1 Building Public/Private Partnership for Health System Strengthening Hospital Contracting Professor EK Yeoh School of Public Health and Primary Care The

1

Building Public/Private Partnership

for Health System Strengthening

Hospital ContractingProfessor EK Yeoh

School of Public Health and Primary Care The Chinese University of Hong Kong

Bali Hyatt Hotel, Sanur, Bali21-25 June 2010

2

Objectives Understanding the nature of hospital

contracting and context under which hospital contracting may be considered;

Knowledge of different models and options of hospital contracting;

Understanding why and how hospital contracting works; and

Developing a framework for hospital contracting

2

3

Outline Discussing nature and rationale of hospital

contracting Different models and options of hospital

contracting from the experience of a number of countries

Discussing the issues, logistics and application of hospital contracting in different countries

Discussing the challenges and issues of hospital contracting and PPP programmes in the context of the health care system of Hong Kong

Discussing a framework for hospital contracting

3

4

What is Contracting?

Contracting is a mechanism for a financing entity (such as a government ministry) to acquire a specified set of services, with specified objectives, of a defined quantity, quality, and equity, in a particular location, at an agreed-on price, for a specified period, from a particular nonstate provider (such as an NGO, private sector firm, or private practitioner).

Source: Benjamin Loevinsohn, Performance-Based Contracting for Health Services in Developing Countries: A toolkit. World Bank, 2008

4

5

What is Performance-Based Contracting?

A form of contracting that explicitly includes a clear definition of a series of objectives and indicators by which to measure contractor performance, collection of data on the performance indicators, and consequences for the contractor based on performance such as provision of rewards (such as performance bonuses or public recognition) or imposition of sanctions (such as termination of the contract or public criticism).Source: Benjamin Loevinsohn, Performance-Based Contracting for Health Services in Developing

Countries: A toolkit. World Bank, 2008

5

6

Defining services

Sanction

Performance monitoring

Grant ContractingPerformance-based

Contracting

“Loosely”defined

Clearly defined

Insufficient Sufficient

Weak Strong

Difference between Grant, Contracting and Performance-based Contracting

7

Contracting for Health Service Delivery in Developing Countries

“the impetus for all the contracting initiatives [studied] was the inadequate quality and coverage of government services, especially for poor people.”

Benjamin Loevinsohn, April Harding. Buying results? Contracting for health service delivery in developing countries.

Lancet 2005; 366: p. 680.

7

8

Nature of Hospital Contracting Performance-based

- clear objectives and indicators,- systematic data collection of the progress of the selected indicators- rewards or sanctions based on performance.

Services - primary healthcare; hospital surgeries; establishing a health insurance system; setting up and operating a voucher project; providing ancillary services such as equipment maintenance, cleaning, waste management, food preparation, and security, etc.

Typology- a management contract and a service delivery contract approaches

- context and services specific

Pay-for-Performance- focus on important objectives and uses financial rewards to reinforce good performance. Specific explicit, measurable outcomes and allows for termination of the contract for nonperformance.

8

9

Typology of Service Delivery Arrangement Service Provider Services Infrastructure Arrangement design selection management setup Financing Example

1. Government Government Government Government Government Government Government sets up public services primary health care centers

2. Inter- Government-1 Government-1 Government-2 Government-2 Government-1 Government transfers funds governmental from federal to provincial agreements governments

3. Management Government Government Private sector Government Governmenta Government hires a private contracts sector manager to manage existing government health services 4. Service delivery Government Government Private sector Private sector Governmenta Government hires NGO to contracts provide services where none exist 5. Government Private sector Government or Private sector Private sector Government NGOs submit proposals to grants to NSPs donor (w/ or w/o NGO government for needs identi- or community fied by community or NGO contribution) 6. Private sector Private sector Consumer Private sector Private sector Consumer or ?NGO establishes health services NGO/donor services in slum areas using its own funds ?For-profit providers establish private clinicNote: Government-1 and Government-2 refer to different levels of government. NGO = nongovernmental organization; NSP = nonstate provider.

a. Financing may be supplemented by formal or informal user charges.


