Demand

Demand data is usually the most nationally representative and is found in Demographic and Health Surveys, National Health Surveys, and other national household survey data. The limitation of national demand data is that it often does not differentiate among types of goods or services purchased from the private sector. While over the counter pharmaceutical purchases are extremely important in many countries and may represent 60% or more of total expenditure on health, these expenses may or may not be subsequent to interaction with a clinical practitioner who in turn may or may not be in the private sector. Variability in the reporting of consultations, clinical care, and pharmaceutical sales are a limiting factor or "a limitation" in most surveys.

Despite these caveats, demand data is usually the best information available to measure the private sector importance in overall delivery of health care, and in the absence of other measures it can be used as a proxy for the private healthcare sector, with the caveat that pharmaceutical sales may overshadow information on the relative importance of private clinical care for outpatient or inpatient services.

Demographic and Health Surveys (DHS) provide nationally representative population data for over 75 countries, including information on sources of medical care for two childhood illnesses, acute respiratory infection and acute diarrhea infection. Useful in its own right, it has been made more so by the World Bank’s Health Nutrition and Population ‘Poverty Thematic Reports,’ which have applied wealth quintile breakdowns to this data for 38 countries. A summary of these analyses has been used to demonstrate that even among the poor, use of the private sector is as high as among the wealthy, ranging from 34% to 96% for all treated diarrhea and from 37% to 99% for all treated ARI.

World Health Survey data is able to disaggregate demand for ambulatory and in-patient care. As one would expect, in all countries the demand for private ambulatory care is higher than the demand for private in-patient care. The median rate of use of private services for ambulatory care was 32%, and for inpatient care 15%. In six of the countries surveyed more than 60% of respondents reported using non-state services for ambulatory care. These were Nepal, Ireland, Uruguay, India, Czech Republic and Israel (in order of lowest to highest percentage).

Ambulatory Care

In the AFRO region the WHS results show that for the majority of countries (17 out of 18) the government is reported as the main provider of ambulatory services (over 50% of respondents reported use in the last year). Kenya had the largest percentage of respondents reported use of non-state (private and NGO) ambulatory care, at around 44%.

Percentage of respondents using non-state (private or NGO) services

In Asia, six of the ten countries showed more than 50% of respondents using of non-state or "other" providers. This was largest in India, where 72% of respondents reported seeing non-state providers for their most recent ambulatory care. In both Asia and AFRO, the country with the lowest use of government ambulatory services also had a significant percentage of respondents using ‘other’ services (Bangladesh and Mali, respectively). This suggests either that respondents had difficulties categorizing services, or more likely the use of services from traditional practitioners or informal providers. Strikingly, in Bangladesh, over half of the respondents reported use of ‘other’ services for ambulatory care.

Inpatient Care

For clinical visits, in all countries surveyed except India, the government remains the most important provider of inpatient care. In the AFRO region over 60% of respondents reported use of government inpatient services in their most recent inpatient episode (figure 5). In all Asian countries surveyed save India, more than 50% of respondents reported use of government inpatient services.

Where people fo for inpatient care in AFRO and Asia

The reported use of ‘other’ services is much lower for inpatient care than for ambulatory care with the exception of Mali.