Expecting the unexpected: applying the Develop-Distort Dilemma to maximize positive market impacts in health

D. H. Peters, L. Paina, S. Bennett
2012 Health Policy and Planning  
Although health interventions start with good intentions to develop services for disadvantaged populations, they often distort the health market, making the delivery or financing of services difficult once the intervention is over: a condition called the 'Develop-Distort Dilemma' (DDD). In this paper, we describe how to examine whether a proposed intervention may develop or distort the health market. Our goal is to produce a tool that facilitates meaningful and systematic dialogue for
more » ... ers and researchers to ensure that well-intentioned health interventions lead to productive health systems while reducing the undesirable distortions of such efforts. We apply the DDD tool to plan for development rather than distortions in health markets, using intervention research being conducted under the Future Health Systems consortium in Bangladesh, China and Uganda. Through a review of research proposals and interviews with principal investigators, we use the DDD tool to systematically understand how a project fits within the broader health market system, and to identify gaps in planning for sustainability. We found that while current stakeholders and funding sources for activities were easily identified, future ones were not. The implication is that the projects could raise community expectations that future services will be available and paid for, despite this actually being uncertain. Each project addressed the 'rules' of the health market system differently. The China research assesses changes in the formal financing rules, whereas Bangladesh and Uganda's projects involve influencing community level providers, where informal rules are more important. In each case, we recognize the importance of building trust between providers, communities and government officials. Each project could both develop and distort local health markets. Anyone intervening in the health market must recognize the main market perturbations, whether positive or negative, and manage them so as to maximize the benefits to the health system and population health. KEY MESSAGES We apply a Develop-Distort Dilemma (DDD) framework to diagnose and plan for development rather than distortions in health markets, using intervention projects conducted in Bangladesh, China and Uganda. It is important to understand both current and future market players, as well as the formal and informal rules that influence health providers, communities and government officials. Policy makers, implementers and those conducting research or facilitating health system change need to recognize market perturbations, whether positive or negative, and better manage them to improve health systems. We recommend using the DDD framework from the early stages of project design in order to identify potential opportunities to develop the market and the potential distortions that should be managed or avoided.
doi:10.1093/heapol/czs085 pmid:23014153 fatcat:gkcffrvtbnealkof3vh2zeqyhm