1 / 46

Public Private Partnership in Health Service Delivery: Experiences & Lessons

Public Private Partnership in Health Service Delivery: Experiences & Lessons. A.Venkat Raman Faculty of Management Studies University of Delhi. WHY PARTNER WITH THE PRIVATE SECTOR?. Omnipresence of the Private Sector. 93% of all hospitals 64% of all beds 80% doctors 80% of OP and

gale
Download Presentation

Public Private Partnership in Health Service Delivery: Experiences & Lessons

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Public Private Partnership in Health Service Delivery: Experiences & Lessons A.Venkat Raman Faculty of Management Studies University of Delhi

  2. WHY PARTNER WITH THE PRIVATE SECTOR? A.VENKAT RAMAN FMS-DU

  3. Omnipresence of the Private Sector • 93% of all hospitals • 64% of all beds • 80% doctors • 80% of OP and • 57% of IP ….are in the Pvt. Sector • (World Bank 2001) • Estimated at Rs. 1,56,000 Cr. in 2012 +Rs. 39,000Cr.. for health insurance(NCMH 2005) A.VENKAT RAMAN FMS-DU

  4. Share of Pvt. Sector- Non- Hospitalized care (60th NSS-2004) A.VENKAT RAMAN FMS-DU

  5. Share of Pvt. Sector- Hospitalized care (60th NSS-2004) A.VENKAT RAMAN FMS-DU

  6. Share of Private Sector in Rural Areas (NCMH,2005) A.VENKAT RAMAN FMS-DU

  7. Relative expenditure in the private sector - in Rural Areas(NCMH,2005) A.VENKAT RAMAN FMS-DU

  8. Who Pays for the Services?Percentage of Private Expenditure(NHA-2004-05) A.VENKAT RAMAN FMS-DU

  9. Implications >80% of health expenditure is out-of-pocket. (NSS 2005; NHA,2004-05) Debilitating Effects on the poor: Liquidation of assets, indebtedness. 40% of hospitalized & 2% in the country every year end up BPL (World Bank, 2001). Compounded by poor regulation of private sector A.VENKAT RAMAN FMS-DU

  10. Private sector is needed because.... India needs an additional 750,000 beds 520,000 doctors overall investment of Rs 1,50,000Cr. 80% likely to come from the private sector (NMCH,2005) A.VENKAT RAMAN FMS-DU

  11. PPP MODELS & TYPES A.VENKAT RAMAN FMS-DU

  12. Not all interactions between the Government and Private sector are PPPs A.VENKAT RAMAN FMS-DU

  13. Financing vs Delivery:Public vs Private modes(Bloom, 2001) A.VENKAT RAMAN FMS-DU

  14. Common PPP Models • Contracting (‘in’ and ‘out’) • Joint Ventures • Build/ Rehabilitate, Operate, Transfer • Health Financing (Vouchers, CBHI, Illness fund) • Mobile Health Units • Franchising • Social Marketing • Technology demos (e.g. Telemedicine) • Public-Private Mix A.VENKAT RAMAN FMS-DU

  15. Core Principles of Partnership True partnerships entail • Relative Equality between partners • Mutual Commitment to Public Health objectives • Benefits for the Stakeholders • Autonomyfor each partner • Shared decision-making and accountability • Equitable Returns / Outcomes A.VENKAT RAMAN FMS-DU

  16. PPP Models in Practice: A.VENKAT RAMAN FMS-DU

  17. A.VENKAT RAMAN FMS-DU

  18. A.VENKAT RAMAN FMS-DU

  19. A.VENKAT RAMAN FMS-DU

  20. A.VENKAT RAMAN FMS-DU

  21. A.VENKAT RAMAN FMS-DU

  22. A.VENKAT RAMAN FMS-DU

  23. A.VENKAT RAMAN FMS-DU

  24. A.VENKAT RAMAN FMS-DU

  25. A.VENKAT RAMAN FMS-DU

  26. A.VENKAT RAMAN FMS-DU

  27. A.VENKAT RAMAN FMS-DU

  28. OTHER MODELS IN OPERATION A.VENKAT RAMAN FMS-DU

  29. A.VENKAT RAMAN FMS-DU

  30. A.VENKAT RAMAN FMS-DU

  31. A.VENKAT RAMAN FMS-DU

  32. EMERGING MODELS • Regional Diagnostic Centres- Hub/Spoke • Medicity • Co-location of Specialty services • District Hospital + Medical College (Hub) • Franchised /Accredited Health Units • RBF – Incentive Contracts A.VENKAT RAMAN FMS-DU

