The Triple Win. Rethinking Public Private Partnerships for Healthcare in Vietnam

Transcription

1 The Triple Win Rethinking Public Private Partnerships for Healthcare in Vietnam Dr. Niti Pall Medical Director to the Global Health Practice KPMG Center for Universal Health Coverage

2 Contents A Global Snapshot of PPPS for Health Spotlight on Vietnam Defining success and understanding failure Rethinking PPPs for Universal Coverage What this means for Vietnam

3 Our global healthcare network Healthcare systems around the world are facing unprecedented challenges that require policy makers, payers, providers and suppliers to rethink how they work. With deep industry experience, KPMG member firms are uniquely positioned to provide guidance and support to clients. 45 KPMG country KPMG health practices 4,500+ Partners and staff work in healthcare

4 Our global healthcare network KPMG has one of the world s largest health PPP networks, working on dozens of deals a year for public & private clients. Bahamas Implementation of Universal Health Coverage using a Third Party Insurer for the National Health Fund United Kingdom Multiple NHS hospital and clinic PPPs nationwide Portugal Implementation of one of the first true population-based PPP hospital projects India Multiple PPPs for entire hospital and specialty centre groups (5-12 hospitals at a time) Australia PPPs for managed services and one of the largest new academic medical centers in the country

5 What is a PPP? Privatisation Degree of private sector risk Joint Ventures (e.g. equipment) Service contracts Concession model DBFM plus clinical operations Design-build-finance-maintain (DBFM) facility PPP models Degree of private sector responsibility

6 PPPs and health: The market is shifting east Mature - Continuing Mature - Declining Growth High Growth - Moderate Emerging

7 PPPs and health: The market is shifting east For the private sector, there is appeal in emerging health systems growing at several times those of the West A B C D E A B C D E $3.2 trillion +4.6% p/a $0.5 trillion +6% p/a $2.2 trillion +3% p/a $0.2 trillion +8% p/a $1.6 trillion +10% p/a

8 PPPs and health: The market is shifting east Limit the seemingly bottomless pit of UHC s potential costs to government De-risk projects where govt lacks expertise (e.g. digital health) 1 2 For governments pursuing UHC, PPPs offer 4 key benefits 4 3 Bring new innovations and ideas into the provision of services Improve access and quality while limiting upfront investment by the state, whose capital can go further

9 Spotlight on Vietnam Vietnam Ministry of Planning and Investment has had success with PPPs in non-health sectors: transport, energy, agriculture, science. In the health sector, PPPs are being used but are sporadic and not necessarily coordinated to greatest needs and government vision: Many related to joint ventures for equipment High interest in quick win areas large hospitals in urban centers: not always the biggest need Untapped potential of private sector partners in: 1. Integrated healthcare networks 2. Chronic disease partnerships / Primary care 3. IT/eHealth 4. Management skills to operate effective providers

10 Why PPPs fail: Lessons from mature health systems Choosing the wrong partner Erroneous projections about the future This triple win is not always realized, however Narrow thinking of what services to target Paying for what is easily measured, not what matters

11 Rethinking PPP for Universal Coverage The public sector is finding new areas to leverage private expertise 1 New private sector partners are coming to the fore 2 New partnership forms emerging, to reward outcomes not activity 3

12 Success stories: A population based PPP model in Spain Primary health centers (primary care) 20 centers Population of Manises Specialist center in Mislata (specialist care) 21 outpatient consultation rooms Mislata Hospital (long-term care) 21 beds Manises Hospital (acute care) 219 single rooms 11 large multipurpose operating theatres 24 post-surgery recovery rooms 32 outpatient examination rooms 6 pre-delivery labor rooms 2 delivery rooms 53 outpatient consultation rooms 10 intensive care rooms 34 dialysis units Specialist center in Aldaia (specialist care) 20 outpatient consultation room PLUS 193, % Hospitals (450 beds) Primary care clinics Long-term care center Specialist centers Community teams Population Concession to Sanitas

13 Success stories: A population based PPP model in Spain Primary health centers (primary care) 20 centers Population of Manises Specialist center in Mislata (specialist care) 21 outpatient consultation rooms Mislata Hospital (long-term care) 21 beds Manises Hospital (acute care) 219 single rooms 11 large multipurpose operating theatres 24 post-surgery recovery rooms 32 outpatient examination rooms 6 pre-delivery labor rooms 2 delivery rooms 53 outpatient consultation rooms 10 intensive care rooms 34 dialysis units Specialist center in Aldaia (specialist care) 20 outpatient consultation room PLUS 193, % 38 Hospitals (450 beds) vs 120 days Primary care clinics 149 average waiting Long-term care center time for ER vs 224 mins Specialist centers 42% Community teams fewer 8.9 average waiting time for surgery complications Population average patient Concession to Sanitasatisfaction score vs 8.5

14 What works? How to make PPPs a success Sweat the small stuff Active market management Scaling up PPP capacity in the public sector Embrace, rather than resist, the politics of PPP Data systems you can trust From clarity of objectives to clarity of requirements

15 ACCELERATE THE GOVERNMENTS GOALS ON UNIVERSAL LTHHEALTHCARE ACCESS Ongoing monitoring to ensure projects and wider market are performing as intended Undertake a detailed strategic analysis of the future health system to 2030 mapping projected population health needs and future possibilities of digital health etc. Shape and evaluate specific projects based on this longterm vision Implement projects Design and execute innovative partnerships models and contracts A whole health system view of PPPs for health Undertake a global search for the best possible private partners to work with

16 Thank you