Transcript Slide 1

The Right for Health & Private
Public Partnership in care delivery
Issues to be considered by policy
makers
SDU‐UK&I Spring Conference
16th & 17th June 2012
Dr Ibrahim M Abdel Rahim
UN Declaration of Human Rights
Article 25
1) Everyone has the right to a standard of living
adequate for the health and well-being of himself and
of his family, including food, clothing, housing
and medical
services …
care
and
necessary
social
2) Motherhood and childhood are entitled to special care
and assistance. All children, whether born in or out of
wedlock, shall enjoy the same social protection
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WHO Constitution - Declaration of Principles
 The enjoyment of the highest attainable standard of health is
one of the fundamental rights of every human being without
distinction of race, religion, political belief, economic or social
condition.
WHO constitution
first signed 1948
Please take note
of definition of
health
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WHO Constitution - Declaration of Principles.
Governments have a
responsibility for the health of
their peoples which can be
fulfilled only by the provision of
adequate health and social
measures.
How to make
governments
accountable?
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WHO Constitution - Declaration of Principles.
Unequal development in different
countries in the promotion of
health and control of disease,
especially communicable
disease, is a common danger.
How to assure global
health security
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ALMA ATA DECLARATION
 The existing of gross inequality in the health status of the people
particularly between developed and developing countries, as well
as within countries (advantaged and poor segments), is politically,
socially and economically unacceptable and is, therefore, of
common concern to all countries.
Almata PHC
Declaration 1978 .
How close are we to
The health for all
goal?
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HEALTH SYSTEM CONCEPTUAL
FRAMEWORK
SYSTEM BUILDING BLOCKS
GOALS OF HEALTH SYSTEM
Leadership & governance
Health workforce
Financing
Coverage
Service Delivery
Information Support
Responsiveness
Health technology
---
Provider
performance
Quality &
Safety
Efficiency
Financial
protection
Equity
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Irrespective of the Financial arrangement or
the mode of care delivery
Population
Good
Health
outcomes
These are the
goals of national
health delivery
system
Quality of Care &
Responsiveness
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Equity
in Access
to Health
Affordable
cost
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Definitions
 The Public health delivery sector: defined as all
health facilities owned, controlled and financed by
various levels and agencies of government.
 The private delivery sector is a residual category not
under the direct control of the government
 Within the private sector itself, additional
classification: The private for profit and private not
for profit, faced-based organization, traditional &
non-traditional, etc.
 Partnership: “a relationship based upon agreements,
reflecting mutual responsibilities in furtherance of
shared benefits.”1
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Status of private care delivery in the EMR
region?
 Has established role in infrastructure development, pharmaceutical
and non clinical services.
 Role in care delivery reached sky rocketing rates in recent past
(more 70% of ambulatory care in some EMR countries).
 Some of the reasons include poorly funded and managed public
delivery systems providing poor quality care, population growth
and marketing practices … etc
 Most of the delivery modalities are unregulated individual vendors
(including dual practice) and small inpatients faculties with limited
capacity.
 PPP may offer an opportunity and a leverage to streamline,
regulate and positively engages Private Sector.
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While performance of each sector depends on context &
varies case by case yet: Public vs. Private comparison
Provider
Public
Advantage •
•
•
Areas of
concern
•
•
•
Private
Improvement in overall health of
population drives growth and expansion
strategy
Potential for economy of scale to be
realized both within a unit as generally
facilities are large and across units due
to extensive network
More equitable in outlook
•
•
•
Bureaucratic management hampers the •
system from realizing complete potential
Inflexibility and Sluggish in taking
corrective decisions/ measures
•
Customer satisfaction and quality
reception is low (issues in
responsiveness)
•
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Efficiency in management and
operations with a thrust towards
employing technology and latest
best practices
Increased access in areas of
operation and availability of round
the clock service
Increased flexibility and
responsiveness
Financial sustainability without
government support restricts
expansion into all regions
Quality of service can suffer in areas
of low competition and lack of
regulation
High costs exclude large sections of
the poor population
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Key types of public private partnerships
and collaboration in health sector
Concessions( activities on
Contracting out: (activities
new inputs from private partner)
supported from Public funds)
•
Service delivery contracts
• Management contracts
• Construction, maintenance, &
equipment contracts
• Hybrid contracts (e.g., large IT
infrastructure or service)
• Leases of facilities/assets
Sample benefits:
•
Efficiency
•
Quality
•
Cost- and risk-sharing
•
Improve access
- Government guarantees/other
fiscal incentives (loans)
- Other Government incentives
Land prices , taxes, amenities
• Private Financing Initiatives
• Other types, typically without
government guarantees, i.e.
