UHC landscape in Asia and the Pacific:

Private sector in the UHC

Eduardo P. Banzon

Private sources dominate health financing particularly

for low and middle income countries (LMICs)

Share of Private Health Expenditure to Total Health Expenditure

and Share of OOP to total Private Health Expenditure 2013
80%

79%
73%
63%

61%

OOP of PvtHE

65%
58%

56%
51%

33%

94%
83%

HI

Source: WHO Global Health Expenditure Database

LMIC

LIC

Tajikistan

57%

Nepal

99%

Cambodia

Philippines

Pakistan

Myanmar

Lao PDR

Indonesia

India

UMIC

8%

6%
63% 57%

56%

Fiji

Thailand

Marshall Islands

Maldives

Malaysia

Azerbaijan

Singapore

Republic of Korea

75% 57%

Papua New Guinea

80%

81%

89%

13%

10%
64%

94%

Kyrgyzstan

20%

79%

Bangladesh

75%

Viet Nam

20%

87%

85%

Vanuatu

16%

93% 75%

83%

Sri Lanka

80% 88%

79%

87%

Timor-Leste

86%

94%

Japan

49%
41%

90%
18%

57%

42%

Solomon Islands

45%

Samoa

47%

Uzbekistan

60%

69%

68%

68%

PvtHE of THE

HI
UMIC

Source: WHO Global Health Expenditure Database

LMIC

60 60

LIC

Tajikistan

49

Nepal

40

Kyrgyzstan

Cambodia

57

Bangladesh

46

Viet Nam

Vanuatu

47

Uzbekistan

11

Timor-Leste

46

Sri Lanka

Solomon Islands

Samoa

55

Philippines

12 11

Papua New Guinea

58

Pakistan

71

Myanmar

36 37

Lao PDR

Indonesia

57

India

Fiji

Thailand

14

Marshall Islands

Maldives

37

Malaysia

Azerbaijan

Singapore

Korea

Japan

Households still pay for majority

of health expenditures
%OOP as share of Total Health Expenditure 2013
68
60

46

36

21

3
7

limited participation of private health

insurance providers
Sources of Private Expenditure (2013)
100%
80%

60%
40%
20%

HI

Private Insurance

UMIC

Out of Pocket Expenditure

Source: WHO Global Health Expenditure Database

LMIC

LIC

Non-profit Institutions serving households (e.g. NGOs)

Tajikistan

Nepal

Kyrgyzstan

Cambodia

Bangladesh

Viet Nam

Vanuatu

Uzbekistan

Timor-Leste

Sri Lanka

Solomon Islands

Samoa

Philippines

Papua New Guinea

Pakistan

Myanmar

Lao PDR

Indonesia

India

Fiji

Bhutan

Thailand

Marshall Islands

Maldives

Malaysia

Azerbaijan

Singapore

Korea

Japan

0%

In the
Philippines,
medicines account for

43% of household
out-of-pocket health
expenditures

Private

Source: WHO Global Health Expenditure Database

Afghanistan
Bahamas
Bolivia
Brazil
Burkina Faso
Burundi
China
Colombia
Congo
Cook Islands
Dem Rep of the Congo
Dominican Republic
Ecuador
El Salvador
Haiti
India
Indonesia
Iran (Islamic Rep of)
Kazakhstan
Kyrgyzstan
Malawi
Mauritius
Mexico
Mongolia
Nicaragua
Niger
Oman
Philippines
Republic of Moldova
Russian Federation
Rwanda
Sao Tome and Principe
Sudan
Syrian Arab Republic
Uganda
Ukraine
United Rep of Tanzania
Zambia

Afghanistan
Bahamas
Bolivia
Brazil
Burkina Faso
Burundi
China
Colombia
Congo
Cook Islands
Dem Rep of the Congo
Dominican Republic
Ecuador
El Salvador
Haiti
India
Indonesia
Iran (Islamic Rep of)
Kazakhstan
Kyrgyzstan
Malawi
Mauritius
Mexico
Mongolia
Nicaragua
Niger
Oman
Philippines
Republic of Moldova
Russian Federation
Rwanda
Sao Tome and Principe
Sudan
Syrian Arab Republic
Uganda
Ukraine
United Rep of Tanzania
Zambia

