ASCON XII
Future Health Systems
Special session:
Health markets – their implications
for the poor
1

Why markets may be bad for the
poor
Markets can worsen distributive outcomes and hence

produce or worsen health inequities
Markets for goods and services that embody expert

knowledge produce information asymmetry between
providers and clients. This can make clients vulnerable to
abuse of provider power and the poorer the client, the
more vulnerable
Health markets tend to be very segmented, with the poor

facing particular challenges in terms of gaining access to
affordable, competent care
The poor are the most likely to get goods and services

from unregulated markets, thereby getting the worst
deal
The poor often spend unnecessarily in these markets

2

How markets could help improve
access to health care for the poor
Markets can make available mass produced lower cost,

quality assured products (e.g. standard minor
procedures, basic health care commodities)
Markets can provide capital and ideas to drive innovation

more effectively
Market based services can respond more flexibly to

specific mass market niches that the poor engage with
Provided subsidies are well targeted or there is a third

party payer, private provision can complement public
services or fill service gaps
3

Important questions to ask about how a
health market affects the poor
Does it reduce information asymmetry and enable

patients to better assess whether the health services
they are acquiring are appropriate to their condition?
Does it align incentives better or worse with patient

welfare?
Does it relieve or exacerbate constraints on competence,

finance, and management?
Is there evidence that it results in better health-related

outcomes?
Does it provide benefits to the poor and/or does it

support the creation of sustainable arrangements to
meet the needs of the poor in the longer-term?
4