Why Public Health Care is Better

Viva Salud is a Belgian NGO that supports movements for health in the Philippines, Palestine and DR Congo. Recently, they launched the paper Why Public Health Care is Better  with the aim to debunk long lasting myths concerning the commercialisation of health care

 By Julie Steendam

Policy Officer on Health, Viva Salud

Brussels, Belgium

 Why Public Health Care is Better


This article is a summary of the paper
 Why Public Health Care is Better
 We hope that this paper can be a support for those social movements standing up for social justice


 The majority of countries in the world agreed to take all possible measures to fulfil the right to accessible and qualitative health care for their population. However, year 2019, this is far from achieved. Even worse, many national governments and international institutions direct health policies along a market-led approach. Privatisations have been brought up as the solution to national health systems’ funding shortages. But numerous case studies and comprehensive research show that health outcomes get worse when the pursuit of profit comes in:

Privatisation triggers higher inequality in access to care
Private hospitals have to make a profit, so they focus mainly on people who can afford it. This creates the risk of a health system at two speeds. On the one hand, high-tech and specialised care for the rich and, on the other hand, simple public health care for the less well-off. This despite the fact that it is the duty of public service providers to provide care to everyone, without distinction.

Privatisation is often more expensive in the long run
Unexpected costs, such as rising interest rates or expensive energy prices, are usually passed on to the government or the patient in private hospitals. An Oxfam study calculated that a public-private hospital in Lesotho costs the government three times more than the public hospital it replaced. Under some contracts, the company can even sue the state for costs related to protests of employees.

Privatisation isn’t more efficient
Public systems are more efficient because they ensure economies of scale in the purchasing, supply and distribution of drugs and equipment.
By contrast, in the United Kingdom, the number of managers in the National Health Service tripled since the introduction of a market logic. In the Netherlands, private health insurers spend 500 million euros per year on advertising campaigns.

Privatisation doesn’t lead to better quality
In today’s market logic, private institutions will focus on the treatments that are financially interesting, instead of those that benefit the patient the most. In Peru, private hospitals are much more likely to choose a more risky caesarean section than a natural birth, because the doctor can charge more.

Privatisation leads to less public control
Negotiations between private players often take place under strict rules of confidentiality. Public control is therefore very difficult, which makes the risk of corruption increase. Engaging funds from the private sector opens the way for corporate involvement in policy shaping.

Privatisation leads to a lower availability of health workers and deteriorating working conditions for them
Commercial companies take the scarce resources, such as health workers, away from the public sector. This so-called “brain drain” leads to shortages in the public sector and in more remote areas. Moreover, the drive for ever higher profit margins often leads to poorer working conditions, unpaid overtime and higher work pressure. Burn-out and stress symptoms are very common in the health sector.

The alternative exists

This paper starts from the positive side. All over the world, social movements and governments make efforts to change their health care system for the benefit of the population.

Universal access to quality health care is a feasible political choice

Countries that prioritise people’s well-being and choose to invest in making health care accessible to all achieve better health outcomes. Even countries with low expenditure on health have been able to build strong health systems.

Need, not wealth

The only proven route to realise this is cancelling all fees for health care and essential medicines, and increasing public investments in well-trained staff, nearby health facilities, and prevention and health promotion programs. A unified public system does not have the disadvantageous contradictions brought by the fragmentation and competition that characterises mixed private-public health systems.

What the international community can do

Reinforcing countries financial capacities to cope with a potential budget increase should also be a focus of the international community and international institutions, for example by

– stepping away from imposed budget restrictions in public services

– regulating pharmaceutical companies’ monopoly positions

– cancelling debt

– fighting large-scale tax evasion

– excluding health services from trade and investment agreements.

Due to globalisation, the vast majority of people in the world are subjected to very similar economic realities, forces and dynamics: environmental degradation, the global competition of workers, attacks to and exclusion from social protection schemes and a growing inequality between social classes to name but a few.[i]

This global emergency situation represents an unprecedented challenge for humanity. Since health and other societal challenges are very interconnected, the struggle for health can function as a major unifying factor in the mobilisations required to address these issues.


[i] The Struggle for Health, 2018, p.2