Public-Private-Partnership and Social Protection Current context The case of the health sector

Transcription

1 Public-Private-Partnership and Social Protection Current context The case of the health sector Isabelle Wachsmuth 1

2 What is the situation today in social protection? Little progress has been made to decrease poverty and inequalities (UNECE Issue brief ) 17% of the entire EU population was at risk poverty in 2011 Inequalities still continue to growth relate to the lack of inequitable distribution of resources *3.2 billion people, representing 68.7% of the world s adult population, control just 3% of the world s wealth, or about $7.3 trillion. *32 million people, representing 0.7% of the world s adult, population control $98.7 trillion or about 41% of the world s wealth. The right to social security and protection is a universal human right (Recommendation No 202 from ILO Social Protection Floor, June 2012) *The global wealth pyramid. Credit Suisse Global Wealth Databook

3 What can be the role of PPP for social protection? How PPP can contribute and support the delivery of adequate social protection and social protection systems? How PPP can have impact on human security, equity and social justice (including human right)? How PPP can improve essential social services which include essential health care (including Universal Health Coverage), education, water and sanitation, energy access for all range of age in life? How PPP can contribute to increase social benefits and prevent a resurgence of poverty and address vulnerable groups? 3

4 PPP use mainly for Infrastructure and not yet for social services Number of PPP (2005 to 2013) in healthcare for infrastructure Worldwide Africa & Middle East Americas Asia & Pacific Europe PPP Hospitals 4

5 PPP Context for social protection PPP Implementation only for investors in infrastructure or also to contribute in social services and social protection? PPP approach still not very common in developing countries (3% compare to 69% for Europe for all sectors) Potential positive effects: empowerment at local level, the active participation of the concerned population and synergetic effects positive impacts on the efficiency, equity and quality of health care provision have been observed Condition: new ways of service provision and a legal framework which guarantees a transparent and credible relationship between the different actors 5

6 Potentials of a public-private-partnership (PPP) to improve social protection Reallocate resources due to fiscal pressures governments Private providers both non-profit or for profit oriented play an important role in social service provision and can support public sector Identify different strengths and weaknesses of the state, for-profit and non-profit institutions What extent a complementarity between these partners can be organized in the provision of social services? How PPP can improve social assistance, insurance and equitable access to basic public/social services? 6

7 What type of PPP for social benefits? 7

8 Objective of PPP for social protection Exploring the complex issues of inter-institutional coordination to which new systems of provision give rise Identification of conditions under which PPP can contribute to an increase in access to social protection at lower costs is helpful to design appropriate social policies. Voluntary participation of individual citizens (Community based) in the production of public goods by local governments Local enterprises can be engaged in successful partnerships on the local level. 8

9 How to do it for health sector? The setting of standards regarding price building and quality in the provision of health services is a precondition for a functioning PPP in healthcare Ensure that the service price and quality is acceptable. Where there are monopolies and only a small number of providers, it is important to identify and address potential market failures Guaranteed minimum outcome in service provision. 9

10 Why and which role the government should play in health care provision? The degree of control desired by the government; The government s capacity to provide the desired services; The capacity of private parties to provide the services; The legal framework for monitoring and regulation; The availability of financial resources from public or private sources Market failure and equity considerations call for public sector intervention 10

11 Improve health care systems WHO 1998 Economic: the replacement of direct, hierarchical management structure by contractual relationships between purchasers and providers will increase transparency of prices, quantity and quality as well as competition which will lead to a gain in efficiency. Political: In the context of welfare systems reform world wide, decentralization of services from the national to the local level is frequently suggested in conjunction with an improved participation of the population in determining and implementing the services. Contracting out could be an element in this overall strategy. 11

12 Major concerns/risks on the effects of private health care provision Distortions in resource allocation Private providers serve groups in the population who are most willing to pay (urban residents). The result will be increased inequity in access and use of health care. Private providers will undersupply socially desirable services (immunizations and personal preventive care). This will worsen allocative efficiency in the health sector. Excessive administration and sales Driven by the profit motive, and because they have significant control over demand, private providers will take advantage of patients by supplying more health care than is required. This is inefficient and may result in healthimpairing actions. Private providers can also take advantage of patients by providing low-quality health care, which may result in health and welfare losses. 12

13 How to mitigate the risks: Equity Correcting the final allocation of goods and services as it heavily depends on the initial distribution of ownership The state might want to correct for these imbalances by a policy which directly benefits the poorer part of the population, e.g. through exemption from payment for certain services How to use PPP approach to address unequal coverage of health care services are private run insurance schemes? 13

14 Public direct-delivery systems Universal health coverage Less than 2 % of the population are covered by private insurance schemes Market-oriented systems Creation of new management models for public hospitals and the setting up of alternative insurance schemes based on risk sharing and solidarity PPP in the health sector Conceptual framework of a 14

15 Arguments in favor of PPP approach The private sector alone cannot solve the problem of an equitable provision of health care or social services, which underpins the theoretical argument above to think about a synergy between different actors in order to overcome their individual weaknesses Balance between curative and preventive services is critical Unequal coverage, the oversupply of high quality and cost intensive services while at the same time undersupply of prevention services and high administrative costs are the major factors explaining the inefficiencies 15

16 Lessons learned Political commitment for a shift of financial and political power from the national government level to the local level and to other actors is a pre-condition for any PPP Without a political will to challenge vested interests, particularly among suppliers of medical inputs and equipment it is nearly impossible to get other actors involved The contribution of communities to make service available is a necessity for an effective PPP. 16

17 Recommendations for social protection system Proper awareness, training and education on how to develop human capital and preserve it appears critical for the maintain of social protection at each stage of life Specific focus on the understanding of root causes of problems Shift of paradigm to perceive life as quality and not quantity and by consequence improve lifestyle, education to human right and peace. Implementation of the Universal Declaration of Human Right Cross-sectoral approaches to social protection with pro-poor policies and pro-poor PPP approaches to address equitable distribution of resources, disaster risk reduction and rural and community development 17