تحلیلی بر مدل‌های مشارکت عمومی - خصوصی در مدیریت بیمارستانی: مرور دامنه‌ای
محورهای موضوعی : -مدارک پزشکیحسین مینایی 1 , محمد پیکان پور 2 , علی ذاکری نژاد 3 , نوشین شیرزاد 4 , فرزاد پیرویان 5
1 - دکتری حرفه‌ای داروسازی، دانشکده داروسازی دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
2 - دستیار گروه اقتصاد و مدیریت دارو، دانشکده داروسازی دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
3 - دکتری حرفه‌ای داروسازی، دانشکده داروسازی دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
4 - کارشناسی فیزیوتراپی، دانشکده توانبخشی دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
5 - استادیار، گروه اقتصاد مدیریت دارو، دانشکده داروسازی دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
کلید واژه: مشارکت عمومی - خصوصی, بیمارستان دولتی, تامین مالی خصوصی,
چکیده مقاله :
مقدمه: روند فزاینده مخارج درمانی، محدودیت‌های مالی، کیفیت و کارایی پایین خدمات بیمارستان‌های دولتی و انتظارات روزافزون، نظام‌های سلامت را ملزم به استفاده از ظرفیت‌های بخش خصوصی نموده است. مشارکت عمومی- خصوصی به عنوان راه حلی که مزایای هر دو بخش راجمع کرده و معایب آنها را به حداقل می‌رساند در سیاست‌گذاری نظام سلامت مطرح می‌شود. هدف مطالعه حاضر، بررسی مدل‌های مشارکت عمومی - خصوصی در حوزه بیمارستانی و ارائه پیشنهاداتی جهت انتخاب مدل بهینه در شرایط گوناگون است.روش پژوهش: در این پژوهش پس از ساختاربندی پرسش و تعیین دامنه مطالعه، مقالات منتخب ارزیابی عمیق شده و تعاریف، مزایا و معایب انواع مدل‌های مشارکت بکار رفته در مدیریت بیمارستانی بررسی و این مدلها از نظر شاخص‌های کیفیت - اثربخشی، دسترسی، کارایی مالی و میزان تسهیم ریسک مقایسه شدند.یافته‌ها: با مرور دامنه‌ای 32مقاله، انواع مدل‌های مشارکت در قالب ارائه خدمات، تامین مالی و اصلاح زیرساخت‌ها و سطح ترکیبی تحلیل شدند. برهمین مبنا مدل‌های "برونسپاری بالینی" و "قرارداد مدیریت" بالاترین سطح دسترسی و کیفیت - اثربخشی را به خود اختصاص داده و مدل‌های "DBFO"،"BOO" و "برونسپاری بالینی" بالاترین سطح کارایی مالی را درپی داشتند. هم‌چنین "قرارداد خدمت" و "خصوصی سازی کامل" در دو سر طیف تسهیم ریسک قرار گرفتند. در نهایت، جهت ارتقای بهره‌وری بیمارستان‌های دولتی، قراردادهای "برونسپاری"، "مدیریت" و "اجاره" و جهت افزایش تعداد تخت‌های بیمارستانی، مدل‌های "BOO"،"BOT" و "DBFO" توصیه گردیدند.نتیجه‌گیری: با لحاظ چالش‌های مدیریت بیمارستانی و هم‌چنین ویژگی‌های اختصاصی اقتصاد سلامت درعدم تبعیت از فروض اقتصاد هنجاری، بکارگیری مدل‌های مشارکت عمومی- خصوصی، امری ضروری در راستای تحقق اهداف نظام سلامت است.
