Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners-both unlicensed and licensed-to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa.

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Migrant nurses play a key role in the delivery of 'frontline' care to patients. The role many currently play reinforces disadvantage within nursing in ways that are problematic for the profession, patients and clients. The recognition and valuing of their skills is critical to the promotion of their own morale which in turn has an impact on their relationship with colleagues and the delivery of patient and client care.

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Objectives. To explore the experiences of governance and incentives during organizational change for managers and clinical staff. Study Setting. Three primary care settings in England in 2006-2008. Study Design. Data collection involved three group interviews with 32 service users, individual interviews with 32 managers, and 56 frontline professionals in three sites. The Realistic Evaluation framework was used in analysis to examine the effects of new policies and their implementation. Principal Findings. Integrating new interprofessional teams to work effectively is a slow process, especially if structures in place do not acknowledge the painful feelings involved in change and do not support staff during periods of uncertainty. Conclusions. Eliciting multiple perspectives, often dependent on individual occupational positioning or place in new team configurations, illuminates the need to incorporate the emotional as well as technocratic and system factors when implementing change. Some suggestions are made for facilitating change in health care systems. These are discussed in the context of similar health care reform initiatives in the United States. Key Words. Emotions, chronic illness, relationships, health care, health policy/ policy analysisIn this article we discuss findings from a three-center study in England, which explored the professional experience of evolving organizational and governance structures in primary health and social care, in relation to the 1 These governance structures include incentives to achieve local service reconfiguration of community teams similar to the North American "medical home" policy ( Jackson et al. 2012). We argue that these rapidly changing governance systems create uncertainty for interprofessional teams. Integrating new interprofessional teams to work effectively is a slow process, especially if structures do not acknowledge the emotions involved or support staff during periods of uncertainty. The experiences that emerge from the formation of new community-based interprofessional teams, sometimes together in new physical locations but often apart, distance managers and frontline staff, and reinforce existing divisions between health and social care (Allan et al. 2005;Hall 2005;Baxter and Brumfitt 2008). We discuss the experiences of clinical staff and their managers in relation to the literature on teamwork, governance, and incentives in primary health care. We focus on the emotional reactions to the changes which were expressed by both managers and staff.