医疗服务公私伙伴关系个案分析及对中国的启示——基于巴西、南非和印度的分析

当前,世界各国的医疗服务供给都面临严峻挑战.特别是一些发展中国家面临着基层医疗基础设施设备老化、药品短缺、医疗服务能力和效率低下的问题.越来越多的国家开始采用公私伙伴关系来实现其公共政策目标,其中,巴西、南非和印度三国在运用公私伙伴关系转变地方政府角色、提高基层医疗服务能力和效率、促进卫生公平上取得了优异的成绩.文章通过整理分析这三个国家案例来探讨其通过公私伙伴关系改善基层医疗服务供给的基本经验,为我国基层推广和使用医疗服务公私伙伴关系提供参考.     

卫生领域的公私合作

公私合作伙伴关系（PPP）是指公共／政府实体与私有／商业实体以及民间团体之间的合作关系。PPP是以创新方式合并各组织之间不同技能和资源,为提供公共产品或服务而建立起来的一种长期伙伴关系的组织模式。     

澳门回归20年卫生服务体系及公私合作伙伴关系发展

澳门的卫生服务体系是公立为主、私立为辅的混合型体系,在政府主办的医疗卫生机构外,存在一个庞大的私营部门,并不断推进公私合作伙伴关系。私立医疗机构在澳门卫生服务体系中发挥了重要作用,公私合作伙伴关系改善医疗服务供给的经验,对内地深化公立医院改革、促进资源合理配置具有重要借鉴意义。     

南非公立医院改革的主要做法与特点

相对于私立医院占有五分之三的卫生支出为20%的人群提供服务,南非公立医院约使用五分之二的卫生支出,为南非80%的人群提供医疗卫生服务,但面临着资源不足和人力短缺的问题。为此,南非政府着重建立公平导向的卫生管理体制,加大政府财政投入,重点保障基层公立医院发展,探索公私合作,在优先保障弱势人群基本医疗服务的同时,动员可利用的所有医疗资源,着力保障居民公平地获得基本医疗卫生服务。改革的主要特点是建立以基本医疗卫生保健为基础的医疗管理体制,以更公平的方式分配医疗资源,建立公私合作机制,动员民营机构力量,优先保障居民对基本医疗卫生服务的可及性和公平性。这些经验对于同属于发展中国家的中国有良好启示。     

公私合作伙伴关系的模式、范围及实施原则

探讨英国及加拿大公私合作伙伴关系的模式、PPP模式服务范围,分析在公用事业领域导入PPP机制的流程及实施原则。     

公共卫生服务提供的公私合作模式综述

通过系统整理和分析国内外关于公共卫生服务提供的公私合作模式的研究文献,阐述了公私合作模式的内涵、分类和国内外公共卫生服务公私合作的主要方式和实践应用,并阐明了公共卫生服务领域公私合作对减轻政府财政压力、推动卫生体制创新、促进政府职能转换、提高公共卫生服务效率、提高私立卫生机构综合竞争力及贫困人群服务公平性都有积极作用;指出了公私合作过程中存在合作双方缺乏信任、沟通不足、政府管理滞后、职能不强等影响服务效果的问题;建议建立公私部门信息共享机制、设计合理的风险分担机制、改进政府对公私合作的管理手段、强化政府主导作用等措施;启示我国在基本公共卫生服务公私合作供给过程中要强化政府职责、成立第三方组织对公私合作进行协调、沟通、监督和考核以及建立有效的公私合作机制。     

上海市青浦区基本职业卫生服务提供模式现状

本研究通过对上海市青浦区现有3种基本职业卫生服务提供模式的对比分析,判断推导出公私合作提供基本职业卫生服务模式是适合今后青浦区基本职业卫生服务的发展和需求的模式,并在此基础上提出了"建立区、镇2级政府为主导,区、镇(街道)、村3级公立卫生服务网络为基础、市级公立职业卫生服务机构为依托、民营职业卫生服务机构为补充、区职业卫生行业协会为平台的青浦区基本职业卫生服务公私合作模式"的总体框架与保障措施。     