Introduction Growth of health expenditures, financial limitations, low efficiency and quality of service provision in public hospitals and ever-increasing expectations have obligated healthcare systems to utilize private sector’s capabilities. According to other countries’ experiences, public-private partnership (PPP) is a solution that not only reduces defects of every sectors, but also integrates both sectors’ advantages. This study was aimed to review PPP models in hospital management and propose suggestions for best model selecting in different situations. Methods: In this study, after organizing questions as well as determining search strategies, opted articles were assessed deeply; definitions as well as different PPP models’ pros and cons in hospitals management were analyzed; and finally, these models were compared according to quality-effectiveness, access, financial efficiency, and risk sharing indicators. Results: By reviewing 32 peer-reviewed articles, PPP models were categorized in service providing, financing as well as developing infrastructures, and compound levels. Based on the results, “clinical outsourcing” and “management contract” have attained high level in access and quality-effectiveness indicators and “BOO”, “DBFO”, and “clinical outsourcing” models have achieved high level in financial efficiency. Furthermore, “operating contract” and “privatization” are placed in two ends of risk sharing spectrum. Finally, “outsourcing”, “management”, and “lease” contracts are advised to improve productivity of public hospitals; and “BOO”, “BOT”, as well as “DBFO” models are advised to develop infrastructures and increase the number of hospitals beds. Conclusion: Considering hospital management challenges and health economics specifications, utilizing public-private partnership models is a vital issue to fulfill the aims of healthcare system.
1- Jafari Sirizi M, Rashidian A, Abolhasani F, Mohammad K, Yazdani Sh PP. Qualitative assessment of dimensions and degree of autonomy granting to university hospitals. Hakim Res J, 2008; 11(2): 59–71.] In Persian[
2- Desmarais-Tremblay M. On the Definition of Public Goods. Assessing Richard A. Musgrave’s contribution; 2014.
3- Number of hospital beds per 1000 inhabitants [Internet]. OECD. [cited 2018 Jun 3]. Available from: https://data.oecd.org/healtheqt/hospital-beds.htm
4- Distribution of Hospital beds and Physiciant in Islamic Republic of Iran [Internet]. Tehran; 1395. Available from: http://hekmatac.ir.] In Persian[
5- Harirchi.I. About 45% of hospital beds in Iran are exhausted [Internet]. IRIB news agency. Available from: http://www.iribnews.ir/fa/news/1478009
6- Mohammadkarim B, Jamil S, Pejman H, Seyyed MH, Mostafa N. Combining multiple indicators to assess hospital performance in Iran using the Pabon Lasso Model. Australas Med J., 2011; 4(4): 175.] In Persian[
7- Blumenthal D, Hsiao W. Privatization and its discontents—the evolving Chinese health care system. N Engl J Med; 2005: 1165–70.
8- Raman AV, Björkman JW. Public-private partnerships in health care in India: lessons for developing countries. Routledge; 2008.
9- Heilman JG. The politics and economics of privatization: The case of wastewater treatment. University Alabama Press; 1992.
10- Jeffers JP, McDavid CL, Broadhurst J V, Grosskopf KR, Jones JJ, Kamnikar EG, et al. Audit Stewardship and Oversight of Large and Innovatively Funded Projects in Europe; 2006.
11- Reich MR. Public-private partnerships for public health. Public-private partnerships for public health; 2002.
12- Pongsiri N. Regulation and public-private partnerships. Int J Public Sect Manag, 2002; 15(6): 487–95.
13- Scharle P. Public-private partnership (PPP) as a social game. Innov Eur J Soc Sci Res, 2002; 15(3): 227–52.
14- Chong E, Huet F, Saussier S. Auctions, ex post competition and prices: the efficiency of public-private partnerships. Ann Public Coop Econ, 2006; 77(4): 521–54.
15- Denyer D, Tranfield D. Producing a systematic review; 2009.
16- Rousseau DM, Manning J, Denyer D. 11 evidence in management and organizational science: Assembling the field’s full weight of scientific knowledge through syntheses. Acad Manag Ann, 2008; 2(1): 475–515.
17- Barnum H, Kutzin J. Public hospitals in developing countries: resource use, cost, financing. Johns Hopkins University Press; 1993.
18- Bossert TJ, Beauvais JC. Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space. Health Policy Plan, 2002; 17(1): 14–31.
19- Pessoa A. Public–private partnerships in developing countries: are infrastructures responding to the new ODA strategy? J Int Dev, 2008; 20(3): 311–25.
20- Sadka E. Public-Private Partnerships--A Public Economics Perspective (EPub). International Monetary Fund; 2006.
21- Renda A, Schrefler L. Public–Private Partnerships National Experiences in the European Union. Cent Eur Policy Stud Brussels, 2006; 22(5).
