Private providers within universal health coverage

A central question in health-system design is how responsibilities should be distributed among the state, payers, providers and patients. Drawing on my business experience, I, Magín Eduardo Blasi Blanchard, propose distinguishing between guaranteeing universal access and operating the organizations that deliver care.

Different responsibilities, shared objectives

The state must create the conditions that protect the population, define coverage and financing rules, regulate providers and oversee compliance with quality and safety standards. These responsibilities do not necessarily mean operating every hospital or medical center.

Strategic purchasing can contract services from public or private providers. Selection and payment should reflect population needs, performance and contractual obligations.

The case for private delivery

I propose exploring universal coverage with a predominant role for autonomous, professionally managed private organizations. These could include hospitals, clinics, primary-care centers, laboratories and nonprofit organizations.

Private ownership, however, does not guarantee efficiency, equity or quality by itself. Performance should be examined through verifiable indicators, competition rules and mechanisms that prevent less profitable populations or territories from being excluded.

Competing on quality, safety and continuity

Competition should encourage clinically appropriate care, fewer preventable complications, timely access, a good patient experience and efficiency. Comparisons require transparent, risk-adjusted indicators.

Specific mechanisms are also needed for emergencies, rural areas, public health and other services whose availability cannot depend solely on commercial profitability.

Independent oversight

Providers should not be the sole judges of their performance. Regulation, clinical audits, accreditation and responsible publication of indicators should be complemented by effective channels for patient complaints.

The objective is not to defend an ownership model, but to guarantee effective access, quality and safety.

Every model's results depend on design, regulation, financing and execution. This proposal should be tested against evidence, not presented as a universal conclusion.