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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 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 • 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
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.
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.
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.
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.
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.
