Download - Public Private Partnership in Health
-
8/14/2019 Public Private Partnership in Health
1/47
Public Private Partnership in Health
State Institute of Health & Family Welfare, Jaipur
-
8/14/2019 Public Private Partnership in Health
2/47
SIHFW: an ISO 9001: 2008 certified institution 2
Public Private Partnership
Not all interactions between the private and the public sector is PPP
-
8/14/2019 Public Private Partnership in Health
3/47
3
then what is Partnership?
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
4/47
4
PPP ?
Public-Private Partnerships (PPP) arecollaborative efforts, between private andpublic sectors, with clearly identified
partnership structures, shared objectives,and specified performance indicators fordelivery of a set of health services(MOHFW,GOI)
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
5/47
SIHFW: an ISO 9001: 2008 certified institution 5
Attribute Privatization PPP
Responsibility Entrepreneur Govt.
Ownership Private sector Govt.
Nature ofservices
Decided byprivate operator
Mutual agreement
Risk & Reward Private sector Shared betweenGovt. & Privateparty
PPP v/s Privatization
-
8/14/2019 Public Private Partnership in Health
6/47
6
Selection of Service Provider
Competitive Bidding
Swiss Challenge Approach
Competitive Negotiation
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
7/47
7
Payment Mechanism
Contractual payments
Grants-in-aid
Right to levy user charges for the assetcreated/leased-in
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
8/47
8
Risk & Revenue Sharing
Construction/implementation risk,arising from:
Delay in project clearance
Contractor default
Environmental damage
Market risk, arising from:
Insufficient demandImpractical user levies
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
9/47
9
Finance risk, arising from:Inflation
Change in interest rates
Increase in taxes
Change in exchange rates
Operation and maintenance risk, arisingfrom:
Termination of contractTechnology risk
Labour risk
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
10/47
10
Legal risk, arising from:
Changes in law
Changes in title/lease rights
Insolvency of developer/serviceprovider
Change in security structure
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
11/47
11
Potential Benefits of PPP
Cost-effectivenessHigher Productivity-by linking payments
to performance
Accelerated Delivery since the
contracts generally have incentive andpenalty clauses vis-a-vis
Clear Customer Focus - the shift infocus from service inputs to outputs
Enhanced Social ServiceRecovery of User Charges- Innovative
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
12/47
-
8/14/2019 Public Private Partnership in Health
13/47
13
Public-Private Equilibrium
PublicSector
PrivateSector
Advantages:
Improvement in Healthis the primary
objectiveEconomies of ScaleMore Equitable
Advantages:
Market/Choiceand Access
EfficiencyFlexibility
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
14/47
14
Things to watch:Efficiency
Inflexibility/Respons-iveness
Customer satisfaction
Things to watch:Primary objective is
profit
Quality of services
Cost
PublicSector
PrivateSector
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
15/47
SIHFW: an ISO 9001: 2008 certified institution 15
Objectives
Improving access to essentialservices
Improving the quality of services
Exchange of expertise
Mobilize additional resources foractivities
Improve efficiency
-
8/14/2019 Public Private Partnership in Health
16/47
-
8/14/2019 Public Private Partnership in Health
17/47
17
Basics of PPP
Problem
Profile of Partners
Process of Building a partnership
Profit Mutual BenefitPhase start small & build
Proliferate Grow, Expand, & Sustain
Priorities & Preferred group
Policing Mechanism of Monitoring& Transparency
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
18/47
18
Politics Governance, Administration,Peoples audit
Protection/proof: A security system
Price: A cost share in terms ofmoney/kind
Professional Network
Platform
Prize: Acknowledgement/recognition
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
19/47
19
Factors Influencing PPP
Clarity of Purpose
Creation of value
Congruency of Mission, Strategy and
ValuesConnection with purpose and people
Communication between partners
Continual learning
Commitment to the partnership
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
20/47
20
Action Principles for PPP
Combined action at all stagesplanning, follow up and termination
Complimentary rolesexpectation of each other are clarified
and stabilized
Creation of a temporary system
task force with representatives fromboth sides
Continuous Communication
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
21/47
21
How PPP Helps:
Economies of scaleUtilizing existing capacity
Create synergyTargeting poorFlexibility in actionResource mobilizationTechnical Up-gradation
BetterServices
Better
Health
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
22/47
SIHFW: an ISO 9001: 2008 certified institution 22
Models of PPP
Social Franchising
Branded Clinics
Contracting
Social MarketingBuild, Operate and Transfer
Joint Venture Companies
Voucher System
Donations from individuals
-
8/14/2019 Public Private Partnership in Health
23/47
SIHFW: an ISO 9001: 2008 certified institution 23
Involvement of Corporate sectorPartnership with Professional
Associations
Capacity Building of Private
ProvidersAutonomous Institutions
Mobile Health Vans
Health Insurance
Partnerships with Social Clubs andGroups
-
8/14/2019 Public Private Partnership in Health
24/47
SIHFW: an ISO 9001: 2008 certified institution 24
STRAIGHT Approach to PPP-
Identifying the Scope of partnership Identifying the appropriate Target Population
Selecting the RightPartners and Model
Ensuring AccountabilityEnsure active Involvement of the Govt.
Generate Support of stakeholders throughIEC, advocacy and rapport building
Highlight achievementsBuild Trust of all the partners and clients
-
8/14/2019 Public Private Partnership in Health
25/47
SIHFW: an ISO 9001: 2008 certified institution 25
Some PPP Models in India
Conventional
Contracting in
SMS Hospital, Jaipur
Bhagajatin HospitalKolkata
Radiology &
Drug storeDiet, Cleaning,Laundry, security
Private Company/
IndividualEntrepreneurs
Contracting out Karuna Trust,Karnataka
Shamlaji HospitalGujaratRajiv GandhiHospital, Raichur
PHC Mgt.CHC Mgt.
