Cost, Quality, and Accessibility: A Comparative Analysis of Business Profiles in Public and Private Healthcare Institutions - А Literature Review
Abstract
Aims and Objectives: The main objective of the research is to study the differences between public and private healthcare institutions in terms of cost, service quality, and accessibility. Methods: The paper is a systematic literature review based on the PRISMA guidelines. The materials were searched in international scientific databases: PubMed, Elsevier, Scopus, and Google Scholar. The study includes an analysis of peer-reviewed international articles published in the last 10 years. Of the 182 records initially identified, 98 remained after removing duplicates and ineligible records. After screening titles and abstracts, 33 articles met the inclusion criteria and were used for the final synthesis. Results: The evidence synthesis showed that systems with strong public funding are more effective in reducing patients’ out-of-pocket costs and ensuring financial protection. The private sector is distinguished by its promptness of service, reduced waiting times, and a patient-centered approach, although this is often associated with high costs and does not always translate into improved clinical outcomes. It was revealed that the creation of a unified e-health network significantly improves cost-effectiveness and collaboration between sectors. Findings and Conclusion: The study concludes that neither the public nor the private sector can achieve full efficiency and equity independently. A balanced hybrid approach is considered the optimal model for progress towards universal health coverage (UHC). It is recommended that public policymakers increase public funding, strengthen public-private partnerships (PPPs), and scale up electronic systems, ensuring equitable access to quality healthcare services and system sustainability.
Downloads
PlumX Statistics
References
2. Berendes, S., Heywood, P., Oliver, S., & Garner, P. (2011). Quality of private and public ambulatory care in low- and middle-income countries: Systematic review of comparative studies. PLoS Medicine, 8(4), e1000433.
3. Blendon, R. J., Schoen, C., DesRoches, C., Osborn, R., & Zapert, K. (2003). Common concerns amid diverse systems: Health care experiences in five countries. Health Affairs, 22(3), 106–121.
4. Busse, R., Blümel, M., Knieps, F., & Bärnighausen, T. (2017). Statutory health insurance in Germany: A health system shaped by 135 years of solidarity, self-governance, and competition. The Lancet, 390(10097), 882–897.
5. Cutler, D. M., & Zeckhauser, R. J. (2000). The anatomy of health insurance. In A. J. Culyer & J. P. Newhouse (Eds.), Handbook of Health Economics (Vol. 1, pp. 563–643). Elsevier.
6. Devereaux, P. J., Choi, P. T. L., Lacchetti, C., Weaver, B., Schünemann, H. J., Haines, T., … Guyatt, G. H. (2002). A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. Canadian Medical Association Journal, 166(11), 1399–1406.
7. Evans, R. G., Barer, M. L., & Marmor, T. R. (1994). Why are some people healthy and others not? The determinants of health of populations. Aldine de Gruyter.
8. Figueras, J., Robinson, R., & Jakubowski, E. (Eds.). (2005). Purchasing to improve health systems performance. Open University Press.
9. Goddard, M., & Smith, P. (2001). Equity of access to health care services: Theory and evidence from the UK. Social Science & Medicine, 53(9), 1149–1162.
10. Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., … Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 6(11), e1196–e1252.
11. Le Grand, J. (2007). The other invisible hand: Delivering public services through choice and competition. Princeton University Press.
12. Moscone, F., Tosetti, E., & Vittadini, G. (2017). Efficiency and quality of care in public and private hospitals: A comparative analysis. Health Policy, 121(4), 377–385.
13. Newhouse, J. P. (1992). Medical care costs: How much welfare loss? Journal of Economic Perspectives, 6(3), 3–21.
14. 14.OECD. (2019). Health for everyone? Social inequalities in health and health systems. OECD Publishing.
15. OECD. (2021). Health at a Glance 2021: OECD indicators. OECD Publishing.
16. OECD. (2023). Health at a Glance 2023: OECD indicators. OECD Publishing.
17. Preker, A. S., & Harding, A. (2003). Innovations in health service delivery: The corporatization of public hospitals. World Bank.
18. Propper, C., Burgess, S., & Green, K. (2004). Does competition between hospitals improve the quality of care? Journal of Public Economics, 88(7–8), 1247–1272.
19. Saltman, R. B., Busse, R., & Mossialos, E. (Eds.). (2004). Regulating entrepreneurial behaviour in European health care systems. Open University Press.
20. Savedoff, W. D. (2004). Tax-based financing for health systems: Options and experiences. World Health Organization.
21. Schoen, C., Osborn, R., Squires, D., & Doty, M. M. (2010). How health insurance design affects access to care and costs. Health Affairs, 29(10), 1783–1790.
22. Smith, P. C., Mossialos, E., Papanicolas, I., & Leatherman, S. (2009). Performance measurement for health system improvement. Cambridge University Press.
23. Thomson, S., Cylus, J., & Evetovits, T. (2020). Can people afford to pay for health care? New evidence on financial protection in Europe. WHO Regional Office for Europe.
24. Thomson, S., Cylus, J., & Evetovits, T. (2024). Financial hardship and unmet medical need in Europe: Policy challenges and responses. Health Systems in Transition.
25. Wagstaff, A., & van Doorslaer, E. (2003). Catastrophe and impoverishment in paying 26.for health care. Health Economics, 12(11), 921–934.
26. World Bank. (2019). High-performance health financing for universal health coverage. World Bank Publications.
27. World Bank & World Health Organization. (2017). Tracking universal health coverage: 2017 global monitoring report. World Health Organization.
28. World Health Organization. (2010). Health systems financing: The path to universal coverage. WHO Press.
29. World Health Organization. (2015). Tracking universal health coverage: First global monitoring report. WHO.
30. World Health Organization & World Bank. (2023). Tracking universal health coverage: Global monitoring report 2023. WHO.
31. Abashidze-Gabaidze, G., Loria, L., & Gabaidze, M. (2023). Dynamics of changes in expenditures on medical services over the last ten years, their structure in parallel with the dynamics of changes in health indicators. International Journal of Community Medicine and Public Health, 10(6). https://doi.org/10.18203/2394-6040.ijcmph20231711
32. Abashidze-Gabaidze, G., Gakharia, M., et al. (2025). The positive impact of electronic healthcare integration on quality and safety: a systematic review. International Journal of Community Medicine and Public Health DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20253706 2025
Copyright (c) 2026 Salome Abashidze, Tengiz Taktakishvili, Gulnara Abashidze Gabaidze

This work is licensed under a Creative Commons Attribution 4.0 International License.


