© Atos KPMG Consulting 2003 PPPs IN HEALTH CARE: AN INTERNATIONAL PERSPECTIVE Emmett Moriarty Senior Health Sector Specialist.
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© Atos KPMG Consulting 2003
PPPs IN HEALTH CARE:AN INTERNATIONAL PERSPECTIVE
Emmett MoriartySenior Health Sector Specialist
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Public Private Partnerships in the Health Sector
Introduction
Overview of PPPs
Views on PPPs
Advantages and disadvantages
PPPs in other countries
Lessons learned
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Definition of a PPP
A Public-Private Partnership is a contractual agreement between a public agency and a private sector entity.
Through PPP agreements, the resources of each sector (public and private) are shared in delivering a service or facility for the use of the general public.
In addition to the sharing of resources, each party shares the potential risks and rewards in the delivery of the service and/or facility.
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There are different types of health PPPs
Outsourcing non-clinical support services
Outsourcing clinical support services
Outsourcing clinical services
Private management of a public hospital
Private financing, construction and operation of a public hospital
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Many countries are adopting PPPs in Health Care
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What is the difference between privatisation and PPP ?
Where does accountability forpublic services delivery lie?
Where does accountability forpublic services delivery lie?
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Why should we consider PPPs ?
Demand
Supply
Can PPPs fill this gap ?
Hea
lth
Car
e R
esou
rces
time
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What should determine the model of PPP in China ?
Each Country’s approach to PPP is:
Designed to meet the policy objectives of its Government
Developed to complement other public procurement and public service delivery methods
Designed according to the available private sector resources
Implemented according to the available public sector resources
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Views on PPPs vary widely
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Can PPPs solve China’s health issues ?
“Our ten year programme of modernisation includes the biggest ever hospital building programme in the history of the National Health Service.
The PPP Initiative is a vital element in renewing the fabric of the NHS”
Alan Milburn - Secretary of State for Health 2001
PPP
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Or will PPPs make matters worse ?
“The political consequences are not to be under estimated. There will be a mobilization like hundreds of forest fires burning slowly against each PPP scheme. They haven’t ignited but they will. You can fool the public for quite a long time using technical and arcane jargon but it only takes an Enron for the public to realize the way in which private finance is removing rights and entitlements and the whole thing does begin to come apart.”
Dr. Allyson Pollock, Head of Health Policy Research Unit, University College London
PPP
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Advantages and disadvantages of PPPs
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Potential Benefits of PPPs
More incentives for private sector to perform
New facilities available earlier
Increased levels of efficiency and innovation
Risks transferred to private sector
Forward spending commitments known and able to be planned for
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Potential Issues with PPPs
PPP contracts can be very complex
Results assessment is often subjective
Public sector may be locked into contracts while health demands change
PPPs may not gain the population’s trust
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Hospital Facilities PPPs in the UK (DBFO):
>60 new hospitals built
>90% of hospital projects have been delivered on time
All projects were delivered within the public sector budgets
77% of hospital managers stated that the projects met their expectations (only 4% described value-for-money as poor)
Estimated that PPP projects cost 17% less than public sector projects – a saving of $4 billion on a $22 billion programme – the equivalent of 25 hospitals
BUT:
PPPs have failed to win the people’s trust
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Hospital services PPP in Spain
First wave of 8 PPP (DBFO) contracts awarded in 2006
8th hospital: Valdemoro Hospital – includes Care Contract
€72 million investment – awarded to Capio
Care Contract includes full responsibility for local population
30 year concession – total value c. €1.3 billion
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TB Control PPP in India
Highest burden of TB worldwide
State government contracted with NGO hospital to provide TB control services to 500,000 population
Better outcomes than Control Comparison:Cost per patient 10% lower ($88)
21% more TB cases found
14% better treatment success rate
Cost per successful treatment 14% lower ($118)
Being extended across other parts of India (with ongoing independent evaluation)
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Nutrition services PPP in Bangladesh
Government contracted with NGOs to control areas with no organised nutrition services
15 million people covered
Cost per person = $0.96
Results:
Malnutrition rates declined by 18% (compared with 13% in publicly covered areas)
Programme now expanded to cover 30 million
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Primary Health Care PPP in Pakistan
Management contract with 104 basic health units in one district
3.3 million people covered
Annual cost per person $0.44
Result:
Four-fold increase in number of outpatient visits
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Conclusions andlessons learned
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Lessons learned
Design to meet policy objectives
Political commitment
Planning and piloting
Enabling legislation
Transparency
Good governments get good PPPs
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谢谢(Thank you !)
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