9

10

Types of Pay for Performance and Their Relationship to Contracting


Who receives What the funds can Who provides Relationship to Type of P4P the funds be used for the funds Contracting

1. Rewards for local Local Programs of local National Performance agreements governments governments governments government rarely true contracts 2. Rewards National Programs of national Development Not related to national governments governments partners governments 3. Payment per Individual Personal uses Government, May be easier to introduce service (fee for health workers individuals, or in the context of contracting service) NSPs with NSPs 4. Performance NSP Other programs or at Purchaser Sometimes used in health bonuses the discretion of the care contracting NSP 5. Performance- NSP At discretion of the Purchaser Can be incorporated fairly based payment NSP easily into contracts Source: Author. Note: DPT3 = third dose of diphtheria/pertussis/tetanus vaccine; GAVI Alliance = formerly the Global Alliance for Vaccines and Immunization; NGO = nongovernmental

organization; NSP = nonstate provider.

10

1111

Models of Public–Private Partnership in Hospital Provision

Franchising Public authority contracts a private company to manage existing hospital

DBFO (design, build, finance, operate) : Private consortium designs facilities based on public authority’s specified requirements, builds the facility, finances the capital cost and operates their facilities

BOO (build, own, operate) Public authority purchases services for fixed period (say 30 years) after which ownership remains with private provider

BOOT (build, own, operate, transfer): Public authority purchases services for fixed period after which ownership reverts to public authority

BOLB (buy, own, lease back) Private contractor builds hospital; facility is leased back and managed by public authority

Alzira model Private contractor builds and operates hospital, with contract to provide care for a defined population

Martin McKee, Nigel Edwards, & Rifat Atun, Public–private partnerships for hospitals. Bulletin of the World Health Organization, November 2006; 84 (11)

1212

Other Private Participation in HospitalsOption Private sector Public sector responsibility

Colocation of private wingwithin or beside public hospital

Operates private wing for privatepatients. May provide onlyaccommodation services or clinicalservices as well.

Manages public hospital for publicpatients and contracts with private wingfor sharing joint costs, staff, andequipment.

Outsourcing nonclinicalsupport services

Provides nonclinical services(cleaning, catering, laundry,security, building maintenance) andemploys staff for these services.

Provides all clinical services (and staff)and hospital management.

Outsourcing clinical supportservices

Provides clinical support servicessuch as radiology and laboratoryservices.

Manages hospital and provides clinicalservices.

Outsourcing specialized clinicalservices

Provides specialized clinicalservices (such as lithotripsy) orroutine procedures (cataractremoval).

Manages hospital and provides mostclinical services.

Private sector responsibility

1313

Other Private Participation in HospitalsOption Private sector responsibility Public sector responsibility

Private management of publichospital

Manages public hospital under contractwith government or public insurance fundand provides clinical and nonclinicalservices. May employ all staff. May alsobe responsible for new capital investment,depending on terms of contract.

Contracts with private firm forprovision of public hospital services,pays private operator for servicesprovided, and monitors and regulatesservices and contract compliance.

Private financing, construction, andleaseback of new public hospital

Finances, constructs, and owns new publichospital and leases it back to government.

Manages hospital and makes phasedlease payments to private developer.

Private financing, construction, andoperation of new public hospital

Finances, constructs, and operates newpublic hospital and provides nonclinical orclinical services, or both.

Reimburses operator annually forcapital costs and recurrent costs forservices provided.

Sale of public hospital as goingconcern

Purchases facility and continues to operateit as public hospital under contract.

Pays operator for clinical services andmonitors and regulates services andcontract compliance.

Sale of public hospital foralternative use

Purchases facility and converts it foralternative use, depending on salesagreement.

Monitors conversion to ensureadherence to contractual obligations.

1414

Critical Policy Issues Regarding Hospital Contracting Universal access. To ensure that all public patients, particularly

the poor and uninsured, have access to adequate hospital care, most contracts for private management of public hospitals require the provider to continue service to all public patients.

Funding. Governments generally fund public hospitals through budgetary payments or public health insurance programs, shifting the basis for payments from historical or input costs to the clinical mix of patients to be treated.

Consolidation. Many countries, particularly in Eastern Europe, have too many public hospitals and will need to downsize, consolidate, and close some facilities. Public-private partnerships can spur consolidation of services.

Competition. Competition between hospitals stimulates improvements in the quality and efficiency of service.

Regulation. Public-private partnerships may impose additional public policy obligations that require monitoring, sanctions for noncompliance, and dispute resolution procedures.

1515

Other Issues Relating to Hospital Contracting

Cost: There are significant costs for the firms bidding for a public–private partnership and for the health-care provider.

Quality: Trade off between cost, time and quality. Priority has been to meet the specifications agreed in the initial contract, with a reluctant acceptance that the project may go over time or budget.

