ROLE OF THE ROLE OF THE PRIVATE SECTOR IN PRIVATE SECTOR IN

DELIVERY OF DELIVERY OF HEALTHHEALTH CARE CARE

Dr. Aruna RabelDr. Aruna Rabel

Medical Medical Administration ManagerAdministration Manager

Durdans HospitalDurdans Hospital

Annual Health Forum – 2007, BMICHAnnual Health Forum – 2007, BMICH

This is a joint This is a joint presentation ofpresentation of

• Appollo HospitalAppollo Hospital• Ceylon College of General Ceylon College of General

PractitionersPractitioners• Durdans HospitalDurdans Hospital• Glaxo Smith KlineGlaxo Smith Kline• MackwoodsMackwoods• Nawaloka HospitalNawaloka Hospital• Oasis HospitalOasis Hospital

What is the Private What is the Private Sector ?Sector ?

Any thing other than Any thing other than

Government (State or Public) SectorGovernment (State or Public) Sector

- - Mr.C.P.de Silva – Former Chairman Chamber of CommerceMr.C.P.de Silva – Former Chairman Chamber of Commerce

At OPA Annual Sessions 2004At OPA Annual Sessions 2004

Private Sector in Health Private Sector in Health Care Care

The whole gamut from The whole gamut from small scale pharmaciessmall scale pharmaciesand and General PractitionersGeneral Practitioners to to

large scale hospitals and large scale hospitals and pharmaceutical companiespharmaceutical companies

Contribution to GDPContribution to GDP

• State Sector - 20%State Sector - 20%

• Informal Private Sector – 45%Informal Private Sector – 45%

• Formal Private Sector – 35%Formal Private Sector – 35%

Private Sector in Health Private Sector in Health CareCare

• HospitalsHospitals• General PractitionersGeneral Practitioners• Diagnostics ServicesDiagnostics Services• Physiotherapy and Rehabilitation UnitsPhysiotherapy and Rehabilitation Units• Ambulance ServicesAmbulance Services• Home Nursing ServicesHome Nursing Services• Centres for DisabledCentres for Disabled• PharmaciesPharmacies• Pharmaceutical CompaniesPharmaceutical Companies• And many moreAnd many more

Health Expenditure – Sri Health Expenditure – Sri LankaLanka

as a percentage share of GDPas a percentage share of GDP [ [Source – National Health Accounts Source – National Health Accounts

2000 – 2002 2000 – 2002 ]]

0

0.5

1

1.5

2

2.5

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

Public

Private

Number of Private Number of Private HospitalsHospitals

Courtesy – Institute of Health Courtesy – Institute of Health

PoliciesPolicies

0

10

20

30

40

50

60

1990 1995 2000 2005

<10

.10 - 29

.30 - 99

100 +

Beds in Private HospitalsBeds in Private Hospitals Courtesy – Institute of Courtesy – Institute of

Health PoliciesHealth Policies

0

200

400

600

800

1000

1200

1400

1600

1800

1990 1995 2000 2005

100 +

.30 - 99

.10 - 29

< 10

Bed CapacityBed Capacity

• State : Private –State : Private –

Sri Lanka -- 16 : 1Sri Lanka -- 16 : 1

Western Province – 8 : 1Western Province – 8 : 1

• 65 % of the Private Sector beds are 65 % of the Private Sector beds are in Western Provincein Western Province

PerformancePerformance

Performance ( 1990 – Performance ( 1990 – 2005 )2005 )

• Number of Private Hospital beds - + Number of Private Hospital beds - + 100 %100 %

• Number of Inpatients - + 100 %Number of Inpatients - + 100 %

• Number of Out patients - + 140 %Number of Out patients - + 140 %

Performance - CABGPerformance - CABG

0

200

400

600

800

1000

1200

1400

2001 2002 2003 2004 2005

State

Private

Performance - PTCAPerformance - PTCA

0

100

200

300

400

500

600

700

800

900

2001 2002 2003 2004 2005

State

Private

General PracticeGeneral Practice

• Full Time GPs – 600 ( CCGP )Full Time GPs – 600 ( CCGP )

800 800 ( Independent ( Independent Survey)Survey)

• 2.8 / 100,000 population ( 1:35,000 people 2.8 / 100,000 population ( 1:35,000 people ))

• 35 % of Ambulatory Care handled by GPs35 % of Ambulatory Care handled by GPs

Exact details of the private sector Exact details of the private sector performance is not readily available performance is not readily available as there is no mechanism to collect as there is no mechanism to collect data.data.