Generic medicines are accessible in both

private and public facilities
Median availability of selected generic medicines (%)
Private and Public (2007-2013)

100

80

60

40

20

Public

Philippines

China

Private

Source: WHO Global Health Expenditure Database

Afghanistan
Bahamas
Bolivia
Brazil
Burkina Faso
Burundi
China
Colombia
Congo
Cook Islands
Dem Rep of the Congo
Dominican Republic
Ecuador
El Salvador
Haiti
India
Indonesia
Iran (Islamic Rep of)
Kazakhstan
Kyrgyzstan
Malawi
Mauritius
Mexico
Mongolia
Nicaragua
Niger
Oman
Philippines
Republic of Moldova
Russian Federation
Rwanda
Sao Tome and Principe
Sudan
Syrian Arab Republic
Uganda
Ukraine
United Rep of Tanzania
Zambia

20

Afghanistan
Bahamas
Bolivia
Brazil
Burkina Faso
Burundi
China
Colombia
Congo
Cook Islands
Dem Rep of the Congo
Dominican Republic
Ecuador
El Salvador
Haiti
India
Indonesia
Iran (Islamic Rep of)
Kazakhstan
Kyrgyzstan
Malawi
Mauritius
Mexico
Mongolia
Nicaragua
Niger
Oman
Philippines
Republic of Moldova
Russian Federation
Rwanda
Sao Tome and Principe
Sudan
Syrian Arab Republic
Uganda
Ukraine
United Rep of Tanzania
Zambia

but not as much in China, India and

Philippines.
Median availability of selected generic medicines (%)
Private and Public (2007-2013)

100

80

60

40

China
Philippines

India

Public

Total expenditure on inpatient care

as %THE (2003-2008)

Inpatient
care remains
as one of the
drivers of
increasing
total health
expenditure

Source: WHO Global Health Expenditure Database

44%
39%
35%

34%
31%

33%
31%

31%
27%

27%
21%

20%

The private hospital/provider sector

is a major player
Lao PDR: Private sector is growing in
urban areas; private hospitals are

forthcoming

Malaysia: 57% of outpatient visits,

two-thirds of physicians and

specialist services are private

Cambodia: 48% of population

uses private providers

(vs. 22% in public)

Korea: 87% of hospital beds are

in private hospitals and clinics

Philippines: 62% of

hospitals are private

Vietnam: Expanding private
sector; accounts for 50% of
outpatient visits

Indonesia: Private hospitals account

for 42% of patient bed days
in general hospitals

Source: (2007) John C. Langenbrunner and Aparnaa Somanathan..Financing Health Care in East Asia and the Pacific Best Practices and Remaining Challenges

Space for harnessing and aligning the

private sector to support UHC efforts
the results suggested that although there

A meta-analysis of all studies exploring the impact of

healthcare type and mortality showed that patients in

was a substantial increase in the

proportion of children who were fully
immunized in all districts, children in the

a private healthcare setting are less likely to

die than patients in a public healthcare
setting.

poorest 50% of households in the districts

served by contractors were more likely to be
fully immunized than poor children living in
similar circumstances in districts

contracting-out has in many cases

improved access to services

Montagu DD, Anglemyer A, Tiwari M, Drasser K, Rutherford GW,

Horvath T, Kennedy GE, Bero L, Shah N, Kinlaw HS (2011)
Private versus public strategies for health service provision for
improving health outcomes in resource-limited settings. San
Francisco, CA: Global Health Sciences, University of California,
San Francisco. ISBN: 978-1-907345-18-0

It was, however, evident that many (private sector)

interventions have worked successfully in poor
communities and positive equity impacts can be
inferred from interventions that work with types of
providers predominantly used by poor people.