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ROLE OF THE ROLE OF THE PRIVATE SECTOR IN PRIVATE SECTOR IN
DELIVERY OF DELIVERY OF HEALTHHEALTH CARE CARE
Dr. Aruna RabelDr. Aruna Rabel
Medical Medical Administration ManagerAdministration Manager
Durdans HospitalDurdans Hospital
Annual Health Forum – 2007, BMICHAnnual Health Forum – 2007, BMICH
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This is a joint This is a joint presentation ofpresentation of
• Appollo HospitalAppollo Hospital• Ceylon College of General Ceylon College of General
PractitionersPractitioners• Durdans HospitalDurdans Hospital• Glaxo Smith KlineGlaxo Smith Kline• MackwoodsMackwoods• Nawaloka HospitalNawaloka Hospital• Oasis HospitalOasis Hospital
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What is the Private What is the Private Sector ?Sector ?
Any thing other than Any thing other than
Government (State or Public) SectorGovernment (State or Public) Sector
- - Mr.C.P.de Silva – Former Chairman Chamber of CommerceMr.C.P.de Silva – Former Chairman Chamber of Commerce
At OPA Annual Sessions 2004At OPA Annual Sessions 2004
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Private Sector in Health Private Sector in Health Care Care
The whole gamut from The whole gamut from small scale pharmaciessmall scale pharmaciesand and General PractitionersGeneral Practitioners to to
large scale hospitals and large scale hospitals and pharmaceutical companiespharmaceutical companies
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Contribution to GDPContribution to GDP
• State Sector - 20%State Sector - 20%
• Informal Private Sector – 45%Informal Private Sector – 45%
• Formal Private Sector – 35%Formal Private Sector – 35%
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Private Sector in Health Private Sector in Health CareCare
• HospitalsHospitals• General PractitionersGeneral Practitioners• Diagnostics ServicesDiagnostics Services• Physiotherapy and Rehabilitation UnitsPhysiotherapy and Rehabilitation Units• Ambulance ServicesAmbulance Services• Home Nursing ServicesHome Nursing Services• Centres for DisabledCentres for Disabled• PharmaciesPharmacies• Pharmaceutical CompaniesPharmaceutical Companies• And many moreAnd many more
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Health Expenditure – Sri Health Expenditure – Sri LankaLanka
as a percentage share of GDPas a percentage share of GDP [ [Source – National Health Accounts Source – National Health Accounts
2000 – 2002 2000 – 2002 ]]
0
0.5
1
1.5
2
2.5
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
Public
Private
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Number of Private Number of Private HospitalsHospitals
Courtesy – Institute of Health Courtesy – Institute of Health
PoliciesPolicies
0
10
20
30
40
50
60
1990 1995 2000 2005
<10
.10 - 29
.30 - 99
100 +
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Beds in Private HospitalsBeds in Private Hospitals Courtesy – Institute of Courtesy – Institute of
Health PoliciesHealth Policies
0
200
400
600
800
1000
1200
1400
1600
1800
1990 1995 2000 2005
100 +
.30 - 99
.10 - 29
< 10
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Bed CapacityBed Capacity
• State : Private –State : Private –
Sri Lanka -- 16 : 1Sri Lanka -- 16 : 1
Western Province – 8 : 1Western Province – 8 : 1
• 65 % of the Private Sector beds are 65 % of the Private Sector beds are in Western Provincein Western Province
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PerformancePerformance
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Performance ( 1990 – Performance ( 1990 – 2005 )2005 )
• Number of Private Hospital beds - + Number of Private Hospital beds - + 100 %100 %
• Number of Inpatients - + 100 %Number of Inpatients - + 100 %
• Number of Out patients - + 140 %Number of Out patients - + 140 %
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Performance - CABGPerformance - CABG
0
200
400
600
800
1000
1200
1400
2001 2002 2003 2004 2005
State
Private
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Performance - PTCAPerformance - PTCA
0
100
200
300
400
500
600
700
800
900
2001 2002 2003 2004 2005
State
Private
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General PracticeGeneral Practice
• Full Time GPs – 600 ( CCGP )Full Time GPs – 600 ( CCGP )
800 800 ( Independent ( Independent Survey)Survey)
• 2.8 / 100,000 population ( 1:35,000 people 2.8 / 100,000 population ( 1:35,000 people ))
• 35 % of Ambulatory Care handled by GPs35 % of Ambulatory Care handled by GPs
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Exact details of the private sector Exact details of the private sector performance is not readily available performance is not readily available as there is no mechanism to collect as there is no mechanism to collect data.data.
