تحلیلی بر مدل‌های مشارکت عمومی - خصوصی در مدیریت بیمارستانی: مرور دامنه‌ای
الموضوعات :حسین 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
الکلمات المفتاحية: مشارکت عمومی - خصوصی, بیمارستان دولتی, تامین مالی خصوصی,
ملخص المقالة :
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.
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.
