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Governments frequently draw upon the private health care sector to promote sustainability, optimal use of resources, and increased choice. In doing so, policy-makers face the challenge of harnessing resources while grappling with the market failures and equity concerns associated with private financing of health care. The growth of the private health sector in South Africa has fundamentally changed the structure of health care delivery. A mutually reinforcing ecosystem of private health insurers, private hospitals and specialists has grown to account for almost half of the country's spending on health care, despite only serving 16% of the population with the capacity to pay. Following years of consolidation among private hospital groups and insurance schemes, and after successive failures at establishing credible price benchmarks, South Africa's private hospitals charge prices comparable with countries that are considerably richer. This compromises the affordability of a broad-based expansion in health care for the population. The South African example demonstrates that prices can be part of a structure that perpetuates inequalities in access to health care resources. The lesson for other countries is the importance of norms and institutions that uphold price schedules in high-income countries. Efforts to compromise or liberalize price setting should be undertaken with a healthy degree of caution., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: One in three children globally is stunted in growth. Many of the conditions that promote child stunting are amenable to quality care provided by skilled health workers., Methods: The study uses household and facility data from the Indonesian Family Life Surveys in 1993 and 1997. The first set of multivariate regression models evaluate whether the number of medical doctors (MDs), nurses, and midwives predict quality of care as measured by adherence to clinical guidelines. The second set explains the relationships between quality and length among children less than 36 months. Using the information generated from these two sets of regressions, we simulate the effect of increasing the number of MDs, nurses, and midwives on child length and stunting., Results: Increases in the number of MDs and nurses predict increases in the quality of care. Higher quality care is associated with child length in centimeters and stunting. Simulations suggest that large health gains among children under 24 months of age result by placing MDs where none are available., Conclusions: Improvements in child health could be made by increasing the number of qualified health staff. The returns to investing in improvements in human resources for health are high.

Objectives: To investigate factors predicting the quality of care received using a nationally representative dataset from Indonesia., Data Sources: The study combines two surveys in 13 provinces: a household survey of 2451 women who delivered a live birth in 1992-1998, and a facility survey that measured quality available from outpatient providers., Study Design: Multivariate regressions are used to explain the quality of care received. Explanatory variables are high facility quality, maternal education, household wealth, ethnicity, and insurance., Data Collection Methods: Quality available is measured by provider adherence to prenatal protocols using a clinical case scenario. Quality received is measured by maternal reports about routine prenatal services received., Principle Findings: High facility quality predicts an increase in quality received. Although poor households have access to the same or higher quality care compared with the least poor, the poor receive lower levels of quality. In remote regions, quality received rises with increasing levels of maternal education and household wealth., Conclusions: Improving health provider knowledge, and increasing household financial resources and information could redress inequalities in quality received among the poor and least educated.