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Understanding the Supply Side



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Understanding the Supply Side A Conceptual Framework for Describing and Analyzing the Provision of Health Care Services With an Application to Egypt Dr Peter Berman International Health Systems Group Harvard School of Public Health July 1999 Financial support for this research was provided by USAID through the Data for Decision Making Project U S Agency for International Development Cooperative Agreement No DPE5991 A 00 1052 00 Table of Contents 1 Introduction 2 2 Why Develop a Framework for Understanding the Supply Side 4 What types of questions could this framework help to answer 5 3 The structures of health care provision individuals organizations and markets 6 4 A conceptual framework for analyzing the supply side at market and national levels 8 5 Using the framework to think about theories of provider behavior 10 6 Understanding the supply side ambulatory illness treatment in Egypt 13 Content 14 Governance 16 Motivation and incentives for physicians 18 Pecuniary incentives 19 Non pecuniary incentives 19 Financing sources and payment methods 20 Sources of finance for ambulatory illness care 20 Payment methods 20 7 Interventions to improve provider performance how can a better understanding of the supply side improve reform strategies in Egypt 21 Local control and community roles 23 8 Linking Analysis of the Supply Side to the Global Health Reform Agenda 25 References 26 Understanding the Supply Side 1 1 Introduction Health care services certainly deserve some of the credit for the impressive gains in health status experienced in the developing world in the last few decades There have been unprecedented health gains attributable to immunization family planning and control of many infectious diseases However despite these gains much of the health care provided in lower income countries is perceived to be sub standard in quality maldistributed in terms of both types of services and beneficiaries and to impose high cost burdens on individuals and in some cases



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