Integrating the Private Sector into Government Health Insurance: Common Bottlenecks and Potential Solutions

Private sector integration within government-supported health insurance schemes can expand the range of options for affordable access to and use of quality family planning, reproductive, maternal, and newborn services; serve as market-shaping opportunities for accredited private provider networks; and leverage the scale and sustainability of private sector integration. This brief presents results from a study to develop an operational systems framework focused on understanding key functions and business processes and identifying critical challenges and potential solutions, including identifying specific constraints relevant to the provision of family planning services. These efforts will help governments understand where there is a need for: greater capacity in government-related supervisory and regulatory agencies, systems to assess service availability and readiness, and payment mechanisms—all of which will help governments plan for unforeseen bottlenecks.

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