Challenges Challenges

• Investment barriersInvestment barriers• InfrastructureInfrastructure• Human ResourcesHuman Resources• Maintenance of High Quality CareMaintenance of High Quality Care• Introduction of Cutting - edge Introduction of Cutting - edge

TechnologyTechnology• Expectations of ConsumersExpectations of Consumers

History of History of Public – Private PartnershipPublic – Private Partnership• Involvement of Traditional Health Involvement of Traditional Health

Care ProvidersCare Providers• Referrals to State Hospitals by Referrals to State Hospitals by

General PractitionersGeneral Practitioners• ‘‘Channel Practice’ by Government Channel Practice’ by Government

Sector ConsultantsSector Consultants• Supply of equipment and Supply of equipment and

pharmaceuticals by private sectorpharmaceuticals by private sector

Partnership - unofficialPartnership - unofficial

• State sector doctors working in private sector State sector doctors working in private sector after working hoursafter working hours

• Referrals to govt. hospitals from General Referrals to govt. hospitals from General PracticePractice

• Investigations and admissions through channel Investigations and admissions through channel consultationsconsultations

• Certain investigations sent to private sector and Certain investigations sent to private sector and patient bears the cost.patient bears the cost.

Partnership - officialPartnership - official

• Laboratory and other diagnostic services are Laboratory and other diagnostic services are obtained during trade union actions and break obtained during trade union actions and break downsdowns..

• Purchases – drugsPurchases – drugs

state sector monopoly was done away with open state sector monopoly was done away with open economy in 1978.economy in 1978.

• Purchases – equipmentPurchases – equipment

mainly supplied by the private sectormainly supplied by the private sector

Partnership - officialPartnership - official

• President’s Fund – President’s Fund – assistance in major surgical procedures, assistance in major surgical procedures,

treatment abroadtreatment abroad

• Employees’ Trust FundEmployees’ Trust Fund

• Social Services MinistrySocial Services Ministry

• Govt. employees’ insuranceGovt. employees’ insurance

Advantages of Advantages of PartnershipPartnership

• Multi - sectoral collaborationMulti - sectoral collaboration

• Cost reductionCost reduction

• Participatory planningParticipatory planning

• Increased efficiency in delivery of health Increased efficiency in delivery of health carecare

• Fill the service gapFill the service gap

Advantages ……..Advantages ……..

• Sharing of resourcesSharing of resources

• Quality assuranceQuality assurance

• Improved community participationImproved community participation

• Reduced cost for healthReduced cost for health

• Confidence of donor agenciesConfidence of donor agencies

Outcome of Poor Outcome of Poor PartnershipPartnership

• Poor utilization of available resourcesPoor utilization of available resources

• Unnecessary investments by both partiesUnnecessary investments by both parties

• Increasing cost of health careIncreasing cost of health care

• Drawbacks in quality assuranceDrawbacks in quality assurance

• Unplanned health care deliveryUnplanned health care delivery

Areas for partnershipAreas for partnership

• Primary Health carePrimary Health care• Secondary Health careSecondary Health care• Tertiary CareTertiary Care• Training of Health Care PersonnelTraining of Health Care Personnel• Health Care PlanningHealth Care Planning• ManagementManagement

State PolicyState Policy

The government will facilitate the The government will facilitate the development and regulation of the development and regulation of the private health care sector and private health care sector and promote better coordination with promote better coordination with this sectorthis sector..

-National Health Policy -National Health Policy 19961996

Private Sector must be enhanced Private Sector must be enhanced and strengthened to provide a buffer and strengthened to provide a buffer for free health care for free health care

Hon. Nimal Siripala de Silva Hon. Nimal Siripala de Silva

Minister of Health & NutritionMinister of Health & Nutrition

Annual Health Forum - 2007Annual Health Forum - 2007

Need of the HourNeed of the Hour

Public – Private DialoguePublic – Private Dialogue

initiated by the stateinitiated by the state

With equity and fairnessWith equity and fairness

Can’t we do it now?Can’t we do it now?

AcknowledgementsAcknowledgements

• AHF – SecretariatAHF – Secretariat

• Dr. Amal Harsha de Silva – Director Dr. Amal Harsha de Silva – Director PHSDPHSD

• Dr. Ravi RannaneliyaDr. Ravi Rannaneliya

Thank youThank you