PPP医疗项目风险分担定性分析

近年来,发达国家运用PPP提供公共医疗基础设施和服务的做法受到了普遍关注。这些国家采用PPP的主要原因包括:一方面翻新、维护和运营医疗基础设施的费用在不断增长,另一方面财政预算因为经济下行而被缩减。因此,政府需要资金来弥补投入不足,并依靠私营部门的专业技术和管理经验来分担经营风险。本文通过文献研究初步获得18个PPP医疗项目的风险因素,然后通过向专家发放调查问卷的方式得到专家对风险分担的定性判断结果。最后得出PPP医疗项目的风险分担方案,为PPP项目成功实施提供参考。     

基于PEST-SWOT整合模型的公立医院PPP适用性分析

随着政府与社会资本合作(Public Private Partnership,PPP)模式在我国医疗卫生领域大量应用,提高供给改善服务的同时也出现了很多困难和挑战。为了解决这些问题,通过PEST-SWOT整合模型,对公立医院应用PPP模式适用性进行分析,从政府和公立医院视角,进行外部环境条件机会与挑战分析和内部因素优势劣势识别,并提出相应的PPP模式应用策略,从而确保PPP项目物有所值,实现项目目标,为公立医院应用PPP模式提供理论依据和参考。     

天津推出1469亿元PPP项目大单

<正>中国固废网讯日前,天津市公布31个政府和社会资本合作(PPP)推介项目,涉及交通运输、水利、环境保护、林业、重大市政工程、特色小镇及棚户区6个领域,总投资1 469亿元。这是党的十九大以后,天津首次集中推介PPP项目。2015年,天津出台了《天津市推进政府和社会资本合作指导意见》,市和各区相继设立了     

基于HALL模型的大型医疗PPP项目建设与运营集成管理框架研究

为缓解政府投资压力,满足多样化的医疗服务需求,引入PPP模式参与医院建设,但是在实践中医疗PPP模式仍然存在一些问题。文章在总结分析医疗建设项目和PPP项目特点的基础上,在HALL三维模型理论的基础上创新性加入空间环境维度,构建四维医疗建设PPP项目建设与运营集成管理框架模型,并对四个维度进行分析,期望能够促进我国医疗PPP的发展,为社会提供优质高效的医疗健康服务。     

PPP模式怎样发挥最大潜力?

正卫生服务领域如何通过社会资本解决现实问题,PPP模式是其中一种重要的方法。2013年12月26日召开的全国财政工作会议揭开了全国推广PPP模式的序幕,时至今日,我国有近7000多个PPP项目,投资规模约达8万亿元。从世界各国来看,医疗服务是通过PPP模式发挥社会资本作用的一个重要领域,医疗领域如何利用好这一方式值得思考。对PPP的理解各不相同目前,世界各国专家学者对PPP     

英国国民卫生服务体系PFI项目发展现状及借鉴分析

通过访问英国卫生与社会保健部、主流媒体的网站和第三方独立机构发布研究报告以及文献梳理,获取关于英国国民卫生服务体系(NHS)中私人融资计划(PFI)项目信息。再通过对英国PFI项目发展现状的描述,分析存在的主要问题、影响及改进措施,从而为我国卫生健康领域政府与社会资本合作(PPP模式)的开展提供借鉴。     

规范公私合作很紧迫

<正>我国公立医院与社会资本合作并不罕见,但是缺乏相应规范,因此不易推广。在公立医院改革不断推进和鼓励社会办医的大背景下,财政部密集出台4个在公共领域推进政府与社会资本合作模式(PPP)的政策性文件,这对在医疗领域规范和推广公私合作模式提供重要契机。五要素决定公私能否合作PPP即公私合作伙伴关系,是国内外公用事业民营化广泛采用的一种融资及管理机制。目前,国际上对     

政府要充分发挥主导作用

<正>"十三五"期间,医养结合养老模式的实现需要政府充分发挥主导作用和统筹协调作用,主要表现在以下几个方面:创新投融资模式,降低养老机构的风险。拓宽投资资金来源,丰富融资渠道,充实投资资金链,善于利用开发多种社会资源,吸引多种社会资本的投入,鼓励和争取更多的社会资本和民间资本的投资到医养结合养老机构的建设当中来。探索通过PPP等模式来实现由政府提供政策、土地、房屋等,合作方提供资金、人员、先进管理经验等     

社区卫生服务PPP模式中社会资本机会主义行为及监管研究

目的:探讨社区卫生服务领域引入PPP模式的社会资本可能产生的机会主义行为和监管问题,在考虑监管成本的制约下研究政府部门监管的合适时机,以达到效益的最大化。方法:采用博弈分析方法对社区卫生服务引入PPP项目时社会资本方可能产生的机会主义行为进行分析,在对政府和社会资本间的行动策略做出合理前提假设后,构建政府部门与社会资本之间的博弈模型,探讨政府部门监管的最佳时机和策略。结果与结论:在社区卫生服务PPP模式中,社会资本方预测到政府部门监管的概率p*(r2_-r_1)/(r_2-r_1-c_2)的情况下,采取机会主义行为的策略则会获得最优效用。而在政府部门预测到社会资本方采取机会主义行为的概率q* c_1/2R_1时,选择监管的行为策略会获得最优效用。     

以公私合作伙伴关系模式推进公立医院改革的探讨

介绍了公私合作伙伴关系(PPP)模式的概念及内涵,探讨PPP模式在医院产业发展中的应用。认为在深化公立医院改革过程中,采取PPP模式化减部分医院债务,既可减轻地方政府和医院债务的压力,又可调动社会资本的力量来加大、加快医疗卫生建设,并且取得更好的资金使用效率。同时扩大了社会资本的办医空间,符合医改精神,有利于实现多方共赢。     

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.     

