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Submitted by April Harding on

Adam,
We should all be more careful in how we characterize health services provision statistics. We can all frame the available data to make our particular point. If I want to make the private sector seem less significant, I can reference a household survey that asks people about facilities, as the World Health Survey did. If I want to make it seem more significant, I can reference the DHS which asks about careseeking - and therefore captures a much broader set of sources to which people turn when ill (e.g. traditional healers, pharmacies, drug shops and the like). You can look at the aggregate figures from the most recent DHS for SSA here http://www.ps4h.org/globalhealthdata.html Obviously which of these statistics is more relevant depends on what issue you are trying to understand; or which problem you are trying to resolve. The far bigger problem (than strategic data source selection) is that we are turning to household survey data to try to understand health services organization and operation. People's experiences with the health system are certainly relevant and important; however, people do not know much about the organization and operation of health services provision - not even for providers with which they have interacted. The WHS findings on OECD service provision which you reference can serve as Exhibit 1. Primary care organizations are predominantly private in 20 of the 28 OECD countries (see the OECD Health System Institutional Characteristics Survey results here http://www.oecd-ilibrary.org/social-issues-migration-health/health-systems-institutional-characteristics_5kmfxfq9qbnr-en. Interestingly, Sweden has just tipped over into the private provision dominant category. And, specialist care is predominantly private in about half the countries (same source). The likelihood that 70% of outpatient consultations are in public facilities is nil.
OECD survey respondents likely overstate public outpatient consultations because they are thinking of "private" as referring to "outside the system" provision - meaning privately paid.
To me, their misunderstanding illuminates the much more important issue: the collective delusion we all cling to in thinking that we have a handle on important facts and features of service provision systems from examining household survey results.
I think Will Rogers nailed our problem rather well:
"It isn't what we don't know that gives us trouble, it's what we know that ain't so."