上海市青浦区基本职业卫生服务提供模式情景分析

通过对上海市青浦区基本职业卫生服务提供模式现状分析和青浦区构想的3种基本职业卫生服务提供模式情景SWOT分析,判断推导出公私合作提供基本职业卫生服务模式是否适合今后青浦区基本职业卫生服务的发展和需求的模式,并在此基础上提出"建立区、镇两级政府为主导,区、镇(街道)、村三级公立卫生服务网络为基础、市级公立职业卫生服务机构为依托、民营职业卫生服务机构为补充、区职业卫生行业协会为平台的青浦区基本职业卫生服务公私合作模式"的总体框架与保障措施。     

公立医院运营中引入公私合作伙伴关系的理论及对策研究

公私合作伙伴关系是社会资本进入医疗服务领域的方式之一,也是私营部门参与公立医院改革的重要路径。在厘清公立医院公私合作伙伴关系内涵的基础上,对我国公立医院运营引入公私合作伙伴关系的必要性、可行性以及面临的困境进行了探讨。针对其面临的专业促进机构的缺乏、法制体系与监管体系的不完备、公众的认知误区等问题,提出成立专业独立的促进机构、构建系统权威的法律框架、完善合理有效的监管体系、树立正确理性的公众认知等解决对策。     

我国医疗体制改革导入公私合作伙伴关系的初步探讨

简述公私合作伙伴关系(PPP)及其在卫生领域的应用,分析英国医院PPP与英国卫生体制的适配性,探讨我国医疗体制改革导入PPP面临的问题及建议。     

Financing and planning of public and private not-for-profit hospitals in the European Union

While much has been written about health care financing in Europe in recent years, discussion has almost entirely focused on revenue. In contrast, there has been remarkably little written on financing of capital investment in European health care systems. Yet major changes are underway in several countries, in particular involving new forms of public-private partnerships (PPP). At the same time, there is growing recognition of the way in which the inherited structure of the health care delivery system constrains the system's ability to adapt to changing circumstances. This paper reports the results of a survey undertaken among key informants in the member states of the European Union to begin to ascertain existing practices and future plans in relation to hospital planning and financing amongst public and private not-for-profit hospitals. The locus of hospital planning decisions reflect the constitutional framework of the country involved, and thus the emphasis on national or local plans. There has been an expansion of private sector involvement, with four basic models identified: private loans direct to the hospital; private loans to a regional health body; a PPP where the private sector's role is to build, design and operate the non-clinical functions of the hospital; and, finally, a PPP, where the private sector's involvement also includes management of the clinical functions of the hospital. It is too early to say whether these approaches will be more successful than the models they are replacing.     

Public‐private partnerships in non‐profit hospitals: Case study of China

The gap between supply and demand for health care services is expanding rapidly in China. In order to resolve this problem, the government has implemented supply‐side reforms in the health care sector by inviting private capital to increase supply quantity and improve quality. However, health care institutions have high complexity and particular needs, while non‐profit hospitals have very strong public interests. This gives rise to complications in the implementation of public‐private partnerships (PPPs) for health care services. In this paper, the authors have selected one case each from three different models of non‐profit hospital PPP projects in the national PPP project database, operated by the Ministry of Finance, and compared how these projects were operated to identify the differences among them. A content analysis of the vital project documents is the primary analysis technique used for this comparison. Key issues investigated include reasons for model selection, requirements for private sectors and market competition level in different models, risk identification and sharing, design of payment mechanism, operation supervision, and performance appraisal of the project. Based on the comparison, some key lessons and recommendations are discussed to act as a useful reference for future non‐profit hospital PPP projects in China.     