  33. Key Lessons & Challenges in PPP: Indian Experience A.VENKAT RAMAN FMS-DU

  34. Political and Administrative Commitment • Half hearted support for PPP • Top officials are enthusiastic, but success takes them away- leadership vacuum; • Lower level officials suspect PPP as ‘privatization’ or show disdain towards the private provider A.VENKAT RAMAN FMS-DU

  35. Institutional Capacity • Need for technical / managerial skills for designing, negotiating, implementing and monitoring PPP contracts • Develop institutional capacity at all levels, including oversight role. A.VENKAT RAMAN FMS-DU

  36. Policy and Institutional Framework • Lack of policy driven strategy towards PPP in health sector. Need for a PPP policy. • Lack of information on Private sector thus poor regulatory leverage. • No institutional structures to manage PPP contracts. Need for specialized PPP cell in Health Dept. A.VENKAT RAMAN FMS-DU

  37. Social Context of PPP • Antipathy or suspicion towards the private sector and govt’s failure to regulate -raise suspicion. • Unwillingness of ‘civil society’ organisations to explore PPP as an option. • ‘Squeamishness’ about profit making in services meant for poor patients A.VENKAT RAMAN FMS-DU

  38. Diversity and Complexity of Private Sector • Private sector is diverse; Predominantly individuals (owner operated units) and from both recognized and unrecognized systems of medicine; • Diversity of tariffs, thus complicating information on cost vs tariff and tariff negotiations A.VENKAT RAMAN FMS-DU

  39. Process of Contracting : Partner selection • Primarily ‘input’ based contracting rather than outcome based. • (Only) competitively selected partners are less effective. Priorities of : • Govt. Officials: Compulsion of L1 & Completing procedural formalities. • Private Sector: Winning the bid by all means A.VENKAT RAMAN FMS-DU

  40. Risk • Financial risk to the private partner- Non-timely release of funds; Fear of enquiry. • Risk of unsuccessful/ failed contract leading to lack of services – patinets suffer, resources wasted. A.VENKAT RAMAN FMS-DU

  41. Enabling conditions for success • Successful partnerships are contextual. Enabling conditions include • leadership from both partners; • prior consultation; • relational / trust based contracting; • pilot testing, • timely payment; • periodic review and amendments / revision of contract; • specific performance indicators….. A.VENKAT RAMAN FMS-DU

  42. Key Constraints • Payment delays • Personality styles and trust level • Local political interference / political flip-flaps • Non-revision of contract clauses (Tariffs) • Lack of capacity or willingness to supervise / monitor / guide the project • Perceptual and attitudinal orientation to private sector • Lack of clarity of the objective of PPP A.VENKAT RAMAN FMS-DU

  43. Limitations in Contract Features • Defining and verifying beneficiaries (BPL patients)- especially high cost services • Defining Quality or Performance or Outcome indicators; • Supervision and Monitoring mechanism; • Timely revisions / updating of contract; • Ombudsman for dispute settlement; • Clarity on user fee A.VENKAT RAMAN FMS-DU

  44. Summary • Public-private partnership (PPP) is not privatization • Government continues to play a key role • Requires high degree of institutional capacity A.VENKAT RAMAN FMS-DU

  45. In conclusion….Public Private Partnership • ……does help benefiting the poor. • …………one of the pragmatic options for health service delivery, but not an alternative to public delivery or better governance. A.VENKAT RAMAN FMS-DU

  46. THANK YOU Ref. Book: A.Venkat Raman & J.W.Bjorkman Public Private Partnership in Health Care in India: Lessons for Developing Countries. Routledge, London, 2009 http://south.du.ac.in/fms/idpad/idpad.html A.VENKAT RAMAN FMS-DU

More Related