22- Jonidi N, Sadegi M, Izadi M, Ranjbar R. Compare a Tehran hospital’s indicators with National standards. Miliatary Med, 2010; 12(4): 223–8. ]In Persian[
23- Jabari BH, GHolamzadeh NR, Jannati A, Asghari JM, Dadgar E. Prioritization of public hospitals’public–private partnership models based on key performance indicators. Hakim Res J, 2014; 16: 262–72.] In Persian[
24- Basu A, Howell R, Gopinath D. Clinical performance indicators: intolerance for variety? Int J Health Care Qual Assur, 2010; 23(4): 436–49.
25- Davies S. Hospital contract cleaning and infection control. Unison; 2005.
26- Vatankhah S, Maleki M, Tofighi S, Barati O, Rafiet S. The study of management contract conditions in healthcare organizations of selected countries. Hakim Res J, 2012; 9: 424–31.
27- About PPP Models,” The Canadian Council for Public-Private Partnerships" [Internet]. [cited 2015 Feb 6]. Available from: http://www.pppcouncil.ca/
28- Delmon J. Understanding Options for Public-Private Partnerships in Infrastructure: Sorting Out the Forest from the Trees: Bot, Dbfo, Dcmf, Concession, Lease; 2010.
29- IFC. Public-Private Partnership Stories Turkey: Turkish Healthcare PPP Program Adana Hospital Complex.
30- Öge H, Ba\cs T. Public--Private Partnership Healthcare Projects in Turkey. J Bus Sci, 2016; 4(2): 105–19.
31- Hamilton G, Kachkynbaeva M, Wachsmuth I, Masaki E. A Preliminary Reflection on the Best Practice in PPP in Health care Sector: A Review of Different PPP Case Studies and Experiences. In: Conference, PPPs in Health Manila; 2012.
32- Coelho CF, O’farrell C, others. Breaking new ground: Lesotho Hospital Public-Private Partnership—a model for integrated health services delivery; 2009.
33- Feachem NS, Betts S, McNabb H. The Turks and Caicos Islands: A Public Private Investment Partnership For an Integrated Health System.
34- Taylor R, Blair S. Public hospitals: Options for reform through public-private partnerships; 2002.
35- Manavi S, Babashahy S, Sari AA. The Extra Cost of Granting Autonomy to Public Hospitals. J Isfahan Med Sch, 2012; 29(170).] In Persian[
36- Etemadian M, Shadpour P, Soleimani MJ, Biglar M, Hadi Radfar M, Jarrahi M. Iranian-Islamic Model of Public-Private Partnership in Hospital Management: Introducing Moheb Hospital Model. Int J Hosp Res, 2013; 2(2): 95–8.
37- Sadeghi A, Barati O, Bastani P, Jafari DD, Etemadian M. Experiences of selected countries in the use of public-private partnership in hospital services provision. J Pak Med Assoc, 2016; 66: 1401–6.
38- Jabbari Beyrami H., GHolamzadeh Nikjoo R., Jannati A. DE. Introducing public-private partnership options in public hospitals. Hakim Res J, 2013; 16:201–10.] In Persian[
39- Montagu D, Harding A. A zebra or a painted horse? Are hospital PPPs infrastructure partnerships with stripes or a separate species. World Hosp Heal Serv, 2012; 48(2): 15.
40- La Forgia GM, Harding A. Public-private partnerships and public hospital performance in São Paulo, Brazil. Health Aff, 2009; 28(4): 1114–26.
41- Hsiao C-T, Pai J-Y, Chiu H. The study on the outsourcing of Taiwan’s hospitals: a questionnaire survey research. BMC Health Serv Res, 2009; 9(1): 78.
42- Loevinsohn B, Harding A. Buying results? Contracting for health service delivery in developing countries. Lancet, 2005; 366(9486): 676–81.
43- Soeters R, Griffiths F. Improving government health services through contract management: a case from Cambodia. Health Policy Plan, 2003; 18(1): 74–83.
44- English LM. Public private partnerships in Australia: An overview of their nature, purpose, incidence and oversight. UNSWLJ, 2006; 29: 250.
45- Hjertqvist J. Swedish health-care reform: from public monopolies to market services. Montr Econ Inst; 2001.