PPP医疗项目关键成功因素分析

随着政府与社会资本合作模式(PPP)在中国的推广运用,越来越多的社会资本参与到公共设施的融资、设计、建造和运营中来。然而,由于PPP本身的复杂性和合同义务的长期性,PPP项目要实现落地并不容易。目前,部分PPP医疗项目在吸引社会资本进入和提供服务上遇到困难。本文通过文献综述和专家咨询获得中国医疗领域PPP的18个关键成功因素(CSF),包括收益分配合理、政府政策稳定、风险分担合理、职责划分明确等,并通过近期财政部PPP中心综合信息平台项目库的公开资料来验证中国PPP关键成功因素体系,为促进PPP成功达成协议提供参考。     

公私合作模式在我国城市医疗服务业中应用的探讨

公私合作模式已经在各国的公共事业方面得到了很好的发展。我国的城市医疗服务业正面临着需求增长和供给不足的矛盾,通过探讨公私合作模式在我国城市医疗服务业中应用的可行性和前景,认为公私合作模式将为我国的医疗改革提供一个全新的出路,在我国的城市医疗事业中发挥重要作用。     

Finanzierung von Gesundheitsförderung auf kommunaler Ebene

Background

Limited financial resources are a major barrier to implementing health promotion activities on the community level. Thus, the generation of funds and material resources by developing ties with the private sector, for example, is promising. Fundraising and public–private partnerships (PPP) are possible approaches to this end.

Results

Fundraising, such as through sponsors, donations, or foundation grants, allows organizations to raise small or large financial amounts for activities and projects without long-term contractual obligations. PPP constructs are long-term, binding alliances between the public sector and private organizations; the private partner is assigned a certain task within the health promotion program. Potential supporters are corporations or stakeholders that have a special interest in the program’s content, target group, or region. Risks involved in sponsoring and PPP include conflicts of interests, dependency, and commercialization.

Perspective

The general conditions and competencies for these cooperative relationships must still be developed in many community contexts.     

The relevance of the public–private partnership paradigm to the prevention of diet-associated non-communicable diseases in wealthy countries

The public–private partnership (PPP) paradigm emerged as a form of global health governance in the mid-1990s to overcome state and market failures constraining access to essential medicines among populations with limited purchasing power in low- and middle-income countries. PPPs are now ubiquitous across the development spectrum. Yet while the narrative that the private sector must be engaged if complex health challenges are to be overcome is now dominant in development discourse, it does not yet appear to be shaping government approaches to addressing health inequalities within high-income welfare states such as Canada. This is significant as both the actions and inactions of firms factor heavily into why low-income Canadians face a disproportionate risk of developing diet-associated chronic diseases, such as type II diabetes. In the same ways PPPs have been an effective policy tool for strengthening public health in poor countries, this paper illuminates how the PPP model may have utility for mitigating poverty-associated food insecurity giving rise to diet-associated non-communicable diseases within the context of wealthy states.     

An analysis of ophthalmology services in Finland - has the time come for a Public-Private Partnership?

Background  

We studied the prerequisites for Public-Private Partnership (PPP) in the context of the Finnish health care system and more specifically in the field of ophthalmology. PPP can be defined as a more or less permanent cooperation between public and private actors, through which the joint products or services are developed and in which the risks, costs and profits are shared.     

公私合作制度对我国发展社会办医的启示

新医改形势下,政府大力鼓励社会办医,其中公私合作制度(PPP)是解决公立医院融资困难,加快公立医院改革与建设的重要路径和尝试.结合PPP在国内外的成功经验,立足我国公立医院发展实际,探讨更好地让社会办医落地的政策建议:一是加强PPP模式的制度建设:将社会办医纳入医保,鼓励医师多点执业;二是完善社会办医补偿机制;三是将社会办医纳入医联体共建.     

城市健康医疗大数据实行PPP模式的动力、机制与规制

城市治理中引用PPP模式应用大数据技术,能够创新大数据时代政府提供公共产品和服务的方式,和缓解城市政府依托高科技进行技术治理的资金压力。城市健康医疗大数据PPP模式的良性发展需要通过构建四重相互配合的机制系统得以保障;需要公共部门和私营部门双方都拥有规制精神和树立自觉履行规制的理念,并通过公平设置竞争性招标程序、完善财政补贴管理、常态化监管服务质量、政府诚信制度建设等规制措施得以巩固。