Flexibility: Public–private contracts are often specified in details with large penalties for introducing changes, leading to a lack of flexibility. Some hospitals has been out of date by the time they are opened in a changing environment.

Complexity: Projects involve many different types of stakeholders, such as universities and research funders. The difficulties in reaching agreement with all of the stakeholders, combined with the high costs of the projects, may eventually lead to collapses in the project.

1616

Context Under which Hospital Contracting may be Considered

• Limited health services but with “mission” clinics or other faith-based organizations

• Poorly performing districts, provinces, or states with existing government health services

• Uncoordinated NGO-delivered services with multiple donors (for example, post- conflict situation)

• Few services of any kind, or new kinds of services required (for example, HIV prevention, nutrition services, early childhood development services)

• Existing government services where improved management is needed or innovations are required

• Urban health services with many different providers but limited coverage of preventive services for the poor

1717

Examples for Hospital Contracting in low Income Countries

Contracting out dietary services (Bombay) Contracts to hospital security and cleaning, and

ambulance services (Port Moresby, Papa New Guinea)

Contract for major items, such as CT scanners (Bangkok)

Contract for rural district hospitals (Africa) Contact with a mining companies for the use of

their hospitals to provide hospital services in district (Zimbabwe).

Source: Anne Mills To contract or not to contract? Issues for low and middle income countries . Health Policy and Planning; 1998; 13(1): 32-40.

1818

Corresponding Reasons for Hospital Contracting in Low Income Countries

Reduction of the workload on management; expected to be cheaper; reduces wastage and pilferage; avoid service interruption (type: catering; place: Bombay)

Obtain cheaper; better quality service (type: cleaning; place: Bangkok)

Obtain latest equipment; avoid difficulty and delays in getting government approval and funds; overcoming difficulties of maintenance (type: medical equipment; place: Thailand)

Make use of private sector capital (type: building district hospital; place: South Africa)

Lack of government capacity (type: contract with private hospitals with spare capacity; place: Zimbabwe)

1919

Objective Conditions for Hospital Contracting in Low Income Countries

Sufficient private sector capacity for efficiency gain

Government offers an attractive business market Failure for the government to provide efficiently Inflexible and inefficient public provision Social, political and economic environment such as

functioning legal, banking, and government procedure, resistant to corruption and patronage

2020

Some Problematic Issues regarding Hospital Contracting

Unclear responsibilities for contract design and for monitoring contract performance.

Unclear specification of services to be contracted out

Unclear incentive schemes to motivate performance

2121

Other Motivations for Contracting

Strengthening healthcare financing Cost containment and efficiency gain Improve healthcare quality (such as reduce

waiting time) and patient safety Development of regional medical hub

2222

Steps to ContractStep 1: Conduct Dialogue with StakeholdersStep 2: Define the ServicesStep 3: Design the Monitoring and EvaluationStep 4: Decide how to select contractors and

establish the priceStep 5: Arrange for contract management and

develop a contract planStep 6: Draft the contract and bidding

documentsStep 7: Carry out the bidding Process and

Manage the contract


2323

Complexity of Hospital Contracting

Specify outputs Payment method Price/rate determined Delivery monitored Compliance Conflict resolution Incentives to induce participate Risk sharing arrangements Managing uncertainty Cost recovery and profit

2424

Politics of Hospital Contracting

a) the decision to contract; b) the process to contract;c) the relationship between government,

public sector employees, non-government providers, and citizens

2525

Focus on Results. The very act of drafting a contract can help the purchaser define exactly what services are needed and help make objectives explicit.

Flexibility. NSPs have the important advantage of being less constrained by “red tape” (excessive regulation), bureaucratic inertia, and unhelpful political interference. In many circumstances, this is the largest advantage of NSPs over government delivery of the same services.

Reduction of Important Aspects of Corruption. Contracting appears to reduce some aspects of corruption that plague public health care systems, such as absenteeism, theft of drugs, selling of positions, leakage of funds on their way to peripheral health facilities, and informal payments to providers.

Constructive Competition. Contracting uses constructive competition to increase effectiveness and efficiency. Nonstate providers are impelled through competition to develop the most effective and efficient ways of delivering services, both during the bidding process and during implementation.

Why Contracting work?

2626

Improved Absorptive Capacity. Nonstate providers are usually better at overcoming “absorptive capacity” constraints that often plague government health care systems and prevent them from effectively using the resources made available.

