Universal health coverage and public-private participation: towards a new balance?

Abstract

Abstract This commentary discusses the emergence of a new paradigm to address the health policy issues through Public-Private Participation (PPP). The discussion provides a detailed literature review of PPPs by presenting an initial overview of the ideological shift from state to market intervention, then identifying arguments in support of or against public-private approaches and finally exploring the emergence of this new paradigm of PPP or its hybrid forms. It then discusses the contextual realities of Public-Private Participation in health care, and whether an optimal balance is possible with better government stewardship and private provision. Conceptually, the premise of stewardship in governance is that it is possible to create not only efficient but also effective systems. These ideas may find a receptive audience in many countries, especially in the emerging economies with improving standards. In East Asian societies, the concept of stewardship bears a strong resemblance to Confucian ideals of morality in government, with social expectations of those who govern to be principled and virtuous. Increasingly, a pragmatic theory of development seems to apply in public-private, similarly, through it is expected, that public-private participation in the healthcare system should also achieve the goal of Universal Health Coverage through good governance.