PPP: Global Snapshot

Transcription

1 Gwenae Dhaene, PhD Heath Systems Governance and Financing Department PPP: Goba Snapshot 1 Pubic sector rationae for PPP 2 Avoidance of cost overruns on deivery of capita projects their risk Favouring innovation the service wi be different Management/organisationa change the service wi be better Vaue for money / Cost effectiveness the service wi be cheaper Acceerated provision the service wi be provided more prompty Financia stabiity and economic viabiity - budget nightmare over Outsourcing capita financing going off the books / off baance Operationa effectiveness they wi aways deiver 2 1

2 COXA - Finand 3 Name: Organisationa form: Coxa Hospita for Joint Repacement Limited company Ownership Pirkanmaa Hospita District (PHD) 35 %, Tampere City 20 %, Terveysrahasto Oy 20 %, Orton Hospita 5 % and four Pirkanmaa municipaities 5 % each. Business idea: Voume (2003): (2014): Panning started: 1998 Providing PHD with endoprosthetic surgery and nation-wide services in the area of demanding endoprosthetic reoperations endoprosthetic surgeries. Turnover 12.7 miion. Empoys 11 speciaised doctors, 46 nurses and physiotherapists 7,500 endoprosthetic surgeries Turnover 41.3 miion Euro Start date: Company estabished in January 2001 Operations started in September Description of innovation: Outsourcing of a joint repacement surgery from the PHD into a imited company servicing patients from the Pirkanmaa region and private patients. 3 What s the matter? 4 The probem for the Region Increasing waiting times for treatment Shortage of capita Heath inequaities Joint repacements in a major hospitas - dupication The probem for the hospita Joint repacement unit embedded within teaching campus, competing for resources Poor quaity outcomes Capita hunting Uncertainties on staff retaining 4 2

3 The PPP soution 5 Proactive move out of State system via an innovative PPP mode creation of a imited private company with Pubic and private sharehoding such as Municipaities, Other hospitas, Private equity Tota freedoms on capita and workforce strategies Acceptance of risk Concept quaity driven integrated, whoe systems, (regiona) care Viabiity, dependant upon: Roe sharing within other competing oca hospitas ( territories ) Competitive tendering (cost and quaity) Adequate debt servicing (capita and equity) 5 Case performance 6 Operating procedures increase, 1494 in 2003 to 8,000 in 2016 Reduced ength of stay 3 day stay 90% same day operation 90% of patients are transferred for rehabiitation to primary care ed faciities and services Compication (infection) rates < 1% Finnish Occupationa Heath Study (Work and Heath of Finnish Staff) rated Coxa, outstanding for workforce satisfaction Finnish nationa heath and socia wefare institute rated, Coxa as exempary for patient satisfaction Financia security has aowed price reductions and sef-financed sustainabe capita deveopment 6 3

4 Critica success factors 7 Concept based on proven cinica principes Quaity and Responsiveness Transparent cinica governance PPP added vaue to the concept: Financing freedoms Workforce rewards (2009: Award for Best workpace in Finand!) Pubic participation Open diaogue - transparency Generated from within the pubic system Management competency 7 NHS Treatment Centres Mixed feeings? 8 NHS outsourcing through concession with secondary care technica units Increase eective capacity in routine service areas e.g. cataracts no deep eve anaysis of need Reduce spot prices in private sector Increase patient choice Stimuate innovation Reform through competition DH organised tendering and icencing (28centres) Most are stand aone practices Empoyment of NHS staff were prohibited at first (6 month quarantine) Loca hospitas had no say / no invovement in their estabishment 8 4

5 Why it didn t work so we after a 9 Pariamentary seect committee report No major contribution to increasing capacity Measurabe price effect on other private sector providers Increased patient choice, but no information on quaity Evidence of good practice No discernabe systematic transfer of good practice and innovation to the NHS Concerns that preferentia financia status has adversy impacted on NHS hospitas NHS Commission report Comparabe cinica quaity but evidence of seectivity Poor quaity and inconsistent data poor reporting of adverse incidents Poor integration of the process of care and poor reationships between ISTC and NHS staff 9 Insider view (Prof. B. Dowdeswe, Former NHS) 10 Top down imposition Guaranteed contract and prices Likey to prove short term respite for waiting ist pressures Has not created a breakthrough in pubic / private success Has not set higher cinica and performance standards May have destabiised some oca hospita finances Notabe absence of reiabe evidence based comparabiity a probem of transparency New wave of centres scaed down by Minister 10 5