Better Distribution of Health Workers. As a result of greater flexibility and innovative approaches, NSPs can often improve the distribution of health workers and help ensure that skilled health workers are available and working in underserved areas.

Managerial Autonomy. Contracts, if drafted properly, provide managerial autonomy and decentralize decision making to managers closest to the ground.

Government Focus on Stewardship Role. Contracting provides a greater opportunity for government to focus on roles that it is uniquely placed to carry out, such as planning, evaluation, standard setting, financing, and regulation.

Why Contracting work?

2727

Asian PPP Experiences

Singapore – Exploring the role of PPP in healthcare delivery and financing

Malaysia – PPP in healthcare financing via private health insurance

Hong Kong – mainly for healthcare delivery

2828

PPP in Hong Kong’s Healthcare System

Case Study

29

Hong Kong’s Health Policy

“no one should be denied adequate medical treatment through lack of means”

3030

“Dual” health care system

Public sector Private sector

Food & Health Bureau

Department of Health

Hospital Authority

• Execute health care policies & statutory functions

• Statutory body responsible for management of public hospitals

Hong Kong’s Healthcare System

3131

Delivery of Services

Primary care ◦ Health promotion & disease prevention services

mostly provided by the public sector ◦ Primary care curative services

Service provided by Out-Patient departments of HA hospitals (26%)

Service provided by private Western medicine doctors (57%)

Service provided by private Chinese medicine practitioners (13%)

Secondary & tertiary services ◦ Public sector is the dominant provider (79%)

Source: Thematic Household Survey 2008

3232

Public Sector Private Sector

• Hospital Authority (HA) operates 74 general outpatient clinics and 48 specialist outpatient clinics throughout the territory

• Around 3,500 private clinics providing primary & specialist medical care

• HA manages 27,555 hospital beds in 38 public hospitals

• 12 private hospitals, operating a total of 3,438 beds

Source: Hospital Authority Statistical Report 2007-08

3333

Healthcare Expenditure

Total health care expenditure (2005/06 figures)◦ 5.1% of Gross Domestic Product (GDP)

Public sector (52%) Private sector (48%)

Source: Hong Kong’s Domestic Health Accounts, 1989/90-2005/06

3434

Sources of Funding

As percentage of total expenditure on health(All figures refer to calendar year)

2001(%)

2004(%)

General Government 56.9 55.7

Social Security Funds 0 0

Private household out-of-pocket expenditure

29.5 31.1

Private insurance 12.1 12.3

All other source 1.4 1.0

Sources: Hong Kong’s Domestic Health Accounts, 1989/90-2004/05

Tax-based Financing

3535

Healthcare Funding Public sector: heavily subsidized (2006/07

figures)

Private sector: fee-for-service, free market

Public Hospitals & Clinics

User Fees ($)

Cost ($)

Government Subsidy (%)

In-patient (ward level – per day)

100 3,290 97.0

A&E (per visit) 100 700 85.7

SOPC (per visit) - first visit - subsequent visits

10060

740 86.591.9

GOPC (per visit) 45 260 82.7In-patient cost represents general in-patient services, excluding infirmary, mentally handicapped and psychiatric services (Sources: Healthcare Reform Consultation Document, FHB 2008)

3636

Hospitals in Hong Kong

- Pre-Hospital Authority era- Establishment of Hospital Authority - Post-Hospital Authority era

3737

Pre-Hospital Authority Era

A mix of public hospital services provided by government departments and 15 Non-government Organisations on a subvented basis

Overseen by the Medical and Health Department

Lack of explicit services agreement and contracting

Problems: over-centralization, lack of financial incentives, inflexibility, low staff moral, lack of courtesy to patients, long waiting time, over-crowding, poor coordination between government and subvented hospitals

3838

Establishment of the Hospital Authority (HA)

The HA was found in 1990. Establish governance and management

systems across all constituent hospitals. Manage HK’s public healthcare services

including hospitals, specialist out-patient clinics and general out-patient clinics

3939

Post-Hospital Authority Era

A single corporation that manages the public hospitals in HK

Explicit services agreement

4040

PPP: General Principles

Public Private Partnerships (PPPs) are arrangements where the public and private sectors both bring their complementary skills to a project, with varying levels of involvement and responsibility, for the purpose of providing public services or projects.

