{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T12:57:54Z","timestamp":1774443474448,"version":"3.50.1"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T00:00:00Z","timestamp":1618358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Health Systems Research Initiative","award":["MR\/N015061\/1"],"award-info":[{"award-number":["MR\/N015061\/1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Overprovision\u2014healthcare whose harm exceeds its benefit\u2014is of increasing concern in low- and middle-income countries, where the growth of the private-for-profit sector may amplify incentives for providing unnecessary care, and achieving universal health coverage will require efficient resource use. Measurement of overprovision has conceptual and practical challenges. We present a framework to conceptualize and measure overprovision, comparing for-profit and not-for-profit private outpatient facilities across 18 of mainland Tanzania\u2019s 22 regions. We developed a novel conceptualization of three harms of overprovision: economic (waste of resources), public health (unnecessary use of antimicrobial agents risking development of resistant organisms) and clinical (high risk of harm to individual patients). Standardized patients (SPs) visited 227 health facilities (99 for-profit and 128 not-for-profit) between May 3 and June 12, 2018, completing 909 visits and presenting 4 cases: asthma, non-malarial febrile illness, tuberculosis and upper respiratory tract infection. Tests and treatments prescribed were categorized as necessary or unnecessary, and unnecessary care was classified by type of harm(s). Fifty-three percent of 1995 drugs prescribed and 43% of 891 tests ordered were unnecessary. At the patient-visit level, 81% of SPs received unnecessary care, 67% received care harmful to public health (prescription of unnecessary antibiotics or antimalarials) and 6% received clinically harmful care. Thirteen percent of SPs were prescribed an antibiotic defined by WHO as \u2018Watch\u2019 (high priority for antimicrobial stewardship). Although overprovision was common in all sectors and geographical regions, clinically harmful care was more likely in for-profit than faith-based facilities and less common in urban than rural areas. Overprovision was widespread in both for-profit and not-for-profit facilities, suggesting considerable waste in the private sector, not solely driven by profit. Unnecessary antibiotic or antimalarial prescriptions are of concern for the development of antimicrobial resistance. Option for policymakers to address overprovision includes the use of strategic purchasing arrangements, provider training and patient education.<\/jats:p>","DOI":"10.1093\/heapol\/czab039","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T02:05:03Z","timestamp":1616724303000},"page":"695-706","source":"Crossref","is-referenced-by-count":13,"title":["How much healthcare is wasted? A cross-sectional study of outpatient overprovision in private-for-profit and faith-based health facilities in Tanzania"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9681-2684","authenticated-orcid":false,"given":"Jessica J C","family":"King","sequence":"first","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Powell-Jackson","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Makungu","sequence":"additional","affiliation":[{"name":"Health Systems Research Group, Ifakara Health Institute, Plot 463, Kiko Avenue, Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3509-3572","authenticated-orcid":false,"given":"James","family":"Hargreaves","sequence":"additional","affiliation":[{"name":"Department of Public Health and Environments, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2241-3485","authenticated-orcid":false,"given":"Catherine","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,4,14]]},"reference":[{"key":"2021070819024606000_R1","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.26719\/2009.15.5.1126","article-title":"Appropriateness of hospital admissions in general hospitals in Egypt","volume":"15","author":"Al-Tehewy","year":"2009","journal-title":"Eastern Mediterranean Health Journal"},{"key":"2021070819024606000_R2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0030196","article-title":"Validation of a new method for testing provider clinical quality in rural settings in low-and middle-income countries: the observed simulated patient","volume":"7","author":"Aung","year":"2012","journal-title":"PLoS One"},{"key":"2021070819024606000_R3","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1590\/S0034-89102011005000039","article-title":"Patterns of deliveries in a Brazilian birth cohort: almost universal cesarean sections for the better-off","volume":"45","author":"Barros","year":"2011","journal-title":"Revista De Saude Publica"},{"key":"2021070819024606000_R4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1000433","article-title":"Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies","volume":"8","author":"Berendes","year":"2011","journal-title":"PLoS Medicine"},{"key":"2021070819024606000_R5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1080\/15570274.2013.876730","article-title":"Contracting between faith-based health care organizations and the public sector in Africa","volume":"12","author":"Boulenger","year":"2014","journal-title":"The Review of Faith and International Affairs"},{"key":"2021070819024606000_R6","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/S0140-6736(16)32585-5","article-title":"Evidence for overuse of medical services around the world","volume":"390","author":"Brownlee","year":"2017","journal-title":"The Lancet"},{"key":"2021070819024606000_R7","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1001\/jama.280.11.1000","article-title":"The urgent need to improve health care quality. 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