Private Provision in its Institutional Context: Lessons from Health

During the second half of the twentieth century, the health policies of many low and middleincome countries were largely based on expanding government health services. Some countries created effective and equitable government health services. Many did not, and some government health systems have faced difficulties associated with major social and economic change. Pluralistic health systems have emerged in which the boundaries between public and private sectors are blurred, with negative consequences for quality and cost. This is particularly the case in countries that have experienced prolonged economic crisis and in countries in transition to market economies.

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