Tertiary care hospital
Charitable NGOCharitable NGO
Private company
PerformanceManagementContracts
APUHS Project,Adilabad, APChiranjeevi Yojana,Gujarat
RCH ServicesRCH/MH services
Charitable NGOPrivate clinicsCharitable NGO
-
8/14/2019 Public Private Partnership in Health
26/47
SIHFW: an ISO 9001: 2008 certified institution 26
Community/ Health
Insurance
Yeshashvini
Scheme,Karnataka
Surgical Care Private Hospitals
consortium
Voucher Scheme Arogya RakshaScheme, APSIFPSA, Agra UPSCOVA, Haridwar,
UK
HospitalizationMaternity Care/Institutional Delivery
Private Hospitals/PSU insurancePrivate Hospitals
Hospital Autonomy RKS, Bhopal / &Other Places
Patient welfarecommittee
Public Hospital
Franchising Merri Tarang; Merri
Silver; Merri Gold;Life Spring-HLFPPT/ SIFPSAJanani, Bihar
M CH / Other
curative services
Franchised private
entrepreneurs
-
8/14/2019 Public Private Partnership in Health
27/47
27
Contracting In and Out
Legally enforceableContract
Defined Set of
healthcare servicesQuantity of services
Quality of services
Duration of ServiceProvisioning
Public Private
Remuneration
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
28/47
28
Government or Donor Agency
Voucher Agency
ServiceProviders
Voucher Distributo
Voucher Recipients
Vo
ucher
rede
emed
Provid
er
paym
ent
Voucher
redemption
Voucher System/Demand Side Financing
A voucher is adocument that canbe exchanged for
defined goods orservices as a tokenof payment (tied-cash).
Agra Model
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
29/47
29
Partnerships with ProfessionalAssociations
Expert Pool
IAPSM, IPHA
FOGSI Vande Matramscheme
IMA Aao Gaon Chalein
Protocols/ QualityAssurance/ Accreditation
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
30/47
30
Rajasthan :Success Stories in PPP-
Linear Accelerator
MRI and Radio-imaging in Tertiarycare Teaching Hospitals
Geriatric Clinic/ Diabetic centre atBikaner
RMRS
Contracting out of support services
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
31/47
31
Mobile Health Vans
Already implemented ininaccessible areas
Comprehensive Health Services
Fixed Journey PlansPublic Sector contribution
Medical Officers andMedicines
Private Sector for Purchase andManagement of Vans
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
32/47
-
8/14/2019 Public Private Partnership in Health
33/47
33
What should Investor Look into?
Policy prescriptions
Procedural details
Possibilities
Provisions at its command
Presence of Public sector
Purchasing power
PhasingProliferation
Profits
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
34/47
34
What Public Sector should Look into:Key Steering Variable
Preparedness
Land Bank
Priorities
Provisions
Policy
Procedures
Paper workTime fame
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
35/47
35
Policing
RegulatoryMechanism
PerformancePromotion
AccreditationMechanism
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
36/47
36
Health Care Spending in India-2004-05
AP : 1118
Bihar : 1497
Gujarat : 1187 Karnataka : 997
Kerala : 2952
MP : 1200
Maharashtra :1576
Punjab : 1813
Rajasthan : 808 Tamil Nadu : 933
UP : 1152
WB : 1188
National Commission on Macro-economics & Health, GOI, 2005
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
37/47
SIHFW: an ISO 9001: 2008 certified institution 37
Source of Health Spending in India
-
8/14/2019 Public Private Partnership in Health
38/47
38
In FactIndia is One of the Most PrivateSystems of Health Care in the World
Year
Percen
tage
The Heartless Capitalists
SIHFW: an ISO 9001: 2008 certified institution
Healthcare Financing
-
8/14/2019 Public Private Partnership in Health
39/47
39
Healthcare Financing Rs. Billion
1993-94
1994-95 1995-96
1996-97 1997-98 2000-01 2002-03BE
Public Centre 7 11 12 13 14 23 35
State 68 72 89 99 113 156 186
Total%Govt.%GDP
752.910.87
832.130.81
1012.980.86
1122.940.83
1272.700.83
1792.910.81
2213.170.85
Private%GDP
1952.27
2792.75
3292.77
3732.73
4593.00
9824.46
12004.62
Source: Public Expenditures - Finance Accounts up to 2001 and Budget for2003; Private CSO estimates on Consumption Expenditure 1985 series; BE= Budget Estimate
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
40/47
40
Health Financing in India
72%
20%
6%
Individuals
Governmen
Private
Donors
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
41/47
41SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
42/47
42
Objective
Immediate Objective:
Quality Health Care
World Class Infrastructure
Reasonable CostInherent Objective:
Promote PPP
Ultimate Objective:
Promotion of MedicalTourism
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
43/47
43
Procedure
Simple & Transparent
Time Bound Disposal (90 Days)
Rebate gradient
Customized Package For-Corporate Health
Bodies
Facilities inPlace ofTourismimportance
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
44/47
-
8/14/2019 Public Private Partnership in Health
45/47
45
Policys Priority
Super specially Hospital
Medical Colleges
Dental CollegesGeneral Hospitals
Support Units
SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
46/47
46SIHFW: an ISO 9001: 2008 certified institution
-
8/14/2019 Public Private Partnership in Health
47/47
Thank You