Concentration and fragmentation: analysing the implications of the structure of Georgia's private healthcare market for quality and accessibility

集中化和分散化：分析佐治亚州私人医疗保健市场结构对质量和可及性的影响

基本信息

批准号：
MR/T018062/1
负责人：
George Gotsadze
金额：
$ 23.1万
依托单位：
Curatio International Foundation
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2020
资助国家：
英国
起止时间：
2020 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FT018062%2F1
关键词：
Concentration fragmentation analysing implications structure

项目摘要

The private sector is increasingly recognized as playing an important role in health systems in low- and middle-income countries (LMIC), yet policymakers struggle to identify the role of the private sector in relation to their Universal Health Coverage objectives. Developing policies for engaging with private health care providers requires a good understanding of how healthcare markets operate. Markets are described according to their market structure which can range from highly fragmented (a large number of small firms), through to highly concentrated (one or a few large firms, including those where providers have invested in diagnostic facilities or pharmaceuticals). While the risks of excess concentration have long been recognised, evidence is emerging from a number of LMICs about the potential risks to patients of excess fragmentation. These include quality of care, if treatment volumes are too small to be safe or where opportunities for training are absent; or health system risks, arising from the difficulties of purchasing from or regulating large numbers of small providers.The overall aim of this study is to elaborate this conceptual framing of risks of harm from concentration and fragmentation of healthcare markets and develop a set of tools for undertaking healthcare market analysis that can inform policy options for shaping healthcare markets in the context of UHC. We will undertake this research in Georgia, a lower-middle income former soviet country which has undergone extensive privatisation. This award will set the foundation for evaluating future policy changes in Georgia and extendingt the analytic approach to other settings in a future research project. We will achieve this aim through 4 specific research questions: 1. What is the structure and nature of the healthcare market in Georgia: to what extent is the market characterized by fragmentation and concentration, and by horizontal and vertical integration?2. What demand, supply and policy factors are driving this pattern? 3. What are the risks and benefits for patients, and for the health system, of fragmented and consolidated health service provision? 4. What policy levers are available to shape the private healthcare market to better serve the needs of UHC? The study uses a mixed methods approach, collecting qualitative interview data and undertaking quantitative analysis of large social insurance databases. We will describe the Georgian healthcare market in terms of types of business and market structure, explore the reasons for the patterns that we observe, and then construct "theories of harm" which will describe the potential risks to patients and to the health system of fragmentation and concentration. We will use quantitative methods applied to insurance claims data to look at the extent to which key individual outcomes such as price and intensity of treatment, and system level outcomes such as accessibility, approaches to quality assurance and the costs of contracting and regulating, differ by provider business model and market structure. Findings will be presented at a series of structured policy dialogues, to validate our data and interpretations, and to develop potential policy interventions. These will engage a wide variety of health policy stakeholders and consider how to shape private health care markets through for example, changes in regulation and purchasing policies, so that they operate in the interests of UHC.This project is being proposed by a highly experienced, multidisciplinary, international research team with strong connections at the national, regional and global level to support the achievement of research impact. Capacity will be developed in both directions, with Georgian colleagues gaining exposure to approaches to researching the private sector as well as analysis of large administrative datasets, and UK collaborators learning about the nature of privatization in a former Soviet setting.

越来越多的私营部门在低收入和中等收入国家（LMIC）中扮演着重要角色，但决策者努力确定私营部门在其普遍卫生覆盖目标中的作用。制定与私人医疗保健提供者互动的政策需要对医疗市场的运作方式有很好的了解。市场是根据其市场结构来描述的，其市场结构的范围从高度分散（大量小型公司）到高度集中的公司（一个或几家大型公司，包括提供商在诊断设施或药品上投资的大型公司）。虽然长期以来已经认识到过度浓度的风险，但从许多LMIC中出现了证据，表明过度分裂患者的潜在风险。这些包括护理质量，如果治疗量太小，无法安全或没有培训机会的地方；或卫生系统的风险是由于从或规范大量小型提供商中购买或规范大量小型提供者而引起的。这项研究的总体目的是详细说明这种概念性的构架，从而使医疗保健市场的集中和分散造成的危害风险构架并开发了一系列工具，以实现医疗市场分析，从而为您提供了在u hc of UHC中塑造医疗保健市场的政策选择。我们将在佐治亚州进行这项研究，佐治亚州是一个中低收入的前苏联国家，已接受广泛的私有化。该奖项将为评估佐治亚州未来政策变化的基础，并将分析方法扩展到未来研究项目中的其他环境。我们将通过4个特定的研究问题来实现这一目标：1。佐治亚州医疗保健市场的结构和性质是什么：市场在多大程度上以分散和集中度的特征，以及水平和垂直整合？2。哪些需求，供应和政策因素正在推动这种模式？ 3。对患者以及卫生系统的风险和益处是什么？ 4.有哪些政策杠杆可以塑造私人医疗保健市场以更好地满足UHC的需求？该研究使用混合方法方法，收集定性访谈数据并对大型社会保险数据库进行定量分析。我们将以商业和市场结构的类型来描述格鲁吉亚医疗保健市场，探讨我们观察到的模式的原因，然后构建“危害理论”，这些理论将描述患者的潜在风险以及碎片化和集中度的卫生系统。我们将使用适用于保险索赔数据的定量方法来研究关键的个人结果，例如价格和治疗强度以及系统级别的结果，例如可访问性，质量保证的方法以及合同和调节成本，而有所不同，提供者商业模型和市场结构有所不同。调查结果将在一系列结构化政策对话中介绍，以验证我们的数据和解释，并制定潜在的政策干预措施。这些将吸引各种各样的健康政策利益相关者，并考虑如何通过例如监管和购买政策来塑造私人保健市场，以便他们为UHC的利益而运作。该项目是由经验丰富，多学科的，多学科的，国际研究团队提出的，该项目在国家，地区，地区和全球层面上有牢固的联系，以支持研究的成就。能力将在两个方向上开发，格鲁吉亚同事们获得了研究私营部门的方法以及对大型行政数据集的分析，并且英国合作者在以前的苏联环境中学习了私有化的性质。