hese arrangements are independent of whether ownership is public or
private. For example, the ownership of services that are organized as hierarchies can be
public, as in the extensive network of public health, hospital, and ambulatory clinics that
are part of the Turkish Ministry of Health service delivery system and that of many other
countries. But they can also be private, as in a United States health management organization
like Kaiser Permanente. Such private entities often suffer from many of the same bureaucratic
rigidities as public ones. Likewise although market-based interaction between
providers and patients is most common in the private sector, short-term market exchanges
in the form of user fees are pervasive in the public sector in many low income countries.