Access to affordable, quality healthcare is a key driver of economic growth and development. However, persistent epidemics, a rising incidence of non-communicable disease, increasing cost and complexity of diagnosis and treatment, along with growing global demand for more and improved healthcare come together to create a complicated and costly challenge.
As these needs and expectations grow for more and better health care services, most countries face serious resource constraints. The public sector is often constrained by lack of: funding; access to innovation and technology; and efficient and experienced healthcare management. Public-private partnerships (PPPs) can help expand key health services and improve quality, complementing the traditional public-sector approach with various forms of private-sector participation.
Specifically, well-structured PPPs can help improve the delivery of service by:
- facilitating the development of new/refurbished primary, secondary and tertiary health facility infrastructure;
- increasing quality by delivering services to contractually defined standards;
- expanding access to scarce clinical skills by employing and training staff that would not have been attracted to a traditional public facility; and
- increasing the quality of care by ensuring regular maintenance and technology upgrades
In developed countries, PPPs have been used develop and maintain healthcare infrastructure, mostly leaving service provision in the public domain. This mechanism, also known as a “private finance initiative” (PFI), introduces predictability into government payments for creating and operating healthcare facilities as a result of bundling the design, construction and maintenance of the facility into the same contract. Doing this incentivizes the private operator in ways that can lead to better quality and more efficient hospital design, management and maintenance.
In addition to PFIs, healthcare PPPs have been used for the delivery of health services:
- through management contracts for the provision of care in government constructed and maintained facilities;
- delivery, ongoing maintenance and replacement of medical equipment;
- contracts for components of the range of services, such as non-clinical services, clinical support services (such as laboratories, diagnostic services), or specialized clinical services (such as dialysis or radiotherapy); and in some instances,
- for full PPPs where the private party is responsible for the infrastructure and service delivery.
PPPs in health, as with PPPs in education, present a set of challenges that distinguish them from traditional infrastructure. They rely heavily on political support and require a great deal of interdependence between the government and private operator.