Concentration and fragmentation: analysing the implications of the structure of Georgia's private healthcare market for quality and accessibility
Medical Research Council
Curatio International Foundation
To inform decisionmakers on how to engage effectively with the private sector, better evidence is needed of how healthcare markets are structured, the risks of different market structures for patients and for the health system as a whole. This evidence can help design health system policies to (i) shape the market to avoid excessive concentration or fragmentation, and (ii) design appropriate private sector engagement strategies, including by healthcare purchasing agencies. Our study will generate new evidence on the structure of the healthcare market in Georgia, a lower-middle income country where the health system is highly privatized. Applying economic theories of market performance we will: - Describe the Georgian healthcare market in terms of business models and the extent of vertical and horizontal integration. This will use publicly available information (national statistical yearbook, company financial reports, national health accounts), social insurance claims data and key informant interviews - Analyse the demand, supply and policy factors driving the observed market structure and business models, and elaborate a set of "theories of harm" about the risks of concentration and fragmentation and their potential influence on health system outcomes by different provider types. - Assess quantitative, and where necessary, qualitative evidence about the risks of fragmentation and concentration, looking at the extent to which 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. - Conduct structured policy dialogues to test our interpretations of the data and identify potential policy levers to shape the private healthcare sector, engaging key stakeholders from government and the private sector.
8.1 Organisation and delivery of services / Research Grant