46- Barlow J, Roehrich J, Wright S. Europe sees mixed results from public-private partnerships for building and managing health care facilities and services. Health Aff, 2013; 32(1): 146–54.
47- Wood S, Zorbas J, others. Joondalup Health Campus. Medicus, 2014; 54(10): 37.
48- Brown L, Barnett JR. Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia. Soc Sci Med, 2004; 58(2): 427–44.
_||_1- Jafari Sirizi M, Rashidian A, Abolhasani F, Mohammad K, Yazdani Sh PP. Qualitative assessment of dimensions and degree of autonomy granting to university hospitals. Hakim Res J, 2008; 11(2): 59–71.] In Persian[
2- Desmarais-Tremblay M. On the Definition of Public Goods. Assessing Richard A. Musgrave’s contribution; 2014.
3- Number of hospital beds per 1000 inhabitants [Internet]. OECD. [cited 2018 Jun 3]. Available from: https://data.oecd.org/healtheqt/hospital-beds.htm
4- Distribution of Hospital beds and Physiciant in Islamic Republic of Iran [Internet]. Tehran; 1395. Available from: http://hekmatac.ir.] In Persian[
5- Harirchi.I. About 45% of hospital beds in Iran are exhausted [Internet]. IRIB news agency. Available from: http://www.iribnews.ir/fa/news/1478009
6- Mohammadkarim B, Jamil S, Pejman H, Seyyed MH, Mostafa N. Combining multiple indicators to assess hospital performance in Iran using the Pabon Lasso Model. Australas Med J., 2011; 4(4): 175.] In Persian[
7- Blumenthal D, Hsiao W. Privatization and its discontents—the evolving Chinese health care system. N Engl J Med; 2005: 1165–70.
8- Raman AV, Björkman JW. Public-private partnerships in health care in India: lessons for developing countries. Routledge; 2008.
9- Heilman JG. The politics and economics of privatization: The case of wastewater treatment. University Alabama Press; 1992.
10- Jeffers JP, McDavid CL, Broadhurst J V, Grosskopf KR, Jones JJ, Kamnikar EG, et al. Audit Stewardship and Oversight of Large and Innovatively Funded Projects in Europe; 2006.
11- Reich MR. Public-private partnerships for public health. Public-private partnerships for public health; 2002.
12- Pongsiri N. Regulation and public-private partnerships. Int J Public Sect Manag, 2002; 15(6): 487–95.
13- Scharle P. Public-private partnership (PPP) as a social game. Innov Eur J Soc Sci Res, 2002; 15(3): 227–52.
14- Chong E, Huet F, Saussier S. Auctions, ex post competition and prices: the efficiency of public-private partnerships. Ann Public Coop Econ, 2006; 77(4): 521–54.
15- Denyer D, Tranfield D. Producing a systematic review; 2009.
16- Rousseau DM, Manning J, Denyer D. 11 evidence in management and organizational science: Assembling the field’s full weight of scientific knowledge through syntheses. Acad Manag Ann, 2008; 2(1): 475–515.
17- Barnum H, Kutzin J. Public hospitals in developing countries: resource use, cost, financing. Johns Hopkins University Press; 1993.
18- Bossert TJ, Beauvais JC. Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space. Health Policy Plan, 2002; 17(1): 14–31.
19- Pessoa A. Public–private partnerships in developing countries: are infrastructures responding to the new ODA strategy? J Int Dev, 2008; 20(3): 311–25.
20- Sadka E. Public-Private Partnerships--A Public Economics Perspective (EPub). International Monetary Fund; 2006.
21- Renda A, Schrefler L. Public–Private Partnerships National Experiences in the European Union. Cent Eur Policy Stud Brussels, 2006; 22(5).
22- Jonidi N, Sadegi M, Izadi M, Ranjbar R. Compare a Tehran hospital’s indicators with National standards. Miliatary Med, 2010; 12(4): 223–8. ]In Persian[
23- Jabari BH, GHolamzadeh NR, Jannati A, Asghari JM, Dadgar E. Prioritization of public hospitals’public–private partnership models based on key performance indicators. Hakim Res J, 2014; 16: 262–72.] In Persian[
24- Basu A, Howell R, Gopinath D. Clinical performance indicators: intolerance for variety? Int J Health Care Qual Assur, 2010; 23(4): 436–49.
