Private Health Sector: Role and Potential Partnership for Moving towards Universal Health Coverage

Transcription

1 Private Health Sector: Role and Potential Partnership for Moving towards Universal Health Coverage The 14th Arab Conference Public-Private Partnerships for Sustainable Health Care Services Hassan Salah, Medical Officer Department of Health System Development 1

2 Presentation Outline I Why assessment of PHS? II Analysis of PHS III Current statues in EMR IV Challenges & opportunities V Conclusion & next steps

3 Analysis of Private Health Sector: Methodology Analysis follows health systems approach: Financing, delivery, workforce, technology and governance Data collected in two phases: Phase One [ ]: Assessment of private health sector in 12 counties Phase Two [ ]: Review of published reports, ministry of health records and grey literature from EMR countries Studies on private sector regulations 3

4 Private Health Sector: Definition Private sector includes all actors outside of government including for-profit, non-profit, formal and non-formal entities [World Bank, 2008] All formal service providers working for profit and/or not-for-profit (e.g. nongovernmental organization). Focus on for-profit sector [Definition used for the study] 4

5 Trends in Privatization Policies Free market ideology driven generally towards privatization; Growth of private sector driven by market demands leading to a public private mix; Traditional role of state wherein public sector has control and limited interaction with private sector. 5

6 Private Health Sector in EMR Countries: Preliminary Results 6

7 Towards universal health coverage in countries of the Eastern Mediterranean: challenges, opportunities and roadmap 7

8 8

9 (I) Service Provision: Primary Care Facilities Countries Primary care facilities [includes GP clinics] Estimated number [range] Percent in private sector (%) Group Group , Group ,

10 120 (I) Percentage of Public and Private PHC facilities Public Private 20 0 Towards universal health coverage in countries of the Eastern Mediterranean: challenges, opportunities and roadmap 10

11 (I) Service Provision: Hospital Beds Countries Hospital Beds Estimated number [range] Percent in private sector (%) Group , Group , Group ,

12 120 (I) Percentage of Public and Private Hospital beds Public Private

13 37 5.3

14 (I) Service Provision: Pharmacies, laboratories and diagnostic facilities Countries Pharmacies Laboratories and diagnostic Facilities Estimated number [range] Percent in private sector (%) Estimated number [range] Percent in private sector (%) Group , Group , , Group , ,

15 120 (I) Percentage of Public and Private Pharmacies Public Private

16 Percent (I) Service Provision: Use of primary care services, private and public providers Public Private Public Private Public Private Public Private Pakistan Egypt Morocco Jordan Poorest Middle Richest Source: Demographic and Health Surveys 16

17 Main Factors Contributed to PHS Growth Quality of public services High revenue OOP spending Community perception Regulation & enforcement 17

18 (II) Workforce: Private and Public Health Workforce Country Groups* Private sector workforce [Per 10,000 population] Public sector workforce [per 10,000 population] Physicians Nurses Physicians Nurses Group Group Group * Private sector workforce data not available for Group 1 Qatar; Group 2 Egypt, Iran, Iraq, Libya, Syria, Tunisia; Group 3 Afghanistan; Sudan, South Sudan; 18

19 (II) Workforce: Private Health Workforce Issues and Challenges Duality of practice between public and private sectors Concentration of private workforce in urban areas Unregulated expansion, lack of accreditation programs for health professionals education Limited data on workforce distribution, salary structure and multiple job holding Inadequate coordination between MOH and MOHE to plan for public and private sectors

20 (III) Health Finance: Private Health Sector Expenditure in EMR Countries, 2011 Group THE per Capita US$ PHE [% of THE] OOP [% of THE] OOP [% of PHE] Group % 16.7% 61.9% Group % 49.1% 94.4% Group % 69.0% 92.8% THE Total Health Expenditure; PHE Private Heath Expenditure; OOP Out of Pocket Payment 20

21 (III) Health Finance: Public Sector versus Out of Pocket Private Sector Expenditure, 2013 Source: WHO Global Health Expenditure Online Database, 2013

22 (IV) Essential Medicine and Technology Huge investments in high-tech imaging technology, motived by medical tourism Irrational use of biomedical devices and technologies leading to high OOP payment Weak medicine regulatory system and poor enforcement Availability of core medicines lower in public compared to private facilities Non prescription sale of antibiotics in private pharmacies (antimicrobial resistance)

23 Policies for engagement between public and private sectors are evolving in most countries Regulations governing PHS need updating Limited MOH technical capacity to formulate policies and fulfill regulatory responsibility

24 Lack of Competence Official Recognition Whey Governments are not ready for develop PPP? Prime Responsibility First Demand 24

25 Conclusion and Next Steps Preliminary review of private health sector based on systems approach Significant gaps in information that need to be plugged Priority areas that need particular attention are: o MOH regulatory capacity o Partnership with private health sector o Reduce OOP payment incurred in private sector o Improve the quality of care Develop regional strategy that supports countries to engage with private sector for public health goals

26 100% 70% Public 55% 40% Private