There was no reason why private hospitals could not provide services to public sector patients through innovative Public Private Partnerships (PPPs) says Dr Richard Friedland, CEO of Netcare.
Speaking at the Hospital Association of South Africa (HASA) conference in Cape Town last week, Friedland said that PPPs involved a balance between risk and reward across a spectrum of engagement, from leasing, management and construction of facilities to the provision of clinical services and episodes of care.
“The ideal model is a more adventurous model of integration,” said Friedland.
Netcare operates an 18-year PPP in Lesotho where the Lesotho government is the purchaser of services, while Netcare is responsible for the full spectrum of clinical care. “It is a fully integrated model and is a highly structured, ordered and efficient system.”
Friedland said the PPP had enabled the hospital to see more than 400 000 out patients and more than 23 000 in patients in the twelve months since it opened in October last year. Nectare also provides primary and secondary services in the area, with a primary care clinic situated at the entrance which acted as a gatekeeper – patients needed a referral from the primary healthcare centre to be admitted to hospital.
The important factor is training
He added that the most critical factor in ensuring long term sustainability was ongoing training and skills transfer to local staff. External monitoring and technical support also provided ongoing accountability and credibility.
“With PPPs you need extensive stakeholder engagement, contracts need to be robust enough to survive management changes and outcomes must be measurable,” said Friedland. “Payment mechanisms also need to be well defined.”
He added that contracts of longer duration produced a more sustainable impact.
Friedland said that in South Africa, the UK-based Any Qualified Provider concept of service provision could be adapted and implemented. This was based on accreditation of providers and the Department of Health’s Core Standards could provide the basis for this process. Contracting and defined outcomes would require development.
Friedland said it was similar to a mixed-price airline model, where economy and business class passengers were serviced together. “They may be seated in different seats and experience different levels of support such as meals and seating, but they have the same pilot, assistants and ultimately reach the same destination.”
“The Lesotho PPP model is affordable and workable in South Africa and developing countries,” said Friedland. “But it would require not only legislative and regulatory changes in terms of employment of doctors, but also a philosophical mindshift.”
(Press release, September 2012)