Making Health Markets Work for the Poor: Improving Provider Performance

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The sections that follow present the ideas of the authors and an informal network of health system analysts and innovators. Sections 2, 3, and 4 introduce current thinking about the roles of markets and institutions in health systems, outline a framework for analysis of health systems, present some new developments that have emerged in recent years, and explore sources of institutional innovation in these markets. They draw on previous work by the authors on analytical approaches for understanding the pluralistic health systems that have emerged in many countries, scoping studies carried out by partners of the Future Health Systems Consortium in Nigeria, Uganda, Bangladesh, India, and China, a review of current knowledge on innovations to improve the performance of health-related markets (appendix 1), a review of current knowledge on the applications of information and communications technology to health (appendix 2), and discussions between innovators and researchers at a recent workshop hosted by ICDDR,B in Dhaka. Section 5 presents some key elements of a strategy for making health-related markets work better for the poor, and section 6 concludes with a presentation of learning approaches for improving the performance of health market systems. This is one of a series of background papers commissioned by the Rockefeller Foundation that address different aspects of markets for health-related goods and services in low- and middleincome countries.

This paper focuses particularly on innovations for improving provider performance other than through government regulation or the strategic use of the purchasing power of an insurance scheme, which other papers discuss. It explores mechanisms for addressing problems of information asymmetry between provider and client, while noting that the pattern of services provided and the degree to which they meet the needs of the poor are strongly influenced by the specific arrangements for financing and organizing public health services.