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Exhortation and Information as Policy Tools to Improve Private-Sector Hospital Performance in Asia

Exhortation and Information as Policy Tools to Improve Private-Sector Hospital Performance in Asia. DOMINIC MONTAGU Based on slides developed by Abi Ridgway UC Berkeley Haas School of Business. Harding-Montagu-Preker Framework: Overview. Assessment. Strategy. Focus. Goal.

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Exhortation and Information as Policy Tools to Improve Private-Sector Hospital Performance in Asia

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  1. Exhortation and Information as Policy Tools to Improve Private-Sector Hospital Performance in Asia DOMINIC MONTAGU Based on slides developed by Abi Ridgway UC Berkeley Haas School of Business

  2. Harding-Montagu-Preker Framework: Overview Assessment Strategy Focus Goal • Distribution (equity) • Efficiency • Quality of Care PHSA • Gather available information • Identify additional needs • In-depth studies Private Sector Grow Harness Activities • Hospitals • PHC • Diagnostic labs • Producers / Distributors Ownership • For-profit corporate • For-profit small business • Non-profit charitable Formal/ Informal Convert Restrict PublicSector Source: Adapted from Harding & Preker, Private Participation in Health Services, 2003.

  3. Harding-Montagu-Preker Framework: Overview Assessment Strategy Focus Goal • Distribution (equity) • Efficiency • Quality of Care PHSA • Gather available information • Identify additional needs • In-depth studies Private Sector Grow Harness Activities • Hospitals • PHC • Diagnostic labs • Producers / Distributors Ownership • For-profit corporate • For-profit small business • Non-profit charitable Formal/ Informal Convert Restrict PublicSector Source: Adapted from Harding & Preker, Private Participation in Health Services, 2003.

  4. definition Outline of Session • Definition • Typology • Criteria for Assessment • Conclusions

  5. The Problem of Quality In South and Southeast Asia much or most hospital care is provided by the private sector. Quality of care in private hospitals is variable and often inadequate. Due to weak regulatory powers and small budgets, health officials in low and middle-income countries have limited influence on the quality of care provided by private hospitals.

  6. Traditional policies: limited applicability • Pay-for-Performance • Regulation • Accreditation • Contracting Services

  7. Using information as a policy tool Government

  8. Policy Alternatives

  9. #1: Persuasion An intentional effort to change attitudes or behavior by sharing information with hospital providers Target Audience Size

  10. #1: Persuasion

  11. #2: Public Recognition A governmental promotion of a set of standards for hospitals, followed by public recognition of hospitals that meet those standards • Ex: Malcolm Baldrige National Quality Award • Effort by US in 1980s to improve quality of manufacturing Recognizes high quality of goods and services • Xerox, Motorola, Ritz Carlton • Hospitals are included

  12. #2: Public Recognition

  13. #3: Public Reporting A governmental collection of information about patient care from hospitals and dissemination of that information to all players in the healthcare industry to facilitate better decision-making. • Ex: Hospital Compare • Pioneered in US, followed by similar effort in Europe • Relies on “market” forces • Is tied to financial incentives • Trickle down effect

  14. #3: Public Reporting

  15. #4: Negotiation Governments and providers make a mutual agreement for performance improvement Ex: PRACTION Study, India & Pakistan • Goal to get private provider to follow WHO recommended care for childhood illnesses (ICMI) • PRACTION had significant improvement on 16 or 21 desired behavior changes

  16. #4: Negotiation

  17. Summary of policy alternatives

  18. Recommendation • LMIC government should use public recognition as its primary policy tool to improve private sector care • Highly affordable because doesn’t requires monitoring • Politically feasible because voluntary • Technical challenge is agreeing on a standards of quality • Helpful for future interventions • Breaks down the separation between public and private players • In the longer term, negotiation is the next most promising alternative • PRACTION showed that effective for formal providers, but more pushback • No demonstrations yet at hospital level

  19. Caveat A Weak Tool • Among the policy or program options available to influence private hospitals, Exhortation and Information is both the least well documented, and the weakest. • While risks are low in the application of public recognition strategies or other Information-lined policies; the degree of changed practices is likely to be commensurately modest. Conclusion • Exhortation and Information is a useful first-level intervention.

  20. When Exhortation/Information and When Other Interventions • Effectiveness • Improves the quality or equality of care • Structures and processes that reduce morbidity and mortality • Improves patient experience • Improves hospital productivity • Affordability • Affordable to launch and to maintain • Feasibility • Technically: EMRs not yet available • Politically: Support from policy-makers, patients and providers

  21. Thank you! QUESTIONS?

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