014 and January 2020. The chronological trend of
records was progressive until 2019. India was the most frequent location (12%). China and
Sri Lanka on the one end of the spectrum and Somalia along with South Korea from the
other end were, respectively, the least and the most contributed countries in terms of DPHS.
Overall, 90% of the roles were concerned with UHC goals. Although evidence has revealed
inconsistency in the identified roles, a continuous chain of positive or negative effects in the
UHC objectives and goals was observed. Some knowledge gaps about the roles, causes of
the increasing and decreasing DPHS contribution, and its behaviors around the privatization
types and circumstances of the delivery were recommended as prioritized research agendas
for evidence-based policymaking in future.
Keywords
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XEB.0000000000000050].
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authors when choosing between a systematic or scoping review
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s12874-018-0611-x].
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quantitative evidence to inform management and policy‑making
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Research for Universal Health Coverage. Geneva: World Health
Organization; 2013.
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purchase: How should we engage with the private health‑care
sector? Lancet 2016;388:613‑21. [doi:10.1016/s0140-6736(16)30242-
2].
33. Zhu A, Tang S, Thu NTH, Supheap L, Liu X. Analysis of strategies
to attract and retain rural health workers in Cambodia, China,
and Vietnam and context influencing their outcomes. Hum Resour
Health 2019;17:2. [doi:10.1186/s12960-018-0340-6].
34. Chapman AR, Dharmaratne SD. Sri Lanka and the possibilities
of achieving universal health coverage in a poor country. Glob
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80].
35. Gele AA, Ahmed MY, Kour P, Moallim SA, Salad AM, Kumar B.
Beneficiaries of conflict: A qualitative study of people’s trust in the
private health care system in Mogadishu, Somalia. Risk Manag
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private sector and universal health coverage. Bull World Health
Organ 2019;97:434‑5. [doi:10.2471/blt.18.225540].
3. The Elders Foundation. Universal Health Coverage: Position
paper. 2019. Available from: https://theelders.org/sites/default/files/final-uhc-position-paper-for-web.pdf. [Last accessed on 2019
September 28].
4. Russo G. The role of the private sector in health services: Lessons
for ASEAN. Asean Econ Bull 1994;11(2):190‑211.
5. Awoke MA, Negin J, MollerJ, Farell P, Yawson AE, Biritwum RB,
et al. Predictors of public and private healthcare utilization and
associated health system responsiveness among older adults in
Ghana. Glob Health Action 2017;10:1301723. [doi:10.1080/16549
716.2017.1301723.]
6. World Health Organization. The Private Sector, Universal Health
Coverage and Primary Health Care. Geneva: World Health
Organization; 2018. Available from: https://extranet.who.int/iris/
restricted/handle/10665/312248. [Last accessed on 2019 Oct 20].
7. Costanza R, Fioramonti L, Kubiszewski I. The UN Sustainable
Development Goals and the dynamics of well‑being. Front Ecol
Environ 2016;14:59. [doi.org/10.1002/fee.1231].
8. Mackintosh M, Channon A, Karan A, Selvaraj S, Cavagnero E,
Zhao H. What is the private sector? Understanding private
provision in the health systems of low‑income and middle‑income
countries. Lancet 2016;388:596‑605. [doi:10.1016/s0140-
6736(16)00342-1].
9. Bishai D, Sachathep K. The role of the private sector in health
systems. Health Policy Plan 2015;30 Suppl 1:i1. [doi:10.1093/
heapol/czv004].
10. World Health Organization, Regional Office for the Eastern
Mediterranean. Analysis of the Private Health Sector in Countries
of the Eastern Mediterranean: Exploring Unfamiliar Territory.
Cairo: World Health Organization. Regional Office for the Eastern
Mediterranean; 2014.
11. Tourani S, Malmoon Z, Zaboli R, Jafari M, Nemati A. Training
needs assessment of nursing managers for achieving university
health coverage. J Educ Health Promot 2020;9:139. [doi:10.4103/
jehp.jehp_114_20].
12. Weldemariam T, Bayray A. Role of private health sector in
provision of quality health service in developing countries: Does
the private health sector contribute to achieve health‑related
MDGs? A systematic review. Res Rev 2015;5:7‑13.