6 PFI- renewing hospita through capita investment and incusive services 11 Incusive modes for a goba non-cinica service deivery (BOOT, DBFO) «Seing ike hot cakes» in the UK and in Austraia during end 90 s and 00 s (over 2,500 M in capita investment in 2001 with 105 projects and 1,300 M 2014 with ony a few major hospitas in the UK); Taking on wordwide: Barts and the Roya Hospita (London) Port MacQuarie (Austraia) Roubaix Genera hospita - maternity unit (France) Prezeva Regiona hospita (Greece) Typica arrangements provide design, financing through capita investment, buiding, operation and maintenance of faciity (with ownership easing arrangement and a transfer provision to the pubic sector at the end): BOO(T), DBFO, DBFOM 11 Pros and cons in a nutshe 12 Positive resuts Buiding costs reduced by 20% to 25% Quaity Comparabe - Pubic / PPP High performance vaues e.g. bed occupancy rates Quicker access - reduced waiting time Systemising the care pathways Using systemised care pathways as the basis of hospita design High rates of investment in technoogy Negative outcomes ( typicay 3 to 4 years ater) Quaity decay (contracts not sustainaby viabe) Cost spira Unreaistic pricing from the start (to undercut pubic rate) Contract trading Undermined pubic confidence (an hardened opposition) 12 6

7 Case study: UCS Skopje Hospita 13 UCS scattered over 30 sites Reocation / Greenfied site? EIB project: hidden agenda? Internationa co-ordination: overapping with WB PPP projects (miitary hospita reconversion)? DBFO? O&M? Anciary services, concession? What about pubic capacities? 13 FYROM

8 Snapshot: Egypt 15 Aexandrie Governorate Design / Construction of a 100 bed oncoogy centre (contract duration : 20 years) Project aunched in Dec. 2008, awarded in Dec (operationa in Dec. 2011) Independent oncoogy centre DBFOMT Cairo Governorate Design / Construction of a 100 bed rehab centre (contract duration: 20 years) Project aunched in Sept. 2008, awarded in Sept (operationa in Dec. 2011) - DBFOMT Beheira Governorate Design / Construction of bed centra hospitas (contract duration : 20 years) Project aunched in Sept. 2008, awarded in Sept (operationa in Dec. 2011) - DBFOMT Pus 5 more DBFOM projects Pus setting up of a strong PPP unit Pus innovative PPP in the pharmaceutica sector (with Ei Liy) Pus European Commission support (TAIEX 24988) 15 Overview: India (biatera ony!) 16 India, Poicy for Pubic Private Partnerships for State Governments in India (Haryana -2003, Himacha Pradesh , West Benga , Uttar Pradesh ) India - West Benga, (KfW: , DfID: ) Design and Management support for PPP for emergency Transportation Services and Diagnostic Services in Rura Hospitas India - West Benga, (KfW: ) Design of PPP for Management of Primary Heath Centres and Fair Price Medicine Shops in Rura Hospita India - West Benga, (KfW: ) Promotion, Marketing and Advocacy Support for PPPs in PHC India - West Benga, (KfW: 2007) Capacity Buiding for Management of PPPs India - West Benga, (KfW: ) Design and Piot of Voucher Scheme for Ensuring Safety Net for Emergency Transportation Services India - West Benga, (DfID: ) PPP Design for Setting up Fair Price Pharmacy Shops in Medica Coeges and District Hospitas India - West Benga, (DfID: 2007) PPP Design and Operationaization Support for Increasing Access to Institutiona Deivery Services (Ayushmati Scheme) India - Dehi, ( ) PPP Design and Operationaization Support for Pre Hospita Emergency Response (Ambuance) Services India - Uttar Pradesh, (2008) PPP Design and Operationaization Support for Management of PH Faciities India - Himacha Pradesh (2004) Deveoping the Operationa Framework for PPP in Heath India - Haryana (2004) Deveoping the Operationa Framework for PPP in Heath India - Rajasthan, (2007) Contracting Framework for PPP and Support for Deveopment of PPP Ce within the Government Department 16 8

9 13/10/16 17 Karoinska, PPP forward? 17 PPP en et CSU AfHEA_ Shoukran Jazian! Dr Gwenae Dhaene 18 PPP en et CSU AfHEA_