The widening gap in equity of pluralistic health systems in low income and
middle income countries in Asia:
emerging issues in unregulated health systems.
Assoc. Prof. Rohan Jayasuriya
School of Public Health and Community Medicine,
Faculty of Medicine, UNSW, Australia
There is wide recognition that health systems in low income and middle income countries have substantial constraints and that efforts to strengthen them are failing. Evidence shows that in countries with pluralistic (ie mixed) systems there is a widening gap in universal access to primary care and a disproportionate financial burden on the poor. Historically many countries in Asia took the path to build publicly funded national health systems with a focus to cater for episodic care of acute disease.
These investments in secondary and tertiary facilities are now a costly burden in infrastructure and specialised staff. Most countries now face the heaviest burden of disease from chronic disease. Private health care has over the years lead to a distortion of demand and health seeking behaviour. Countries face policy issues of an unregulated private sector and dual practice of public sector staff. A comparative analysis of selected case studies from Asian countries will be used to illustrate the underlying factors that contributed to this situation and to analyse reform strategies, taken by design and default to respond to the emerging crisis.