- Divestiture/privatization
- Free entry
- Other (e.g. provisions for
health saving accounts)
Prerequisites for PPP to aligned with
interests & goals of health/social sectors
 Adherence to Legal and regulatory frameworks
 Transparency and Accountability
 Partnership built on well founded Public policies (no policy without a
policy dialogue)
 Commitment to the notion of “Public Goods“
 Mutual Understanding of terms & obligations
 Sharing of Resources, risks and benefits
 Respond to Consumers and Community needs & expectations
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Due to understandable differences in interests, goals and
approaches to work, the results from PPP are not always rosy:
“In 2008, the Ontario Auditor General concluded that the
Ontario government could have saved $50 million in the
Brampton Civic Hospital P3 project if a public
procurement process had been chosen. The Auditor
General called for the costs and benefits of all feasible
procurement alternatives to be evaluated before entering
into a P3, and value-for-money assessments should
have relevant and clear criteria.” brief on PPP by British Columbia
Government
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Health care delivery, The Market & Health
Financing:
 Health is a commodity whose value could not be easily
monetized (estimated in monetary terms) or traded.
 Health care is an imperfect field for market forces or
mechanisms to work. “i.e asymmetric information exist
between consumer & provider” “market failure”
 Occurrence of liability “ill health” is unpredictable and when it
occurs is unevenly distributed.
 A wide based (universal) system for pooling risks and
resources is needed for attainment of socially & ethically
acceptable health and financial outcomes.
 Pre-paid systems of financing are necessary for equitable
access while out of pocket payments at point of service
delivery lead to unacceptable consequences.
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Health policies should target reducing
out-of-pocket expenditure
Out-of-pocket
health expenditure
Risk of financial
catastrophe
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 Push some households
into poverty
 Reduce expenditures on
other basic needs
 May cause households
to forgo seeking health
care and suffer illness
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Each year Millions suffer financial ruin when
they use health services are the world
Due to absence or inadequacy of social health
protection systems:
 Globally around 150 million suffer severe
financial hardship each year.
 100 million are pushed into poverty because
they must pay out-of-pocket at the time they
receive health care.
Risk of severe financial hardship and impoverishment drops
substantially with out-of-pocket spending less than 20% of total
cost of care
Share of out-of-pocket spending on health care
4.50%
Financial Catastrophe
Impoverished
4.00%
3.50%
3.00%
2.50%
2.00%
1.50%
1.00%
0.50%
0.00%
<10%
10-20%
20-30%
30-40%
40-50%
50-60%
60-70%
70%<
Source: WHO, Health Financing Policy unit database, unpublished
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EMR Share of out-of-pocket
Per capita total health
expenditure (US$) – 2010
expenditure (%) in – 2010
QAT
ARE
KWT
BHR
SAU
OMN
Source: WHO NHA Website
LBY
LBN
IRN
TUN
JOR
MAR
IRQ
SYR
EGY
PAL
Sudan
Sudan
SDN
DJI
YEM
PAK
AFG
1400
1200
1000
800
600
400
200
0
0
20
40
60
80
100
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HealthCare Financing Reform & Universal
Health Coverage
 A World Health Assembly Resolution in 2005 urged countries to
develop their health financing systems to:
 Ensure all people have access to needed services without
the risk of financial hardship linked to paying for care.
 Aspiration to attain UHC was in WHO's constitutions of 1948; in
the Alma-Ata declaration of 1978
The way forward is in adopting policies based on population right for health,
equity in health through committment to universal coverage and health care
delivery based on primary health care
Thank you
Chart to be used
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