Private sector can never deliver public health care

Nobel laureate Prof Amartya Sen speaks at the launching ceremony of "State of Health in Bangladesh 2006" at Brac Inn yesterday. Sitting from left are Prof Rounaq Jahan of Columbia University, Brac Chairperson Fazle Hasan Abed, American philanthropist George Soros and Adrienne Germain. PHOTO: STAR

"The exploitative nature of relying on private health care instead of public services is well established from experiences in Europe, India or China," said Sen.

He was delivering the keynote address at the launch of Bangladesh Health Watch's "The State of Health in Bangladesh Report 2006" at Brac Inn.

Although he mentioned the positive effects of privatisation on other sectors such as agriculture, especially in China, Sen said the lesson for Bangladesh is "not to regard privatisation will work for health care as a basic care for all, as it does so beautifully in other areas, as we do need public provision of health care services."

"The private sector can never deliver public health care," said Sen, who was awarded the 1998 Nobel prize in economics for his "key contributions to the research on fundamental problems in welfare economics."

He observed that as a doctor who wishes to take the patient "for a ride" will not look out for the patient's interests, and hence will jeopardise the patient's cure.

As a lesson to Bangladesh and other South Asian countries, Sen cited China's decision to scrap universal health care and promote health care privatisation that left 70 percent of the population without access to health care because they could not afford it.

This, Sen said, has halved the pace of China's improving life-expectancy rate while limiting 'comfortable' health care to only the top 10 percent of income earners in that country, a statistic, he feels, is reflected in trends in South Asian countries.

Sen, however, stressed that privatisation in other sectors such as agriculture and industries has worked well to boost the country's astronomical growth rate, but at the same time, inequality has doubled.

He added that these results "insist" a greater focus on "equality in health care to improve the system," as "national health service is a major advantage in widespread coverage."

He also underscored the need for a "pragmatic and reasoned" view because "private health care will flourish, so we need to see how to use it to our advantage."

"Inequality will be around for a long time, but we need to see how we can provide health care for all and how inequality can be reduced" in the provision of health care, he noted.

Sen also praised the Bangladesh government and organisations such as Grameen Bank and Brac for the fastest decline in fertility rates and improving health indicators, such as reducing the infant mortality rate. He termed the success "astonishing."

Brac head Fazle Hasan Abed chaired the launch of the report on health in Bangladesh while global financier and philanthropist George Soros, Adrienne Germain, president of International Women's Health Coalition, and Abbas Bhuiyan of the International Centre for Diarrhoeal Disease and Research, Bangladesh, among others, made their views known on the issue.

Rounaq Jahan, a political scientist at Columbia University and one of authors of the health report, presented a brief outline of the report.

"The report focuses on two issues--inequality and a lack of accountability," she said, adding that a lack of accountability in the health sector contributed to its poor condition.

She noted that health accountability improves when citizens' groups demand better health services and performance.