Source: Efficiency unit, HKSAR Government

4141

Characteristics of PPP Large scale expensive long-term projects usually involving

the construction of a new facility designed to deliver particular services;

The Government defines the quality and quantity of services, and the timeframe in which they are to be delivered;

The private sector is responsible for delivering the defined service while the government is mainly involved in regulation and procurement;

A long term relationship is established, typically between 10 years and 30 years, depending on the nature of the facilities, assets or services to be delivered


4242

Characteristics of PPP Responsibilities and risks are allocated to the party best

able to manage them;

The private sector and/or the Government finances the project (wholly or in part). The private sector and/or the Government would recoup its investment from charges on end-users or payments made by the Government during the life of the contract;

The private sector is encouraged to make use of its innovation and flexibility to deliver good quality, cost-effective services throughout the project lifecycle; and

The different functions of design, construction, operation and maintenance are integrated / use a whole-of-life approach.


4343

Healthcare Financing Reform Proposals

Financial pressures on the government provision of public healthcare

Aging population Medical technology Social expectation

Continued reliance entirely on public supply and funding - sustainable?

Any alternatives: financing system; expanding the role of PPP, enhancing public-private interface

4444

Examples of PPP in HK Cataract Surgeries Programme

Haemodialysis Public Private Partnership Programme

General Outpatient Clinic Public Private Partnership Programme

Shared Care Programme

Development of private hospitals - North Lantau Hospital Phase 2 Public-Private Partnership Project Hong Kong Hospital Authority: http://www3.ha.org.hk/ppp/pppprogrammes.aspx

45

Cataract Surgeries Programme (starting from February 2008)

To shorten waiting time for cataract surgery in public hospitals

45

4646

Cataract Surgeries Programme Target Group

Patients who have been on the HA routine cataract surgery waiting list as at 1 Feb 2008

Financial incentives A One-off funding (HK$ 40million) by the Government for

implementation– Providing subsidy to patients to receive cataract surgery in private sector

Fees and Charges◦A maximum subsidy of HK$5,000 to patients for cataract surgery provided by private ophthalmologists.◦Co-pay not more than HK$8,000◦Consists of 1 pre-op assessment, the intraocular lens in the surgery and 2 post-op checks

4747

Cataract Surgeries Programme

Outcome Shorter waiting time: reduce from 35.5 months to 31

months (Dec 2009)

91% of patients are satisfied with the Programme

98% of patients say: - Easy to select a suitable ophthalmologist from the

pool of participating private ophthalmologists, - The Programme has helped them to receive surgery

earlier.

Smooth cooperation between the public and private sectors in arranging surgeries and providing follow up support service

48

Haemodialysis Public Private Partnership Programme

(3-year pilot starting from March 2010)

To enhance HD service for ESRF patients To enhance patients’ self care capacity and

improve QoL To enhance collaboration between HA &

community medical organizations

48

4949

Haemodialysis Public Private Partnership Programme Target Group Patients on haemodialysis (HD) in HA hospitals with stable conditions Arrangement HA will collaborate with community medical organisations to provide

options for patients to receive HD in the community1. Nephrologists assess patients conditions and invite suitable

patients2. Patients complete and sign consent3. Patients enroll in the “Public-Private Interface-Electronic Patient

Record Sharing Pilot Project”4. Patients receive HD in the community; HA will provide follow-up,

medications and examinations. Fees & Charges

Patients pay the community HD centres the same fee as charged by HA

Outcome To be evaluated

50

General Outpatient Clinic (GOPC) Public-Private Partnership Programme

- Tin Shui Wai Primary Care Partnership Project

(a pilot starting from June 2008)

To expand GOPC services in districts with increasing demand for GOPC services by piloting a PPP model for the delivery of primary care service and promote the family-doctor concept in the community

50

5151

GOPC PPP Programme Target Group

Patients suffering from specific chronic diseases such as DM, HT, COAD, etc. with stable medical conditions and in-need of long-term follow-up treatment at GOPCs

Arrangement◦HA to purchase primary care services from private medical practitioners ◦Patients to receive a maximum of 10 subsidized visits to a private doctor for treatment of specific chronic illness and episodic illnesses per each 12 month period of participation

Fees & Charges◦Patient pay for private GP services at the same fee that they currently pay for GOPC services. Outside the 10 subsidized visits, the patient can choose to be treated by private doctor at his/her own cost or attend GOPC for follow up.

52

GOPC PPP Programme Outcome

◦ Over 1,000 patients have been enrolled◦ High satisfaction rate from both participating

patients and PMPs.

An extension phase of the GOPC PPP pilot is under consideration.