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Challenges Challenges
• Investment barriersInvestment barriers• InfrastructureInfrastructure• Human ResourcesHuman Resources• Maintenance of High Quality CareMaintenance of High Quality Care• Introduction of Cutting - edge Introduction of Cutting - edge
TechnologyTechnology• Expectations of ConsumersExpectations of Consumers
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History of History of Public – Private PartnershipPublic – Private Partnership• Involvement of Traditional Health Involvement of Traditional Health
Care ProvidersCare Providers• Referrals to State Hospitals by Referrals to State Hospitals by
General PractitionersGeneral Practitioners• ‘‘Channel Practice’ by Government Channel Practice’ by Government
Sector ConsultantsSector Consultants• Supply of equipment and Supply of equipment and
pharmaceuticals by private sectorpharmaceuticals by private sector
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Partnership - unofficialPartnership - unofficial
• State sector doctors working in private sector State sector doctors working in private sector after working hoursafter working hours
• Referrals to govt. hospitals from General Referrals to govt. hospitals from General PracticePractice
• Investigations and admissions through channel Investigations and admissions through channel consultationsconsultations
• Certain investigations sent to private sector and Certain investigations sent to private sector and patient bears the cost.patient bears the cost.
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Partnership - officialPartnership - official
• Laboratory and other diagnostic services are Laboratory and other diagnostic services are obtained during trade union actions and break obtained during trade union actions and break downsdowns..
• Purchases – drugsPurchases – drugs
state sector monopoly was done away with open state sector monopoly was done away with open economy in 1978.economy in 1978.
• Purchases – equipmentPurchases – equipment
mainly supplied by the private sectormainly supplied by the private sector
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Partnership - officialPartnership - official
• President’s Fund – President’s Fund – assistance in major surgical procedures, assistance in major surgical procedures,
treatment abroadtreatment abroad
• Employees’ Trust FundEmployees’ Trust Fund
• Social Services MinistrySocial Services Ministry
• Govt. employees’ insuranceGovt. employees’ insurance
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Advantages of Advantages of PartnershipPartnership
• Multi - sectoral collaborationMulti - sectoral collaboration
• Cost reductionCost reduction
• Participatory planningParticipatory planning
• Increased efficiency in delivery of health Increased efficiency in delivery of health carecare
• Fill the service gapFill the service gap
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Advantages ……..Advantages ……..
• Sharing of resourcesSharing of resources
• Quality assuranceQuality assurance
• Improved community participationImproved community participation
• Reduced cost for healthReduced cost for health
• Confidence of donor agenciesConfidence of donor agencies
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Outcome of Poor Outcome of Poor PartnershipPartnership
• Poor utilization of available resourcesPoor utilization of available resources
• Unnecessary investments by both partiesUnnecessary investments by both parties
• Increasing cost of health careIncreasing cost of health care
• Drawbacks in quality assuranceDrawbacks in quality assurance
• Unplanned health care deliveryUnplanned health care delivery
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Areas for partnershipAreas for partnership
• Primary Health carePrimary Health care• Secondary Health careSecondary Health care• Tertiary CareTertiary Care• Training of Health Care PersonnelTraining of Health Care Personnel• Health Care PlanningHealth Care Planning• ManagementManagement
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State PolicyState Policy
The government will facilitate the The government will facilitate the development and regulation of the development and regulation of the private health care sector and private health care sector and promote better coordination with promote better coordination with this sectorthis sector..
-National Health Policy -National Health Policy 19961996
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Private Sector must be enhanced Private Sector must be enhanced and strengthened to provide a buffer and strengthened to provide a buffer for free health care for free health care
Hon. Nimal Siripala de Silva Hon. Nimal Siripala de Silva
Minister of Health & NutritionMinister of Health & Nutrition
Annual Health Forum - 2007Annual Health Forum - 2007
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Need of the HourNeed of the Hour
Public – Private DialoguePublic – Private Dialogue
initiated by the stateinitiated by the state
With equity and fairnessWith equity and fairness
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Can’t we do it now?Can’t we do it now?
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AcknowledgementsAcknowledgements
• AHF – SecretariatAHF – Secretariat
• Dr. Amal Harsha de Silva – Director Dr. Amal Harsha de Silva – Director PHSDPHSD
• Dr. Ravi RannaneliyaDr. Ravi Rannaneliya
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Thank youThank you