13. Green A. The role of non‐governmental organizations and the
private sector in the provision of health care in developing
countries. Int J Health Plann Manage 1987;2:37‑58. [doi:10.1002/
hpm.4740020106].
14. Hanson K, Berman P. Private health care provision in developing
countries: A preliminary analysis of levels and composition.
Health Policy Plan 1998;13:195‑211. [10.1093/heapol/13.3.195].
15. Yoong J, Burger N, Spreng C, Sood N. Private sector participation
and health system performance in sub‑Saharan Africa. PLoS One
2010;5:e13243.
16. Zwi AB, Brugha R, Smith E. Private health care in developing
countries: If it is to work, it must start from what users need. BMJ
2001;323:463‑4. [doi: 10.1136/bmj.323.7311.463].
17. Zaidi S, Saligram P, Ahmed S, Sonderp E, Sheikh K. Expanding
access to healthcare in South Asia. BMJ 2017;357:j1645.
[doi:10.1136/bmj.j1645].
18. Zaidi S, Riaz A, Taver A, Mukhi A, Khan LA. Role and
Contribution of Private Sector in Moving Towards Universal
Health Coverage in the Eastern Mediterranean Region. 2012.
Available from: http://ecommons.aku.edu/pakistan_fs_mc_
chs_chs/193. [Last accessed on 2018 Aug 20].
19. Kutzin J. Health financing for universal coverage and health
system performance: Concepts and implications for policy. Bull
World Health Organ 2013;91:602‑11. [doi:10.2471/BLT.12.113985].
20. World Health Organization, Organisation for Economic
Co‑operation and Development, and the World Bank. Delivering
Quality Health Services: A Global Imperative for Universal Health
Coverage. Geneva: World Health Organization; 2018.
21. De Savigny D, Adam T, editors. Systems Thinking for Health
Systems Strengthening: Alliance for Health Policy and Systems
Research. World Health Organization; 2009.
22. Policy Framework. World Health Organization Website.
Available from: https://www.who.int/health_financing/
policy‑framework/en/. [Last accessed on 2019 May 20].
23. AromatarisEM. Joanna Briggs Institute Reviewer’s Manual. Joanna
Briggs Institute 2017. Available from: https://reviewersmanual.
joannabriggs.org/. [Last accessed on 2018 Dec 20].
24. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D,
et al. PRISMA Extension for Scoping Reviews (PRISMA‑ScR):
Checklist and explanation. Ann Intern Med 2018;169:467‑73.
[doi:10.7326/M18-0850].
25. Kastner M, Tricco AC, Soobiah C, Lillie E, Perrier L, Horsley T,
et al. What is the most appropriate knowledge synthesis method
to conduct a review? Protocol for a scoping review. BMC Med
Res Methodol 2012;12:114. [doi:10.1186/1471-2288-12-114].
26. Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC.
A comparison of results of meta‑analyses of randomized control
trials and recommendations of clinical experts. Treatments
for myocardial infarction. JAMA 1992;268:240‑8. [doi:10.1001/
jama.1992.03490020088036].
27. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D,
Soares CB. Guidance for conducting systematic scoping
reviews. Int J Evid Based Healthc 2015;13:141‑6. [doi: 10.1097/
XEB.0000000000000050].
28. Munn Z, Peters MD, Stern C, Tufanaru C, McArthur A,
Aromataris E. Systematic review or scoping review? Guidance for
authors when choosing between a systematic or scoping review
approach. BMC Med Res Methodol 2018;18:143. [doi: 10.1186/
s12874-018-0611-x].
29. Mays N, Pope C, Popay J. Systematically reviewing qualitative and
quantitative evidence to inform management and policy‑making
in the health field. J Health Serv Res Policy 2005;10 Suppl 1:6‑20.
[doi:10.1258/1355819054308576].
30. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using
the framework method for the analysis of qualitative data in
multi‑disciplinary health research. BMC Med Res Methodol
2013;13:117. [doi:10.1186/1471-2288-13-117].
31. World Health Organization. The World Health Report 2013:
Research for Universal Health Coverage. Geneva: World Health
Organization; 2013.
