Devex: Opinion: Trickle-down health care
Patrick Fine, chief executive officer of FHI 360

“Do investments in private hospitals and clinics catering to the wealthy strengthen primary health care systems in poor countries? … The vision is for private capital to fill the gap left by the public sector’s inability to meet demand for high-quality tertiary care and, in so doing, provide the foundation for a self-sustaining system. That stronger ecosystem can propagate skills, standards, and systems throughout health care delivery. In other words, trickle-down health care. … My problem is representing services for those who are most well off as ‘social impact’ investments that will benefit the poor. The argument that investing in expensive, curative tertiary care benefits the poor is too far of a stretch for me. Of more concern is whether those investments are being subsidized by governments or donors and are exacerbating the growing problem of inequality. … We need to keep the focus on preventive and primary care and not allow expensive curative systems from consuming the lion’s share of public health budgets for the benefit of a small minority of the population” (11/16).