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 middle-income 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.
Following the Introduction, 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.
Future Health Systems Working Paper 6, 49 pp.
Making health markets work better for poor people: Improving provider performance