public private partnership in health

8/14/2019 Public Private Partnership in Health

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Public Private Partnership in Health

State Institute of Health & Family Welfare, Jaipur


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SIHFW: an ISO 9001: 2008 certified institution 2

Public Private Partnership

Not all interactions between the private and the public sector is PPP


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then what is Partnership?

SIHFW: an ISO 9001: 2008 certified institution


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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)



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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


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Selection of Service Provider

Competitive Bidding

Swiss Challenge Approach

Competitive Negotiation



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Payment Mechanism

Contractual payments

Grants-in-aid

Right to levy user charges for the assetcreated/leased-in



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Risk & Revenue Sharing

Construction/implementation risk,arising from:

Delay in project clearance

Contractor default

Environmental damage

Market risk, arising from:

Insufficient demandImpractical user levies



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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



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Legal risk, arising from:

Changes in law

Changes in title/lease rights

Insolvency of developer/serviceprovider

Change in security structure



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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



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Public-Private Equilibrium

PublicSector

PrivateSector

Advantages:

Improvement in Healthis the primary

objectiveEconomies of ScaleMore Equitable

Advantages:

Market/Choiceand Access

EfficiencyFlexibility



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Things to watch:Efficiency

Inflexibility/Respons-iveness

Customer satisfaction

Things to watch:Primary objective is

profit

Quality of services

Cost

PublicSector

PrivateSector



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Objectives

Improving access to essentialservices

Improving the quality of services

Exchange of expertise

Mobilize additional resources foractivities

Improve efficiency


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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



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Politics Governance, Administration,Peoples audit

Protection/proof: A security system

Price: A cost share in terms ofmoney/kind

Professional Network

Platform

Prize: Acknowledgement/recognition



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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



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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



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How PPP Helps:

Economies of scaleUtilizing existing capacity

Create synergyTargeting poorFlexibility in actionResource mobilizationTechnical Up-gradation

BetterServices

Better

Health



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Models of PPP

Social Franchising

Branded Clinics

Contracting

Social MarketingBuild, Operate and Transfer

Joint Venture Companies

Voucher System

Donations from individuals


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Involvement of Corporate sectorPartnership with Professional

Associations

Capacity Building of Private

ProvidersAutonomous Institutions

Mobile Health Vans

Health Insurance

Partnerships with Social Clubs andGroups


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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


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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


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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


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Contracting In and Out

Legally enforceableContract

Defined Set of

healthcare servicesQuantity of services

Quality of services

Duration of ServiceProvisioning

Public Private

Remuneration



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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



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Partnerships with ProfessionalAssociations

Expert Pool

IAPSM, IPHA

FOGSI Vande Matramscheme

IMA Aao Gaon Chalein

Protocols/ QualityAssurance/ Accreditation



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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



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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



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What should Investor Look into?

Policy prescriptions

Procedural details

Possibilities

Provisions at its command

Presence of Public sector

Purchasing power

PhasingProliferation

Profits



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What Public Sector should Look into:Key Steering Variable

Preparedness

Land Bank

Priorities

Provisions

Policy

Procedures

Paper workTime fame



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Policing

RegulatoryMechanism

PerformancePromotion

AccreditationMechanism



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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



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Source of Health Spending in India


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In FactIndia is One of the Most PrivateSystems of Health Care in the World

Year

Percen

tage

The Heartless Capitalists


Healthcare Financing


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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



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Health Financing in India

72%

20%

6%

Individuals

Governmen

Private

Donors



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41SIHFW: an ISO 9001: 2008 certified institution


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Objective

Immediate Objective:

Quality Health Care

World Class Infrastructure

Reasonable CostInherent Objective:

Promote PPP

Ultimate Objective:

Promotion of MedicalTourism



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Procedure

Simple & Transparent

Time Bound Disposal (90 Days)

Rebate gradient

Customized Package For-Corporate Health

Bodies

Facilities inPlace ofTourismimportance



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Policys Priority

Super specially Hospital

Medical Colleges

Dental CollegesGeneral Hospitals

Support Units



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46SIHFW: an ISO 9001: 2008 certified institution


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Thank You

public private partnership in health

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