CURRENT SITUATION ASSESSMENT AND RECOMMENDED SOLUTIONS TO STRENGTHEN PUBLIC PRIVATE PARTNERSHIP IN HEALTH SECTOR
Public private partnership (PPP) in health sector has been implementing in many countries worldwide, including Vietnam to enhance resources for health care, improve health service quality and efficiency. Within the public-private mix health system in Vietnam at present, partnership between public and private health to reach the objectives of equity, efficiency and development is becoming a priority in health policy making. Study to develop and propose appropriate, scientific and evidence-based PPP models is very necessary and significant under the current health context of Vietnam.
II. STUDY OBJECTIVES
To evaluate the current situation of public private partnership (PPP) in examination, treatment and prevention, and recommend solutions to promote the role and potentials of private health in people’s health care and protection to contribute to ensure the objective of equity, efficiency and development.
III. STUDY METHODS
The study employs cross-sectional descriptive method in combination with data retrospective in period of 2005-2009. Data are collected based on prior designed questionnaires together with in-depth interviews, group discussion with leader of health management agencies, social securities offices, public and private health facilities. The study is conducted in 4 provinces and cities of Ha Noi, HCMC, Thai Binh and Thua Thien Hue. In each province/city, 1 private general hospital, 1 public general hospital at provincial level, 1 public district hospital, 1 private general clines and 1 commune health center in the same location, and 2 private clinics (one day time and another outside working hours) are selected to participate in the study.
IV. KEY STUDY RESULTS
PPP types in area of examination and treatment:
• Private signing contract with social securities to deliver health insured medical services. However this type remain limited. The total private health facilities signing contract on health insured medical service delivery is at 276/7,918, accounting for 3.5%. The number of health insurance cards registered at private health facilities only account for 3.8% of such total at public and private facilities. The rate of health insurance cards registered at private health facilities varies from one to another province. HCMC and Thai Binh Province has higher number of health insurance cards registered at private health facilities compared with Hue and Ha Noi (7.2% and 6.5% compared with 0.8% and 0.4%). Health insured medical services that private health facilities mainly deliver are outpatient services, at 93.8%.
• Private participating to sign contract with public health facilities to provide testing and high-tech services. Nevertheless this type is still limited and only seen in one of the 4 studied provinces.
• Private signing contract to deliver non-health services like sanitation, laundry, security, nutrition kitchen, electricity and water is rather common and effective.
• Private health facilities sign contracts on training and retraining for staffs of private health facilities and issue certificates for participants. However it is only originated from the demands of private health facilities. There is no official cooperation between public and private sectors in human resources for health. In fact nearly 80% of public health professionals work extra hours for private health facilities.
• Private signing contracts with public hospitals to invest in medical devices, mainly in two forms: joint venture to place medical devices for profit sharing, and medical device placement and monopoly rights of chemical supply for public health facilities. This type is strongly developed in large and crowded cities with better economic conditions.
PPP types in prevention: PPP in prevention remain limited. Key forms include social franchising with blue star, sisterhood; social marketing with free condom, syringes and needles distribution for groups; service voucher with voucher for PLHIV/AIDS.
PPP potential in examination, treatment and prevention:
Examination and treatment: Private may sign contracts with public health facilities to invest in medical devices, infrastructure; deliver testing and high-tech services; provide non-health services; and training and technological transfer.
Prevention: Private may participate to carry out some activities within national health programs like HIV/AIDS, TB, reproductive health …
PPP in examination and treatment is applied in most public hospital under different forms. The key PPP in examination and treatment is investment, joint venture in public hospitals in large and crowded cities with better economic conditions, and less investment in rural areas with lower economic conditions. PPP in health insured medical care remains limited with few number of health insurance card registered for primary health care. There has been PPP in testing and high-tech services delivery but at modest level. However PPP in prevention remain limited, mainly focusing in some health programs like HIV/AIDS, TB and reproductive healthcare. Private sector has potentials to cooperate with public in investment in high-tech medical devices and technologies, infrastructure, testing and high-tech service delivery, and training and technological transfer. However, there is less PPP potential in prevention in Vietnam.
• Government policies
+ It is needed to issue policies, management and monitoring instruments as well as PPP guiding documents in health, in general and in examination, treatment and prevention, in particular
+ Create real equality, equity between public and no-public sector based on government laws and regulations
• Ministry of Health:
+ It is necessary to strengthen the role of government control in joint venture for investing in medical devices at public health facilities to limit risks and unwanted impacts based on equity and efficiency criteria
+ It is needed to have incentives and mandatory regulations to make private sector participate in some preventive activities based on principles of equity and mutual benefit protection
+ It is needed to raise right perception/view on PPP relationship, both in public and private sectors
+ It is necessary to conduct evaluation and pilot of PPP models in examination, treatment and prevention in Vietnam to map out strategic solutions to support and attract the participation of private health in both above-mentioned areas.