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Pham Le Tuan, PhD Toronto, July 12 2011

Pham Le Tuan, PhD Toronto, July 12 2011 . Public-private partnership: Potential collaboration with private providers for the provision of ambulatory care in the Mekong region, Vietnam. Outline. Introduction Methods Results Discussions and policy implications. Introduction .

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Pham Le Tuan, PhD Toronto, July 12 2011

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  1. Pham Le Tuan, PhD Toronto, July 12 2011 Public-private partnership: Potential collaboration with private providers for the provision of ambulatory care in the Mekong region, Vietnam

  2. Outline • Introduction • Methods • Results • Discussions and policy implications

  3. Introduction • Private providers have become an important part of many health systems • The Doi Moi process launched in Vietnam in 1986 paved the ways for many substantive health reforms. • The private sector was legalized in same time with the introduction of health insurance two decades ago • Currently, the State owned Social Health Insurance covers some 60% of total Vietnamese population. • A relatively broad benefit package is entitled to the insured but only available in public facilities and a few accredited private hospitals. • The study aims to explore the possibility for collaborating with private providers for the provision of ambulatory care at the primary level in the Mekong region, Vietnam

  4. Methods • Study site: In Mekong Region. • Focus group discussion with government officials: exploring knowledge, views, assessment and attitude towards private providers. • Facility survey: assessing the professional competency of private providers, their qualification, availability of equipment… • Private provider in-depth interview: focusing on potential for and challenges regarding public-private partnerships. • Exist survey of private providers clients: aiming to understand health seeking behaviors, fees, and perceived quality of care. • Data analysis: data entry using SPSS 10, and data analysis using STATA 10. Qualitative data were coded for key themes.

  5. Results • Results of FGDs with health officials • Private providers were recognized for its role in assisting the public sector to reduce crowding within the public hospitals • Overuse of antibiotics and induced-demand interest • Good quality as evidenced by the courtesy of personnel and short waiting time • Strong consensus in favor of public-private collaboration to improve competition between service providers • The collaboration should be piloted in qualified policlinics • Challenges: wide variation of fees for services, “low quality medicines”, low awareness of the population; and lack of human resources for regulating, M&E and quality assurance.

  6. FGDs with health officials • A strong consensus in favor of collaborating with private providers to provide ambulatory health services for insured individuals. • Public-private partnership could improve competition between service providers and be an impetus for both public and private health providers to improve their quality of care. • Such collaboration should be first piloted in qualified policlinics and specialized clinics. The pilot should be rigorously monitored and evaluated before being scaled up. • Challenges to such collaboration: the wide variation between fees for services actually charged by private providers and those regulated by the SIA; limited list of medicines; additional administrative burdens for SIA; low awareness of the health insurance benefit package and co-payment rules; and lack of personnel and relatively weak capacity for regulation, monitoring, and quality assurance.

  7. Results of health facility survey

  8. Characteristics of participants

  9. Characteristics of participants

  10. Health seeking behavior

  11. Healthcare expenditures

  12. Clients’ satisfaction

  13. Discussion • Key findings • Government officials have relatively positive attitudes towards private providers. • Almost all surveyed private providers serve insured patients, although they are not paid by the insurance agency. • The vast majority of providers expressed their willingness to collaborate with the public sector to provide health services for insured people. • Clients who sought care at both public and private sector were much more satisfied with the private providers. • Collaborating with private providers to offer ambulatory care at the primary level to health insurance beneficiaries seems feasible and promising from both health officials’ and private providers’ viewpoints. • The collaboration should be piloted and evaluated before being scaled up.

  14. Policy implications • Provides practical evidence on the possibility collaboration between public and private for ambulatory care at primary level. • Both public and private sectors have gradually been driven towards each other. • The Mekong regions seems ready for a major next step in public-private partnership, with a controlled experiment extending insured primary care benefits through accredited private providers. • The partnership is operationally and administratively feasible as ambulatory services are technically simple and could be monitored at a low cost.

  15. THANK YOU!

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