32. Montagu D, Goodman C. Prohibit, constrain, encourage, or
purchase: How should we engage with the private health‑care
sector? Lancet 2016;388:613‑21. [doi:10.1016/s0140-6736(16)30242-
2].
33. Zhu A, Tang S, Thu NTH, Supheap L, Liu X. Analysis of strategies
to attract and retain rural health workers in Cambodia, China,
and Vietnam and context influencing their outcomes. Hum Resour
Health 2019;17:2. [doi:10.1186/s12960-018-0340-6].
34. Chapman AR, Dharmaratne SD. Sri Lanka and the possibilities
of achieving universal health coverage in a poor country. Glob
Public Health 2019;14:271‑83. [doi:10.1080/17441692.2018.15010
80].
35. Gele AA, Ahmed MY, Kour P, Moallim SA, Salad AM, Kumar B.
Beneficiaries of conflict: A qualitative study of people’s trust in the
private health care system in Mogadishu, Somalia. Risk Manag
Healthc Policy 2017;10:127‑35. [doi:10.2147/rmhp.s136170].
36. Kwon S. Advancing Universal Health Coverage: What Developing
Countries Can Learn from the Korean Experience? Universal
Health Care Coverage Series No. 33. Washington, DC: World
Bank Group; 2018.
37. Cowley P, Chu A. Comparison of private sector hospital
involvement for UHC in the western pacific region. Health Syst
Reform 2019;5:59‑65. [doi:10.1080/23288604.2018.1545511].
38. European Foundation for the Improvement of Living and
Working Conditions. Delivering Hospital Services: A Greater
Role for the Private Sector? Luxembourg: Publications Office of
the European Union; 2017.39. Berendes S, Heywood P, Oliver S, Garner P. Quality of private
and public ambulatory health care in low and middle income
countries: Systematic review of comparative studies. PLoS Med
2011;8:e1000433. [doi:10.1371/journal.pmed.1000433].
40. World Health Organization. The World Health Report 2010‑Health
Systems Financing: The Path to Universal Coverage. Geneva:
2010. Available from: http://www.who.int/whr/en/index.html
. [Last accessed on 2019 Feb 20].
41. Evans DB, Saksena P, Elovainio R, Boerma T. Measuring
Progress Towards Universal Coverage. Geneva: World Health
Organization; 2012.
42. Khoonthaweelapphon Woraset. The Liberalization of Thailand
Medical Services Industry‑Case Study between Thailand and
South Korea, Master’s thesis of International Commerce. Graduate
School of International Studies, Seoul National University;
2019. Available from: http://hdl.handle.net/10371/150912
. [Last accessed on 2019 Oct 11].
43. World Health Organization, Regional Office for the Eastern
Mediterranean. Regional Committee for the Eastern Mediterranean
Sixty‑fifth session‑Provisional Agenda Item 4(e): Private Sector
Engagement for Advancing Universal Health Coverage. 2018.
Available from: http://applications.emro.who.int/docs/
RC_Technical_Papers_2018_8_20546_EN.pdf. [Last accessed on
2019 Nov 19].
44. Titoria R, Mohandas A. A glance on public private partnership:
An opportunity for developing nations to achieve universal health
coverage. Int J Community Med Public Health 2019;6:1353‑7.
[doi:10.18203/2394-6040.ijcmph20190640].
45. Zodpey S, Farooqui HH. Universal health coverage in India:
Progress achieved & the way forward. Indian J Med Res
2018;147:327‑9. [doi: 10.4103/ijmr.IJMR_616_18].
46. Maurya D, Virani A, Rajasulochana S. Horses for courses: Moving
India towards universal health coverage through targeted
policy design. Appl Health Econ Health Policy 2017;15:733‑44.
[doi:10.1007/s40258-017-0358-2].
47. Erdenee O, Narula IS, Yamazaki C, Kameo S, Koyama H.
Mongolian health sector strategic master plan (2006‐2015):
A foundation for achieving universal health coverage. Int J Health
Plann Manage 2019;34:e314‑26. [doi:10.1002/hpm.2651].
48. Tsevelvaanchig U, Narula IS, Gouda H, Hill PS. Regulating
the for‑profit private healthcare providers towards universal
health coverage: A qualitative study of legal and organizational
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