25- Davies S. Hospital contract cleaning and infection control. Unison; 2005.
26- Vatankhah S, Maleki M, Tofighi S, Barati O, Rafiet S. The study of management contract conditions in healthcare organizations of selected countries. Hakim Res J, 2012; 9: 424–31.
27- About PPP Models,” The Canadian Council for Public-Private Partnerships" [Internet]. [cited 2015 Feb 6]. Available from: http://www.pppcouncil.ca/
28- Delmon J. Understanding Options for Public-Private Partnerships in Infrastructure: Sorting Out the Forest from the Trees: Bot, Dbfo, Dcmf, Concession, Lease; 2010.
29- IFC. Public-Private Partnership Stories Turkey: Turkish Healthcare PPP Program Adana Hospital Complex.
30- Öge H, Ba\cs T. Public--Private Partnership Healthcare Projects in Turkey. J Bus Sci, 2016; 4(2): 105–19.
31- Hamilton G, Kachkynbaeva M, Wachsmuth I, Masaki E. A Preliminary Reflection on the Best Practice in PPP in Health care Sector: A Review of Different PPP Case Studies and Experiences. In: Conference, PPPs in Health Manila; 2012.
32- Coelho CF, O’farrell C, others. Breaking new ground: Lesotho Hospital Public-Private Partnership—a model for integrated health services delivery; 2009.
33- Feachem NS, Betts S, McNabb H. The Turks and Caicos Islands: A Public Private Investment Partnership For an Integrated Health System.
34- Taylor R, Blair S. Public hospitals: Options for reform through public-private partnerships; 2002.
35- Manavi S, Babashahy S, Sari AA. The Extra Cost of Granting Autonomy to Public Hospitals. J Isfahan Med Sch, 2012; 29(170).] In Persian[
36- Etemadian M, Shadpour P, Soleimani MJ, Biglar M, Hadi Radfar M, Jarrahi M. Iranian-Islamic Model of Public-Private Partnership in Hospital Management: Introducing Moheb Hospital Model. Int J Hosp Res, 2013; 2(2): 95–8.
37- Sadeghi A, Barati O, Bastani P, Jafari DD, Etemadian M. Experiences of selected countries in the use of public-private partnership in hospital services provision. J Pak Med Assoc, 2016; 66: 1401–6.
38- Jabbari Beyrami H., GHolamzadeh Nikjoo R., Jannati A. DE. Introducing public-private partnership options in public hospitals. Hakim Res J, 2013; 16:201–10.] In Persian[
39- Montagu D, Harding A. A zebra or a painted horse? Are hospital PPPs infrastructure partnerships with stripes or a separate species. World Hosp Heal Serv, 2012; 48(2): 15.
40- La Forgia GM, Harding A. Public-private partnerships and public hospital performance in São Paulo, Brazil. Health Aff, 2009; 28(4): 1114–26.
41- Hsiao C-T, Pai J-Y, Chiu H. The study on the outsourcing of Taiwan’s hospitals: a questionnaire survey research. BMC Health Serv Res, 2009; 9(1): 78.
42- Loevinsohn B, Harding A. Buying results? Contracting for health service delivery in developing countries. Lancet, 2005; 366(9486): 676–81.
43- Soeters R, Griffiths F. Improving government health services through contract management: a case from Cambodia. Health Policy Plan, 2003; 18(1): 74–83.
44- English LM. Public private partnerships in Australia: An overview of their nature, purpose, incidence and oversight. UNSWLJ, 2006; 29: 250.
45- Hjertqvist J. Swedish health-care reform: from public monopolies to market services. Montr Econ Inst; 2001.
46- Barlow J, Roehrich J, Wright S. Europe sees mixed results from public-private partnerships for building and managing health care facilities and services. Health Aff, 2013; 32(1): 146–54.
47- Wood S, Zorbas J, others. Joondalup Health Campus. Medicus, 2014; 54(10): 37.
48- Brown L, Barnett JR. Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia. Soc Sci Med, 2004; 58(2): 427–44.