52

53

(Pilot to be started in mid 2010 at Sha Tin and Tai Po districts)

To test a service model for public-private shared care for chronic disease patients in the primary care settings

To provide patients with choices of private services outside the public healthcare system

To establish long-term patient-doctor relationships in order to achieve the objective of continuous and holistic care

53

Shared Care Programme

5454

Shared Care Programme Target Group

Clinically stable DM and/or HT patients who are currently taken care of by the public healthcare system

Financial Incentives Subsidy in the form of electronic health care

vouchers to patients to use the primary care services from private medical practitioners

55

Shared Care Programme Arrangement

◦ Patients: (a maximum subsidy of HK$1,400 per year) (i) A subsidy of HK$1,200 for at least 4

consultations/case management per year at an interval of not more than 4 months apart and drugs for treating DM and/or HT;

(ii) An incentive of up to HK$200 per year for patients who can meet the preset health outcome indicators and complies with the care requirements prescribed by their private medical practitioners

◦ Private Medical Practitioners: Quality incentive of HK$200 each year for each patient under his/her care in the Programme. They must meet all process indicators in order to receive the payment.

Outcome To be evaluated

55

56

- North Lantau Hospital Phase 2 Public- Private Partnership Project

(to commence in early 2010)

To increase the overall capacity of the healthcare system of Hong Kong and facilitate the development of the medical industry through the promotion of private hospital development

56

Development of Private Hospital

5757

Development of Private Hospitals To address the imbalance between the

public and private sector◦ 39 Public vs. 13 Private Hospitals◦ Over reliant on public service◦ Limited competition and collaboration and

choice for patients◦ Threat to long-term sustainability of healthcare

system

Development of private hospitals at sites at Wong Chuk Hang, Tseung Kwan O, Tai Po and Lantau

Source: Invitation for Expression of Interest – Development of private hospitals at sites HKSAR 2009

5858

Government to facilitate the development of private hospitals through enhanced support in hardware and software

Hardware Reserving suitable sites for private hospital development(4 sites situated in Wong Chuk Hang, Tsueng Kwan O, Tai Po and Lantau)

Software Continue to enhance training and development of healthcare professionals; attract oversea talents to enhance sharing of expertise and raise service standards

Development of Private Hospitals

5959

North Lantau Hospital Project

Phase one – To build a public hospital with 180 beds to meet the needs of the local community on Lantau Island

Phase two – To explore the introduction of PPP for private sector to provide other medical services and facilities in the available area in the hospital site

6060

Possible PPP Models The following models are ruled out:

◦ Financing: Private provider to finance the building of the public hospital.

◦ Ownership: The Government and the private provider to share the ownership of a hospital building.

◦ Operation of services: Private provider to deliver all public clinical services through a contracting-out arrangement.

6161

Possible co-location Models Co-location of public and private

components within the same buildings (i.e. vertical co-location) or in separate buildings on adjacent sites (i.e. horizontal co-location)

6262

Horizontal co-location The private provider will finance, design,

build, own and operate the private component on the land acquired from the Government.

To transfer the ownership and operation of the private facilities to the Government after a pre-determined fixed period of time.

Government may entrust the private provider to design and build the public component in tandem with the private development. The Government will bear the costs for the public component.

6363

Vertical co-location The land and the hospital building to be

built thereon will remain the property of the Government.

Part of the building (e.g. a number of floors) will be let to the private provider to operate and provide private services.

The Government may entrust the private provider to design and construct the hospital building, where both the public and private components will be accommodated.

6464

Collaboration Between 2 Sectors Purchase of services

◦ Clinical and allied health services◦ Clinical supporting services

Other contracting-out arrangements◦ Management and administration (e.g. accounting,

information technology)◦ Building arrangement (e.g. maintenance, cleansing,

security)◦ Other ancillary services (e.g. catering, laundry, portering)

Staff arrangements◦ Cross-attachment of staff between the public and private

Land disposal arrangements

6565

Context◦ Health Systems

Policies Organisation Financing and payment

◦ Capacity Government

−Technical−Political

Private Sector◦ Human resources◦ Social-economic-political environment◦ Societal values

Framework for Hospital Contracting

66

Issues Priorities Objectives of contracting


67

Consider alternatives to contracting Beside options for contracting Assess impact of contracting options Seven-steps to contracting Monitoring and evaluation


6868

Thank You!

Documents

1 Building Public/Private Partnership for Health System Strengthening Hospital Contracting Professor EK Yeoh School of Public Health and Primary Care The