Health care in China: the role of non-government providers

While China's health services are primarily financed by out-of-pocket spending (private financing), health care providers, especially the hospital industry, are still dominated by state ownership and government control (public provision). Even though the private sector plays an increasing role in the ambulatory sector, private services are not included in the social insurance benefit package, and thus, it primarily serves self-paying patients. The ambiguity of the government policy toward private provision stems from concerns that an increasing private sector would drive up costs and its services may be of questionable quality. This paper tries to gather evidence on the relative performance of private and public sector in China. Neither literature review nor our primary data analysis provides any support for the notion that the private sector charges a higher price and they serve primarily the better-off people. Quite on the contrary, available data seem to suggest that not only the private sector tends to serve disproportionately the low-middle income groups (this may well be due to its relative lower direct and indirect costs), consumer satisfaction also seems to be higher with regards to certain dimensions of the private than public sector.     

Efficiency and quality in the public and private sectors in Senegal

It is often argued that the private sector is more efficient than the public sector in the production of health services, and that government reliance on private provision would help improve the efficiency and equity of public spending in health. A review of the literature, however, shows that there is little evidence to support these statements. A study of government and non-governmental facilities was undertaken in Senegal, taking into account case mix, input prices, and quality of care, to examine relative efficiency in the delivery of health services. The study revealed that private providers are highly heterogeneous, although they tend to offer better quality services. A specific and important group of providers--Catholic health posts--were shown to be significantly more efficient than public and other private facilities in the provision of curative and preventive ambulatory services at high levels of output. Policies to expand the role of the private sector need to take into account variations in types of providers, as well as evidence of both high and low quality among them. In terms of public sector efficiency, findings from the study affirm others that indicate drug policy reform to be one of the most important policy interventions that can simultaneously improve efficiency, quality and effectiveness of care. Relationships that this study identified between quality and efficiency suggest that strategies to improve quality can increase efficiency, raise demand for services, and thereby expand access.     

The public and private sectors in health: economic issues

Major changes in the public/private mix of health services are occurring in many countries. These changes may be analysed by examining the financing and provision of services and subsidization of the purchase of the factors of production. The public sector and not-for-profit and for-profit elements of the private sector must be viewed as separate entities in such analyses due to their differing objectives, motives and form of operation. The issues to be dealt with by countries in finding the public/private mix which is appropriate for their health system and achieves their objectives include efficiency, quality, regulation, equity and consumer choice and satisfaction. The recommendations for action for countries include: promoting collaboration between private and public sectors; testing different public/private mix models; identifying appropriate expansion paths for private sector services; improving information for policy and planning decisions; enhancing management capacity; and, reviewing programme and project support. International agencies also have a role in this process by supporting countries through the provision of technical assistance, financial aid, promoting policy reviews, and facilitating the sharing of information and experiences among countries concerning these public/private mix issues.     

Household utilization and expenditure on private and public health services in Vietnam

The private provision of health services in Vietnam was legalized in 1989 as one of the country's means to mobilize resources and improve efficiency in the health system. Ten years after its legalization, the private sector has widely expanded its activities and become an important provider of health services for the Vietnamese people. However, little is known about its contribution to the overall objectives of the health system in Vietnam. This paper assesses the role of the private health care provider by examining utilization patterns and financial burden for households of private, as compared with public, services. We found that the private sector provided 60% of all outpatient contacts in Vietnam. There was no difference by education, sex or place of residence in the use of private ambulatory health care. Although there was evidence suggesting that rich people use private care more than the poor, this finding was not consistent across all income groups. The private sector served young children in particular. Also, people in households with several sick members at the same time relied more on private than public care, while those with severe illnesses tended to use less private care than public. The financial burden for households from private health care services was roughly a half of that imposed by the public providers. Expenditure on drugs accounted for a substantial percentage of household expenditure in general and health care expenditure in particular. These findings call for a prompt recognition of the private sector as a key player in Vietnam's health system. Health system policies should mobilize positive private sector contributions to health system goals where possible and reduce the negative effects of private provision development.     

