Download ROLE OF THE PRIVATE SECTOR IN DELIVERY OF HEALTH CARE

ROLE OF THE
PRIVATE SECTOR IN
DELIVERY OF HEALTH
CARE
Dr. Aruna Rabel
Medical Administration Manager
Durdans Hospital
Annual Health Forum – 2007, BMICH
This is a joint presentation of
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Appollo Hospital
Ceylon College of General Practitioners
Durdans Hospital
Glaxo Smith Kline
Mackwoods
Nawaloka Hospital
Oasis Hospital
What is the Private Sector ?
Any thing other than
Government (State or Public) Sector
- Mr.C.P.de Silva – Former Chairman Chamber of Commerce
At OPA Annual Sessions 2004
Private Sector in Health Care
The whole gamut from
small scale pharmacies
and
General Practitioners
to
large scale hospitals and
pharmaceutical companies
Contribution to GDP
• State Sector - 20%
• Informal Private Sector – 45%
• Formal Private Sector – 35%
Private Sector in Health Care
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Hospitals
General Practitioners
Diagnostics Services
Physiotherapy and Rehabilitation Units
Ambulance Services
Home Nursing Services
Centres for Disabled
Pharmacies
Pharmaceutical Companies
And many more
Health Expenditure – Sri Lanka
as a percentage share of GDP
[Source – National Health Accounts 2000 – 2002 ]
Public
2.5
Private
2
1.5
1
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
0
1990
0.5
Number of Private Hospitals
Courtesy – Institute of Health Policies
60
50
40
<10
.10 - 29
.30 - 99
100 +
30
20
10
0
1990
1995
2000
2005
Beds in Private Hospitals
Courtesy – Institute of Health Policies
1800
1600
1400
1200
1000
800
600
400
200
0
100 +
.30 - 99
.10 - 29
< 10
1990
1995
2000
2005
Bed Capacity
• State : Private –
Sri Lanka -- 16 : 1
Western Province – 8 : 1
• 65 % of the Private Sector beds are in Western
Province
Performance
Performance ( 1990 – 2005 )
• Number of Private Hospital beds - + 100 %
• Number of Inpatients - + 100 %
• Number of Out patients - + 140 %
Performance - CABG
1400
1200
1000
800
State
Private
600
400
200
0
2001
2002
2003
2004
2005
Performance - PTCA
900
800
700
600
500
400
300
State
Private
200
100
0
2001
2002
2003
2004
2005
General Practice
• Full Time GPs – 600 ( CCGP )
800 ( Independent Survey)
• 2.8 / 100,000 population ( 1:35,000 people )
• 35 % of Ambulatory Care handled by GPs
Exact details of the private sector performance
is not readily available as there is no mechanism
to collect data.
Challenges
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Investment barriers
Infrastructure
Human Resources
Maintenance of High Quality Care
Introduction of Cutting - edge Technology
Expectations of Consumers
History of
Public – Private Partnership
• Involvement of Traditional Health Care
Providers
• Referrals to State Hospitals by General
Practitioners
• ‘Channel Practice’ by Government Sector
Consultants
• Supply of equipment and pharmaceuticals by
private sector
Partnership - unofficial
• State sector doctors working in private sector after working
hours
• Referrals to govt. hospitals from General Practice
• Investigations and admissions through channel consultations
• Certain investigations sent to private sector and patient bears the
cost.
Partnership - official
• Laboratory and other diagnostic services are obtained during
trade union actions and break downs.
• Purchases – drugs
state sector monopoly was done away with open economy in
1978.
• Purchases – equipment
mainly supplied by the private sector
Partnership - official
• President’s Fund –
assistance in major surgical procedures, treatment
abroad
• Employees’ Trust Fund
• Social Services Ministry
• Govt. employees’ insurance
Advantages of Partnership
• Multi - sectoral collaboration
• Cost reduction
• Participatory planning
• Increased efficiency in delivery of health care
• Fill the service gap
Advantages ……..
• Sharing of resources
• Quality assurance
• Improved community participation
• Reduced cost for health
• Confidence of donor agencies
Outcome of Poor Partnership
• Poor utilization of available resources
• Unnecessary investments by both parties
• Increasing cost of health care
• Drawbacks in quality assurance
• Unplanned health care delivery
Areas for partnership
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Primary Health care
Secondary Health care
Tertiary Care
Training of Health Care Personnel
Health Care Planning
Management
State Policy
The government will facilitate the development
and regulation of the private health care sector
and promote better coordination with this
sector.
-National Health Policy 1996
Private Sector must be enhanced and
strengthened to provide a buffer for free health
care
Hon. Nimal Siripala de Silva
Minister of Health & Nutrition
Annual Health Forum - 2007
Need of the Hour
Public – Private Dialogue
initiated by the state
With equity and fairness
Can’t we do it now?
Acknowledgements
• AHF – Secretariat
• Dr. Amal Harsha de Silva – Director PHSD
• Dr. Ravi Rannaneliya
Thank you