Evaluation of immunization knowledge, practices, and service-delivery in the private sector in Cambodia

A study of private-sector immunization services was undertaken to assess scope of practice and quality of care and to identify opportunities for the development of models of collaboration between the public and the private health sector. A questionnaire survey was conducted with health providers at 127 private facilities; clinical practices were directly observed; and a policy forum was held for government representatives, private healthcare providers, and international partners. In terms of prevalence of private-sector provision of immunization services, 93% of the private inpatient clinics surveyed provided immunization services. The private sector demonstrated a lack of quality of care and management in terms of health workers' knowledge of immunization schedules, waste and vaccine management practices, and exchange of health information with the public sector. Policy and operational guidelines are required for private-sector immunization practices that address critical subject areas, such as setting of standards, capacity-building, public-sector monitoring, and exchange of health information between the public and the private sector. Such public/private collaborations will keep pace with the trends towards the development of private-sector provision of health services in developing countries.     

Role of the private sector in the provision of immunization services in low- and middle-income countries

The authors conducted a literature review on the role of the private sector in low- and middle-income countries. The review indicated that relatively few studies have researched the role of the private sector in immunization service delivery in these countries. The studies suggest that the private sector is playing different roles and functions according to economic development levels, the governance structure and the general presence of the private sector in the health sector. In some countries, generally low-income countries, the private for-profit sector is contributing to immunization service delivery and helping to improve access to traditional EPI vaccines. In other countries, particularly middle-income countries, the private for-profit sector often acts to facilitate early adoption of new vaccines and technologies before introduction and generalization by the public sector. The not-for-profit sector plays an important role in extending access to traditional EPI vaccines, particularly in low-income countries. Not-for-profit facilities are situated in rural as well as urban areas and are more likely to be coordinated with public services than the private for-profit sector. Although numerous studies on non-governmental organizations (NGOs) suggest that the extent of NGO provision of immunization services in low- and middle-income countries is substantial, the contribution of this sector is poorly documented, leading to a lack of recognition of its role at national and global levels. Studies on quality of immunization service provision at private health facilities suggest that it is sometimes inadequate and needs to be monitored. Although some articles on public-private collaboration exist, little was found on the extent to which governments are effectively interacting with and regulating the private sector. The review revealed many geographical and thematic gaps in the literature on the role and regulation of the private sector in the delivery of immunization services in low- and middle-income countries.     

To contract or not to contract? Issues for low and middle income countries

Many low and middle income countries have inherited publicly funded and provided health services, often operating at relatively low levels of technical efficiency. Changing ideas about the management of the public sector, in particular stemming from new public management theory, are spreading to these countries, whether directly or via the recommendations of multilateral and bilateral aid agencies. Pronouncements of agencies such as the World Bank imply that competitive contracting with the private sector is likely to improve the efficiency of services provision. However, very little evidence is available on whether this is likely to be the case, and in what circumstances delivery of services through contracts with the private sector is likely to be preferable to direct provision by the public sector. This paper draws on evidence from five country case-studies of contractual arrangements, in Bombay, Papua New Guinea, South Africa, Thailand and Zimbabwe, done through collaborative research between the LSHTM Health Economics and Financing Programme and local researchers in each country. A common evaluative framework was applied in each country to selected, existing contractual arrangements. Services provided under contract and evaluated included catering, cleaning, security, diagnostic services and whole hospitals. Information is presented on the design of contracts, the process of agreeing contracts including the extent of competition, and the monitoring of contract performance. A variety of evidence, including information on the relative cost and quality of contracted out versus directly provided services in the case of South Africa, Thailand, and Bombay, is used to explore whether or not contracting out to the private sector represented a preferable means of service provision. This analysis, together with information on the capacity of the agency letting the contract, and on the wider environment including the level of development of the private sector, is used to identify which aspects of the contracting process and the context in which it takes place are important in influencing whether or not contracting with the private sector is a desirable means of service provision.     

Economic evaluations of non-communicable disease interventions in developing countries: a critical review of the evidence base

Background

Public-private partnerships (PPP) could be effective in scaling up services. We estimated cost and cost-effectiveness of different PPP arrangements in the provision of tuberculosis (TB) treatment, and the financing required for the different models from the perspective of the provincial TB programme, provider, and the patient.

Methods

Two different models of TB provider partnerships are evaluated, relative to sole public provision: public-private workplace (PWP) and public-private non-government (PNP). Cost and effectiveness data were collected at six sites providing directly observed treatment (DOT). Effectiveness for a 12-month cohort of new sputum positive patients was measured using cure and treatment success rates. Provider and patient costs were estimated, and analysed according to sources of financing. Cost-effectiveness is estimated from the perspective of the provider, patient and society in terms of the cost per TB case cured and cost per case successfully treated.

Results

Cost per case cured was significantly lower in PNP (US $354–446), and comparable between PWP (US $788–979) and public sites (US $700–1000). PPP models could significantly reduce costs to the patient by 64–100%. Relative to pure public sector provision and financing, expansion of PPPs could reduce government financing required per TB patient treated from $609–690 to $130–139 in PNP and $36–46 in PWP.

Conclusion

There is a strong economic case for expanding PPP in TB treatment and potentially for other types of health services. Where PPPs are tailored to target groups and supported by the public sector, scaling up of effective services could occur at much lower cost than solely relying on public sector models.